Case Report Tuberculosis Endometrial Polypdownloads.hindawi.com/journals/criog/2013/176124.pdf ·...
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Hindawi Publishing Corporation Case Reports in Obstetrics and Gynecology Volume 2013, Article ID 176124, 2 pages http://dx.doi.org/10.1155/2013/176124 Case Report Tuberculosis Endometrial Polyp Julien Seror, 1,2 Erika Faivre, 1,2 Sophie Prevot, 3 and Xavier Deffieux 1,2 1 AP-HP, Service de Gyn´ ecologie-Obst´ etrique et M´ edecine de la Reproduction, Hˆ opital Antoine B´ ecl` ere, 157 rue de la Porte de Trivaux, 92141 Clamart, France 2 Facult´ e de M´ edecine, Universit´ e Paris Sud, 94270 Le Kremlin Bicˆ etre, France 3 AP-HP, Service d’Anatomie Pathologique, Hˆ opital Antoine B´ ecl` ere, 92141 Clamart, France Correspondence should be addressed to Xavier Deffieux; xavier.deffi[email protected] Received 10 February 2013; Accepted 17 March 2013 Academic Editors: E. Cosmi, S.-Y. Ku, and E. Shalev Copyright © 2013 Julien Seror et al. is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Tuberculosis can cause infertility when it infects the genital tract (e.g., endometritis). A 31-year-old woman (origin: Algeria) was referred to our academic gynecological institute for unexplained primary infertility. e patient presented with no complaint. Hysteroscopy showed a 10 mm sized endometrial polyp. e polyp was removed. Pathology showed lymphocytic and plasmacytic chronic inflammatory modification, granulomatous modification, and gigantocellular modification, which lead to the diagnosis of tuberculosis. No acid fast organism was seen on Ziehl-Neelsen staining. A chest thorax X-ray revealed no sign of pulmonary tuberculosis. e patient underwent antituberculosis therapy during one year. Posttreatment hysteroscopy revealed no abnormality. is is the first reported case of endometrial tuberculosis diagnosed following removal of a polyp with classical benign appearance. 1. Introduction Endometrial polyps are very common and are oſten discov- ered during the exploration of infertility. Most polyps are mucosal benign tumors. Genital tuberculosis is a frequent disease in nondeveloped countries but very rare in developed countries. It can be an etiology for infertility. 2. Case Presentation A 31-year-old woman (origin: Algeria) was referred to our academic gynecological institute for unexplained primary infertility. e patient presented with no complaint. Hys- teroscopy showed a 10 mm sized endometrial polyp located on the leſt lateral wall of the uterine isthmus. Neither adhesion (synechia) nor other abnormality was noted during hysteroscopy. Hysteroscopic view of superficial blood vessels showed regular vascular pattern, with a classic benign appear- ance. No other infertility etiology was discovered. e polyp was removed using hysteroscopic bipolar loop (24 French). Pathology (Figure 1) showed lymphocytic and plasmacytic chronic inflammatory modification, granulomatous modifi- cation, and gigantocellular modification, which lead to the diagnosis of tuberculosis. No acid fast organism was seen on Ziehl-Neelsen staining. A chest thorax X-ray revealed no sign of pulmonary tuberculosis. e patient underwent antitu- berculosis therapy (rifampicin, isoniazid, pyrazinamide, and ethambutol) during one year. Posttreatment hysteroscopy revealed no abnormality. Followup of the patient was 18 months. She did not start trying to get pregnant since the treatment (marital problems). 3. Discussion is is the first reported case of endometrial tuberculosis diagnosed following the removal of a polyp with classical benign appearance. Due to the paucibacillary nature of endometrial tubercu- losis, conventional methods of diagnosis (histopathological examination and conventional mycobacterial culture) have low sensitivity (low detection rate). In several studies, PCR was found to be useful in the diagnosis of endometrial tuber- culosis when clinically suspected; however, false negative PCR may be observed. In the current case, pathology showed lymphocytic and plasmacytic chronic inflammatory mod- ification, granulomatous modification, and gigantocellular modification, which lead to the diagnosis of tuberculosis.
Transcript of Case Report Tuberculosis Endometrial Polypdownloads.hindawi.com/journals/criog/2013/176124.pdf ·...
Hindawi Publishing CorporationCase Reports in Obstetrics and GynecologyVolume 2013, Article ID 176124, 2 pageshttp://dx.doi.org/10.1155/2013/176124
Case ReportTuberculosis Endometrial Polyp
Julien Seror,1,2 Erika Faivre,1,2 Sophie Prevot,3 and Xavier Deffieux1,2
1 AP-HP, Service de Gynecologie-Obstetrique et Medecine de la Reproduction, Hopital Antoine Beclere,157 rue de la Porte de Trivaux, 92141 Clamart, France
2 Faculte de Medecine, Universite Paris Sud, 94270 Le Kremlin Bicetre, France3 AP-HP, Service d’Anatomie Pathologique, Hopital Antoine Beclere, 92141 Clamart, France
Correspondence should be addressed to Xavier Deffieux; [email protected]
Received 10 February 2013; Accepted 17 March 2013
Academic Editors: E. Cosmi, S.-Y. Ku, and E. Shalev
Copyright © 2013 Julien Seror et al. This is an open access article distributed under the Creative Commons Attribution License,which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Tuberculosis can cause infertility when it infects the genital tract (e.g., endometritis). A 31-year-old woman (origin: Algeria) wasreferred to our academic gynecological institute for unexplained primary infertility. The patient presented with no complaint.Hysteroscopy showed a 10mm sized endometrial polyp. The polyp was removed. Pathology showed lymphocytic and plasmacyticchronic inflammatory modification, granulomatous modification, and gigantocellular modification, which lead to the diagnosisof tuberculosis. No acid fast organism was seen on Ziehl-Neelsen staining. A chest thorax X-ray revealed no sign of pulmonarytuberculosis.The patient underwent antituberculosis therapy during one year. Posttreatment hysteroscopy revealed no abnormality.This is the first reported case of endometrial tuberculosis diagnosed following removal of a polyp with classical benign appearance.
1. Introduction
Endometrial polyps are very common and are often discov-ered during the exploration of infertility. Most polyps aremucosal benign tumors. Genital tuberculosis is a frequentdisease in nondeveloped countries but very rare in developedcountries. It can be an etiology for infertility.
2. Case Presentation
A 31-year-old woman (origin: Algeria) was referred to ouracademic gynecological institute for unexplained primaryinfertility. The patient presented with no complaint. Hys-teroscopy showed a 10mm sized endometrial polyp locatedon the left lateral wall of the uterine isthmus. Neitheradhesion (synechia) nor other abnormality was noted duringhysteroscopy. Hysteroscopic view of superficial blood vesselsshowed regular vascular pattern, with a classic benign appear-ance. No other infertility etiology was discovered. The polypwas removed using hysteroscopic bipolar loop (24 French).Pathology (Figure 1) showed lymphocytic and plasmacyticchronic inflammatory modification, granulomatous modifi-cation, and gigantocellular modification, which lead to thediagnosis of tuberculosis. No acid fast organism was seen on
Ziehl-Neelsen staining. A chest thorax X-ray revealed no signof pulmonary tuberculosis. The patient underwent antitu-berculosis therapy (rifampicin, isoniazid, pyrazinamide, andethambutol) during one year. Posttreatment hysteroscopyrevealed no abnormality. Followup of the patient was 18months. She did not start trying to get pregnant since thetreatment (marital problems).
3. Discussion
This is the first reported case of endometrial tuberculosisdiagnosed following the removal of a polyp with classicalbenign appearance.
Due to the paucibacillary nature of endometrial tubercu-losis, conventional methods of diagnosis (histopathologicalexamination and conventional mycobacterial culture) havelow sensitivity (low detection rate). In several studies, PCRwas found to be useful in the diagnosis of endometrial tuber-culosis when clinically suspected; however, false negativePCRmay be observed. In the current case, pathology showedlymphocytic and plasmacytic chronic inflammatory mod-ification, granulomatous modification, and gigantocellularmodification, which lead to the diagnosis of tuberculosis.
2 Case Reports in Obstetrics and Gynecology
Figure 1: Pathological examination of the endometrial polyp.Microscopic analysis of the surgically removed endometrial polypshowed superficial erosive inflammation with numerous nonnecro-tizing granulomas containing Langhans giant cells. No acid fastorganism was seen on Ziehl-Neelsen staining.
The case is most likely tuberculosis, although no acid fastorganisms were seen on Ziehl-Neelsen staining.The presenceof Langerhans giant cells is not specific for tuberculosis oreven for mycobacterial disease, and that they are found innearly every form of granulomatous disease, regardless ofetiology. The differential diagnosis of tuberculosis endome-trial polyp on pathological findings is other infectious(Mycobacterium leprae and histoplasmosis) or noninfectiousdiseases (beryllium disease, cancer, and sarcoidosis). Gen-ital tuberculosis is usually associated with a high rate ofintrauterine adhesions [1–4]. The influence of tuberculosisendometritis or endometrial polyp on fertility is doubtful.However, a hypothesis is that, during the process of infectionor reactivation, the tuberculosis bacilli may induce immunemodulation within the local tissues (endometrium). Thereis a release of harmful cytokines (IL2, TNF𝛼, and INF𝛾).The immunomodulatory impact will affect adversely theendometrial receptivity.
References
[1] A. M. Sutherland, “The changing pattern of tuberculosis ofthe female genital tract. A thirty year survey,” Archives ofGynecology, vol. 234, no. 2, pp. 95–101, 1983.
[2] G. Bazaz-Malik, B. Maheshwari, and N. Lal, “Tuberculousendometritis: a clinicopathological study of 1000 cases,” TheBritish Journal of Obstetrics and Gynaecology, vol. 90, no. 1, pp.84–86, 1983.
[3] J. B. Sharma, K. K. Roy, M. Pushparaj, and S. Kumar, “Hys-teroscopic findings in women with primary and secondaryinfertility due to genital tuberculosis,” International Journal ofGynecology and Obstetrics, vol. 104, no. 1, pp. 49–52, 2009.
[4] N. Gupta, J. B. Sharma, S. Mittal, N. Singh, R. Misra, and M.Kukreja, “Genital tuberculosis in Indian infertility patients,”International Journal of Gynecology and Obstetrics, vol. 97, no.2, pp. 135–138, 2007.
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