Genital tuberculosis (GTB) typically affects the fallopian tubes first. Which histological finding on endometrial biopsy is pathognomonic of endometrial tuberculosis?
- A Chronic endometritis with plasma cells in the endometrial stroma
- B Eosinophilic infiltration with endometrial gland distortion
- C Langerhans giant cell granuloma with central caseation in the functionalis layer of the endometrium ✓
- D Diffuse endometrial sclerosis with obliteration of the glandular pattern
Explanation
Genital tuberculosis (GTB) is hematogenously spread from a primary focus (usually pulmonary) to the fallopian tubes first (in 95–100% of cases), then to the endometrium (50–80%). Endometrial biopsy during the premenstrual phase (when endometrium is thickest) is the most practical tissue diagnosis method. Pathognomonic histological finding is caseating granuloma—a Langerhans giant cell granuloma with central caseous (cheese-like) necrosis surrounded by epithelioid macrophages and lymphocytes—found in the functionalis layer. Non-caseating granulomas may also be seen. Simple chronic endometritis with plasma cells is nonspecific (seen in PID, post-partum). Ziehl-Neelsen staining may show acid-fast bacilli, though culture (Löwenstein-Jensen medium) is the gold standard for confirmation.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
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