A 32-year-old woman presents with primary infertility, oligomenorrhoea, and TB contact history. Hysteroscopy shows obliterated endometrial cavity with fibrous bands. Endometrial biopsy reveals caseating granulomas. Which histological feature on biopsy is MOST specific for endometrial tuberculosis?
- A Plasma cell infiltration in the endometrial stroma
- B Caseating granulomas in the mid-secretory endometrium (day 22–24) ✓
- C Giant cells with Langerhans morphology in basal endometrium
- D Non-caseating granulomas in the endometrial stroma
Explanation
Finding caseating granulomas in the endometrial biopsy is diagnostic of endometrial tuberculosis. The key specificity comes from the temporal association: since the endometrium is cyclically shed, the granulomas must re-form each cycle — they are therefore found most prominently in the mid-secretory phase (day 22–24), just before shedding. Non-caseating granulomas occur in sarcoidosis and other conditions. Langerhans giant cells alone are non-specific. Plasma cell endometritis suggests chronic endometritis from other organisms. The absence of AFB staining does not exclude TB (low sensitivity), and PCR on biopsy has better sensitivity.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.