A 30-year-old woman with suspected genital tuberculosis undergoes hysteroscopy. Pathology of the endometrial biopsy shows granulomas with central caseation, Langhans giant cells, and acid-fast bacilli. Mycobacterial culture on Löwenstein-Jensen medium is positive at 6 weeks. Which hysteroscopic finding is MOST characteristic of endometrial TB and most accurately predicts amenorrhea?
- A Polypoid endometrium with irregular vascularity
- B Thin stripe endometrium with normal cavity architecture
- C Pale, avascular endometrium with irregular adhesions and calcifications ✓
- D Submucosal fibroids with surrounding edema
Explanation
Hysteroscopy in endometrial tuberculosis characteristically shows a pale, avascular, irregular endometrium with intrauterine adhesions (IUA), calcified deposits, and a scarred, non-compliant cavity (Asherman's syndrome secondary to TB). The IUAs in TB-related Asherman's are often more dense, vascular, and flimsy-to-dense compared to post-curettage adhesions. Complete obliteration of the cavity ('obliterative adhesions') best predicts amenorrhea and infertility. TB-specific hysteroscopic features include the presence of 'tubercles' — whitish nodules — and the characteristic avascular, scarred appearance. This is distinct from the polypoid pattern seen in endometrial hyperplasia.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
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Written and medically reviewed by the StethoPrep medical team.