A 32-year-old woman presents with primary infertility, menstrual irregularity, and a history of pulmonary tuberculosis 5 years ago. HSG shows bilateral blocked tubes with a 'tobacco pouch' appearance. Endometrial biopsy shows granulomas with caseation necrosis. Which histological feature in the endometrial biopsy is most specific for genital tuberculosis?

• A Non-caseating granulomas
• B Caseating granulomas in the secretory phase endometrium ✓
• C Plasma cell endometritis
• D Lymphocytic infiltration of the stroma

Explanation

Caseating granulomas in the endometrium — particularly when present in secretory-phase endometrium — are highly specific for genital tuberculosis, as the endometrium is shed monthly (menstruation) and non-TB granulomas rarely survive to the secretory phase. The combination of caseating granulomas, Langhans giant cells, and epithelioid histiocytes in a secretory-phase biopsy is virtually diagnostic. Non-caseating granulomas can occur in sarcoidosis or other infections. Plasma cell endometritis is seen in chronic non-TB endometritis.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

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Written and medically reviewed by the StethoPrep medical team.