Genital tuberculosis most commonly affects which structure of the female genital tract, and what is the hallmark pathological finding on histology?

• A Ovary; follicular cysts with acid-fast bacilli
• B Fallopian tubes; caseating granulomas with Langhans giant cells and epithelioid histiocytes ✓
• C Endometrium; endometrial polyps with plasma cell infiltration
• D Cervix; fibrinous peritonitis with chalky white plaques

Explanation

The fallopian tubes are the most commonly affected site in female genital tuberculosis (95–100% of cases), as primary haematogenous spread lodges in the tubal mucosa first. The histopathological hallmark is caseating granulomas with Langerhans (Langhans) giant cells and epithelioid macrophages. Secondary endometrial involvement occurs in 50–60%. Ovarian involvement is less common; cervical and vulval TB are rare.

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

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