A 27-year-old woman with suspected genital tuberculosis undergoes endometrial sampling in the premenstrual phase. Which histological finding is PATHOGNOMONIC of genital TB on endometrial biopsy?

• A Non-caseating granuloma with Langhans giant cells
• B Plasma cells within the endometrial stroma
• C Granuloma with acid-fast bacilli on ZN staining
• D Caseating granuloma in the endometrium ✓

Explanation

Caseating granuloma in the endometrium is pathognomonic of endometrial tuberculosis, as non-caseating granulomas can be seen in sarcoidosis, foreign-body reactions, or other granulomatous conditions. The premenstrual biopsy is preferred as progestogenic stroma makes granulomas easier to identify. While AFB on ZN staining confirms mycobacterial infection, this finding is specific but not always positive; caseating granuloma histologically is the diagnostic hallmark.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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