A 29-year-old nulliparous woman presents with postcoital bleeding and a friable, ulceroproliferative growth on the cervix that looks malignant. Punch biopsy shows epithelioid cell granulomas with central caseation and Langhans giant cells; stain for acid-fast bacilli is positive. She has no lymphadenopathy and imaging shows no parametrial extension. The MOST appropriate management is:

• A Radical hysterectomy with pelvic lymphadenectomy
• B Antitubercular therapy with follow-up examination after completion ✓
• C Cryotherapy of the cervical lesion
• D Conisation of the cervix for histological confirmation

Explanation

Cervical tuberculosis is a rare form of genital TB that grossly mimics carcinoma of the cervix, presenting as an ulceroproliferative or hypertrophic lesion with contact bleeding. Caseating granulomas with Langhans giant cells and positive AFB staining confirm the diagnosis, so the correct treatment is standard multidrug antitubercular therapy with reassessment afterwards. Radical surgery is unwarranted without malignancy, and conisation adds nothing once granulomatous inflammation is proven.

Reference: Berek and Novak's Gynecology, 16th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.