A 35-year-old multiparous woman presents with postcoital bleeding. Speculum examination shows a friable, papillary, hypertrophic growth on the cervix that bleeds on touch. Cervical cytology shows only inflammatory cells. Biopsy reveals epithelioid granulomas with Langhans giant cells and central caseation. Acid-fast staining is positive. What is the most likely diagnosis?

• A Squamous cell carcinoma of the cervix
• B Secondary syphilitic chancre of the cervix
• C Chronic follicular cervicitis
• D Tuberculous cervicitis ✓

Explanation

Genital tuberculosis affects the cervix in roughly 5 percent of cases and classically produces either an ulcerative lesion or a hypertrophic papillary growth that mimics carcinoma clinically, causing contact bleeding and a friable appearance. The decisive finding is the biopsy: caseating granulomas with Langhans giant cells and acid-fast bacilli confirm tuberculosis, while the negative cytology argues against malignancy. Any suspicious cervical lesion must be biopsied rather than assumed malignant.

Reference: Jeffcoate's Principles of Gynaecology, 9th ed.

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Written and medically reviewed by the StethoPrep medical team.