A 41-year-old multiparous woman presents with postcoital bleeding of three months. On speculum examination the cervix has an indurated, ulceroproliferative growth suspicious for carcinoma. Biopsy shows granulomatous inflammation with caseation and Langerhans giant cells; no malignant cells are seen. Carcinoma has been excluded. The most appropriate next step is:

• A Radical hysterectomy with pelvic lymphadenectomy
• B Topical imiquimod therapy and repeat biopsy in eight weeks
• C Excision biopsy under anaesthesia followed by routine surveillance
• D Antitubercular therapy with confirmation of mycobacteria by culture or NAAT ✓

Explanation

This is cervical tuberculosis, a rare form of genital TB that classically mimics carcinoma of the cervix as an indurated ulcer or papillary growth. Once caseating granulomas confirm the diagnosis and malignancy is excluded on adequate biopsy, treatment is antitubercular therapy, ideally with bacteriological confirmation by culture or nucleic acid amplification testing. Radical surgery is reserved for refractory disease, and this lesion is neither viral nor a sexually transmitted granuloma requiring topical or excisional approaches.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.