A ten year clinicopathological study of female genital tuberculosis and impact on fertility.
BACKGROUND
To determine the histological pattern of involvement, clinical presentation, impact on fertility in women with genital tuberculosis.


METHODS
A total number of 68 cases of gynaecological tuberculosis affecting different parts of female genital tract from 56 patients were selected. The age range of the patients was 17-36 years with mean age of 25.6 years. The diagnostic procedures used included endometrial curettage and biopsy, histopathological examination, culture and Mycobacterium Tuberculosis Polymerase Chain Reaction (MTB PCR), laparoscopy, Hysterosalpingography (HSG) and Ultrasonography (USG). Most of the specimens received were biopsies of endometrial curettage for evaluation of infertility. In 7 cases, specimens of total hysterectomy with bilateral salpingo-oophorectomy were submitted with lesions involving multiple sites.


RESULTS
Patients presented with infertility (65-70%), pelvic/abdominal pain (50-55%), and menstrual disturbances (20-25%). Tuberculosis involved the endometrium in 55.88%, tubes in 23.53%, ovaries in 14.71% and cervix in 5.88% of the 68 cases. The endometrium(38 cases)was in the proliferative phase in 31 cases (81.57%), secretory phase in 4 cases (10.52%) and it was atrophic in 3 cases (7.89%).Caseation was present in 9 out of 68 cases and Ziehl-Neelsen (ZN) stain revealed Acid Fast Bacilli (AFB) in tissue sections in only 4 cases . After therapy, 9 patients conceived of which 8 suffered spontaneous abortions. Only one patient had a successful pregnancy and the baby was born through caesarean section.


CONCLUSIONS
Genital tuberculosis is an important cause of female infertility in developing countries like India, Nepal, Bangladesh and Pakistan. Successful uterine pregnancy is rare after treatment and chances of ectopic pregnancy are high.
Mondal
S K
SK
Department of Pathology, Medical College, Kolkata-73, INDIA. dr_santoshkumar@hotmail.com
Dutta
T K
TK
D000022:Abortion, Spontaneous; D000293:Adolescent; D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D002584:Cervix Uteri / Q000473:pathology; D004717:Endometrium / Q000473:pathology*; D005187:Fallopian Tubes / Q000473:pathology; D005260:Female; D006801:Humans; D007047:Hysterosalpingography; D007247:Infertility, Female / Q000209:etiology*; D010053:Ovary / Q000473:pathology; D011446:Prospective Studies; D014384:Tuberculosis, Female Genital / Q000150:complications* / Q000188:drug therapy / Q000473:pathology*; D055815:Young Adult
D000995:Antitubercular Agents