1. Pelvic Tuberculosis

2. Pelvic Tuberculosis
Tuberculosis of the genital tract – chronic salphingitis, chronic endometritis
frequent cause of chronic PID and infertility (Asia, Middle East, Latin America)
occur in post menopausal women 10% of the time

3. Pelvic Tuberculosis
caused by by either Mycobacterium tuberculosis or M. Bovis
LUNGS – primary site of infection
→ spread hematogenously → oviduct
- Oviduct – primary and predominant site of pelvic tuberculosis

4. Pelvic Tuberculosis
predominant presentation – infertility and abnormal uterine bleeding
mild to moderate chronic abdominal and pelvic pain occur in 35% of women
pelvic examination are normal in approximately 50% of cases

5. Pelvic Tuberculosis Diagnosis – endometrial biopsy
findings: Giant cells, granulomas, caseous necrosis
“tobacco pouch” appearance
Source: Comprehensive Gynecology by Katz

6. Pelvic Tuberculosis Pelvic TB – common in 20-40 years of age
Common symptoms:
pelvic pain, menstrual irregularity and infertility
Ulcerative or exophytic representing primary malignancy
Source: CERVICAL TUBERCULOSIS: AN IMPORTANT DIFFERENTIAL DIAGNOSIS OF CANCER CERVIX Case Report Ind. J Tub., 2003, 50, by Anil P. Sakhare1, Arun R. Mahale2 and Lata T. Dumne3

7. Pelvic Tuberculosis
Pelvic tuberculosis (PT) infection is usually caused by reactivation of organisms from systemic distribution of Mycobacterium tuberculosis during primary infection.
Direct transmission between sexual partners has been documented although very rare.

8. less common presentations included an adnexal mass, ascites or both
typically presents with pelvic pain, infertility, poor general health or menstrual disturbances
less common presentations included an adnexal mass, ascites or both
CA tumor-associated antigen, is a nonspecific marker of ovarian; elevated in a variety of conditions:
Infections
Tuberculosis
endometriosis
Meigs syndrome,
Menstruation
ovarian hyperstimulation
non-gynaecologic conditions like active hepatitis, acute pancreatitis, pericarditis, pneumonia

9. Abdominal Paracentesis – using the PCR
diagnosis of PT is confirmed by histological examination of frozen or paraffin-embedded sections, positive acid fast stain and positive culture of endometrial biopsy tissue
*epitheloid cell granuloma with or without Langerhans giant cell
Hysteroscopy
Laparoscopy
Abdominal Paracentesis – using the PCR

10. Source: Pelvic Tuberculosis: The Great Simulator of Gynaecologic Malignancies Carla Pina*, Marcília Teixeira*, Diana Cruz†, Eduardo Ferreira‡, Mari Mesquita†, Ana Torgal* *Departamento de Ginecologia, Centro Hospitalar Tâmega e Sousa, EPE, Penafiel; †Departamento de Medicina Interna, Centro Hospitalar Tâmega e Sousa, EPE, Penafiel; ‡Laboratório de Anatomia Patológica Dr. Eduardo Ferreira, Porto

11. Pelvic Tuberculosis
Genitourinary Tuberculosis accounts for about 15% of all extra pulmonary TB.
Hematogenous spread → primary infection