Endometrial Tubercular Abscess

Abstract

A 57-year-old menopausal woman, gravida 5 para 5, with no history of any hormonal therapy presented with irregular heavy bleeding per vaginum after 5 years of amenorrhea. A vaginal ultrasound scan was unremarkable, showing an endometrial thickness of 2.5 mm. This patient was posted for hysteroscopic evaluation. The anterior uterine cavity wall seen in panoramic view revealed multiple whitish abscess like circumscribed lesions that appeared distinctly pale in comparison with the surrounding endometrium (Fig. 1). A closer visualization (Fig. 2) revealed lesions that were oval in shape and had sharp regular margins, and the endometrium surrounding the lesions appeared dirty, pale, and irregular with no visible endometrial gland openings. The endometrium did not bleed on touch. Targeted biopsies were taken from the rounded lesions. Histopathology revealed endometrium with atrophic changes along with caseating epitheloid granulomata; there was no evidence of malignancy. BACTEC culture (Becton, Dickinson and Company, Sparks, MD) was also suggestive of endometrial tuberculosis. The patient was administered antitubercular therapy, to which she subsequently responded. Fig. 2Closer visualization reveals the regular sharp contours of the endometrial tubercular abscesses. View Large Image Figure Viewer Download Hi-res image