Abstract
Background: Tuberculous endometritis is a rare but important disease. We report the cytological features and critical factor in the diagnosis of tuberculous endometritis.
Case: A 68-year-old female who had a past history ofperitonitis, primary amenorrhea, and pulmonary tuberculosis, visited hospital with a complaint of atypical genital bleeding. CT and MRI revealed a uterine body mass. Total hysterectomy was performed due to the possibility of a malignancy. Endocervical smear cytology revealed epithelioid cell granulomas, which showed loose connection of spindle to oval cells with round nuclei, and a few atypical cells. Atypical cells had a polygonal to round shape, an increased N/C ratio, and hyperchromatic nuclei, but evenly distributed nuclear chromatin and smooth nuclear edge. There were many neutrophils and mononuclear cells but no necrosis. Some multinucleated giant cells were found, but these were not typical Langhans' cells. Pathological exami nation and polymerase chain reaction of M. tuberculosis led to the final diagnosis of tuberculous endometritis within adenomyosis. Endometrial glandular epithelium showed regenerative atypia that might be the origin of atypical cells in cytology.
Conclusion: Presence of epithelioid cell granuloma is an important finding in endometrial tuberculosis, in cases with no necrosis and/or Langhans' cells. Bacteriological examination should be performed to make an exact diagnosis of tuberculous endometritis. In endometrial tuberculosis, there were some atypical endometrial glandular epithelial cells, which are considered to be an inflammatory regenerative change.
