Endometrial-malignancy-like Endometrial tuberculosis

A report describes a case of a 60-year-old para 7 woman who presented with abdominal distension and discomfort for two months and anorexia and nausea for three months. Examination revealed her to be emaciated, with Mild pallor, thyroid swelling, and distended Abdomen with considerable ascites, fluid thrill, and shifting dullness, without any palpable mass. 

Transabdominal sonography (TAS) showed marked ascites and an endometrial thickness of 10.4 mm, an unusual finding in a postmenopausal woman. Abdominal paracentesis revealed many lymphocytes and no malignant cells or acid-fast bacilli. The differential diagnosis was endometrial malignancy with metastatic deposits to the omentum. Histopathology of the fractional uterine curettage showed multiple fragments of endometrial tissue in the proliferative phase with multiple well-formed granulomas. Modified ZN staining revealed multiple acid-fast bacilli, confirming a diagnosis of tubercular endometritis.

The patient received antitubercular treatment for six months and recovered completely. The follow-up ultrasound was normal, with an endometrial thickness of 4mm, which was in line with postmenopausal status. 

Jimo K, Miachieo N, Jamir B, Momin R, Yepthomi N. Endometrial tuberculosis mimicking endometrial malignancy - histopathology key to management - a case report. The New Indian Journal of OBGYN. 2023; 10(1): 236-38.