Tuberculosis tubaria y peritoneal que simula carcinomatosis. Linfopenia con trombocitosis como auxiliar en el diagnóstico diferencial / Tubal and peritoneal carcinomatosis-simulating tuberculosis. Lymphopenia with thrombocytosis as an aid in the differential diagnosis

La forma clínica más común de la tuberculosis es la enfermedad pulmonar; la tuberculosis extrapulmonar (TBE) es más rara y de difícil diagnóstico. Las manifestaciones clínicas son inespecíficas y compatibles con otras enfermedades. La afección del peritoneo es el sexto lugar de presentación de la TBE. Eventualmente, del 25 al 75% de los pacientes con tuberculosis abdominal requerirán cirugía: esta debe ser un procedimiento conservador que se reserve para las resecciones intestinales en los casos complicados. La oclusión intestinal representa el 15-60% de las complicaciones, la perforación intestinal el 1-15%, abscesos y fístulas el 2-30% y finalmente la hemorragia el 2%. En el presente documento se presenta el caso de una paciente en la 4.a década de la vida con cuadro de dolor abdominal agudo quirúrgico. Se realiza laparotomía exploradora en la que se encuentra líquido libre y lesiones generalizadas similares a carcinomatosis, así como múltiples adherencias. El diagnóstico definitivo a través de estudio histopatológico es de tuberculosis peritoneal. Se inicia manejo específico y la paciente se encuentra actualmente viva y bien

The most common clinical form of tuberculosis is pulmonary disease; extrapulmonary tuberculosis (ETB) is rarer and difficult to diagnose. The clinical manifestations are nonspecific and compatible with other diseases. ETB with peritoneal involvement ranks sixth. A total of 25-75% of patients with abdominal tuberculosis eventually require surgery; this should be a conservative procedure with resections reserved for complicated cases. Ileus represents 15-60% of complications, intestinal perforation 1-15%, abscesses and fistulas 2-30% and, finally, haemorrhage 2%. Herein we report a case of a female patient in her 30s who presented with surgical acute abdominal pain. At laparotomy we found free fluid, widespread lesions similar to carcinomatosis and multiple adhesions. The definitive diagnosis through histopathology biopsy was peritoneal tuberculosis. Medical management for tuberculosis was administered. At present the patient is alive and well

Large bilateral tubercular pyosalpinx in a young woman with genitourinary malformation: a case report.

INTRODUCTION: Tuberculosis is a chronic infectious disease, and the morbidity associated with it has major health implications. When tuberculosis affects the genital organs of young females, it has the devastating effect of causing irreversible damage to their fallopian tubes, resulting in a possible tubercular pyosalpinx and infertility. However, the disease often remains silent or presents with very few specific symptoms. In adolescents and young women, tuberculosis can also present with hypogastric recurrent symptoms and affectation of the general state, but because in our country genital tuberculosis is uncommon, its diagnosis is unlikely. CASE PRESENTATION: We describe the case of an 18-year-old Spanish woman who had been sexually active for 1 year, nulliparous, who presented with hypogastric discomfort and repeated urinary symptoms complicated with pelvic inflammatory disease after a hysterosalpingography. Genital tuberculosis was not suspected. The echographical findings and tumor markers mimicked those of ovarian tumors, and she was also a carrier of a genitourinary malformation (pelvic kidney and septate uterus). A laparotomy was performed and revealed large pelvic abscesses. On her right adnexum, the large pyosalpinx was free (floating pyosalpinx). Drainage, adhesiolysis and bilateral salpingectomy were performed, and cultures were taken. Histopathological study showed bilateral granulomatous abscessificated salpingitis with suspicion of genital tuberculosis, and cultures were positive for Mycobacterium tuberculosis. She followed a tuberculostatic treatment for 6 months. Eight years later, she presents with normal menstruations and is waiting for an in vitro fertilization cycle. CONCLUSIONS: No other reported case showing similar association of genital tuberculosis and genitourinary malformation was found. The associated genitourinary malformation in this case probably has no relation but it could contribute to diagnosis delay and/or to reactivate the pathology. The hysterosalpingographical findings and the observation of a floating pyosalpinx must alert the clinician to genital tuberculosis, but the diagnosis is suggested by the histopathological studies and confirmed by cultures. In this case study, the necessity of considering the risk of pelvic inflammatory disease reactivation after hysterosalpingography, of suspecting the diagnosis of genital tuberculosis and of establishing the differential diagnosis with ovarian tumors in the presence of large pyosalpinges is highlighted.

Cancer-like presentation of female genital tuberculosis.

Tuberculosis of the female reproductive tract affects usually reproductive age group and is a common cause of infertility with tubal pathology. Diagnosis of the female genital tract tuberculosis is challenging and, very often missed due to the unusual presentations and lack of specific diagnostic tests. This may occasionally lead to unnecessary surgical procedures. We present two case reports of female genital tuberculosis (FGTB) who presented to us with symptoms mimicking malignancy diagnosed TB only on histopalthology.

Coexistence of benign ovarian serous cystadenoma and tuberculosis in a young woman.

Genital tuberculosis involving the ovary in a non-immunocompromised individual is rare. We report a case of coexisting ovarian serous cystadenoma and tuberculosis in a 29-year-old Indian woman. Clinical examination revealed the presence of an abdominal mass suspicious for ovarian neoplasm. Histopathological evaluation revealed ovarian neoplasm and concomitant tuberculosis. To the best of our knowledge, and after an extensive search of the literature, the coexistence of benign ovarian neoplasm and tuberculosis has not been previously documented.

Changes in endometrial receptivity in women with Asherman's syndrome undergoing hysteroscopic adhesiolysis.

OBJECTIVE: To determine whether there is any improvement in the endometrial receptivity in infertile women with Asherman's syndrome undergoing hysteroscopic adhesiolysis. MATERIALS AND METHODS: This was a prospective observational clinical analysis of 40 infertile patients who underwent hysteroscopic adhesiolysis for Asherman's syndrome in a tertiary level hospital. Endometrial thickness and blood flow impedance of the uterine spiral artery by transvaginal color pulsed Doppler ultrasound was measured post-menstrual on day 2/3 and post-menstrual on day 21 pre- and post-hysteroscopic adhesiolysis or at a randomly chosen time in patients with amenorrhea. RESULTS: The age of the patients was 18-36 years (mean 29.2 years). The mean duration of infertility was 6.9 years. There were 27 (67.5 %) women with primary infertility and 13 (32.5 %) had secondary infertility. 22 (55 %) women had had genital tuberculosis in the past. A significant improvement in the endometrial thickness was observed on day 2 (p < 0.0001) and day 21 (p < 0.0001) 3 months post-adhesiolysis. The spiral artery RI was statistically significant (p < 0.04) on day 2 pre-adhesiolysis compared to post-adhesiolysis. CONCLUSIONS: A significant improvement in the endometrial thickness was observed post-adhesiolysis. A high blood flow impedance of spiral artery perhaps impairs growth of the endometrium making it unsuitable for successful implantation.

Tuberculous peritonitis presenting as an acute abdomen: a case report.

Female genital tuberculosis is relatively rare and difficult to diagnose. Often it is mistaken for ovarian malignancy. We report a case of a young immigrant woman with acute abdominal pain.

Pelvic tuberculosis continues to be a disease of dilemma--case series.

Tuberculosis (TB) has become a global epidemic again with emergence of HIV/AIDS and multi-drug resistant strains of TB. Female genital tuberculosis (GT) is typically a disease of young women and its occurrence in post menopausal women is rare. Amongst the genital disorders, GT is the most baffling especially because of its various presentations. So GT is notorious for evading diagnosis. A series of cases of females GT between the age 25 yrs to 40 yrs is being reported with women having spectrum of clinical features, creating diagnostic dilemma and so final diagnosis by histopathology after laparotomy. So a high degree of suspicion aided by intensive investigations may be required for the diagnosis of GT. Medical therapy is the main treatment, however some do need surgery. Research needs to be continued for early establishment of timely diagnosis of GT and modalities of effective therapies.

Hypertrophic tuberculosis of vulva--a rare presentation of tuberculosis.

The authors report a rare case of hypertrophic vulval tuberculosis of primary origin in a 26-year-old female patient. The diagnosis was mainly based on histopathological examination. Good outcome was obtained with antitubercular chemotherapy supplemented with surgical reduction for aesthetic concern.

[TUBERCULOUS SALPINGITIS IN THE STAGE OF CALCIFICATION TO CASEOUS NECROSIS IN TEENAGE GIRL].

The authors observed a case of pinched, calcified, caseously degenerated right uterine appendages in girls aged 14 and 11 years. The disease showed mild symptoms and it was occasionally detected by intravenous urography. Both patients underwent surgery--elimination of tuberculous salpingitis with calcified caseous necrosis. No treatment in the former case and specific treatment in the latter led to two different outcomes: late recurrence and recovery. Pinched, calcified, caseously degenerated uterine appendages are a rare pathology in children in particular. Ovarian dermoid cysts and calcified lymph nodes are differentially diagnosed. Diagnosis and treatment require surgical intervention (laparotomy, laparoscopy), sanitization of an infection focus, chemotherapy.

[Unilateral salpingian and ovarian TB, a rare form of extrapulmonary TB]. / Salpingo--ovarita bacilara unilaterala, forma, rara de tuberculoza extrapulmonara.

TB salpingitis and ovarian TB is a rare association of extrapulmonary tuberculosis, especially when the lesions are not associated with lung involvement. The correct therapy leads to the sterilization of the tuberculosis foci, although the risk of scars and adhesions is high, causing local functional disorders.

Tuberculosis genital en una mujer menopáusica / Genital tuberculosis in a menopausal woman

Presentamos un caso de tuberculosis genital en una mujer menopáusica. Aunque la tuberculosis, en términos generales, ha aumentado en los países desarrollados como consecuencia de la inmigración y algunas enfermedades, como el sida, el proceso puramente ginecológico es una enfermedad con muy baja incidencia. Se trata de una mujer menopáusica, sin hijos, que acude a nuestra consulta para una revisión ginecológica habitual. Se detecta un endometrio engrosado y, tras una biopsia inicial, se termina realizando una histerectomía que pone de manifiesto una tuberculosis genital con diseminación miliar peritoneal. El diagnóstico anatomopatológico se basa en la detección de granulomas con células de Langhans, característicos de este proceso

We report a case of genital tuberculosis in a menopausal woman. Although tuberculosis is becoming more frequent in developed countries as a result of immigration and diseases such as AIDS, its localization exclusively in the female genital tract is still highly infrequent. A menopausal woman, without children, attended her gynecologist for a routine visit. On ultrasound examination, an enlarged endometrium was found. After an initial biopsy, total hysterectomy with double oophorectomy was performed, confirming genital tuberculosis with miliary peritoneal dissemination. The pathologic diagnosis was based on the observation of a granulomatous inflammation with Langhans' giant cells, characteristic of this process

Management of bilateral fallopian tube carcinoma coexistent with tuberculous salpingitis.

Primary carcinoma of the fallopian tube is a rare gynecologic malignancy. Chronic tubal inflammation is associated with primary carcinoma of the fallopian tube. There are only a few reports on primary carcinoma of the fallopian tube coexisting with tuberculous salpingitis. We are reporting a patient with both the primary carcinoma of the fallopian tube and tuberculous salpingitis, which were detected in bilateral fallopian tubes. The histologic type was serous adenocarcinoma. The patient was treated with total abdominal hysterectomy, bilateral salpingo-oophorectomy, infracolic omentectomy, and bilateral pelvic lymphadenectomy followed by chemotherapy consisting of paclitaxel and cisplatin. She has been alive without evidence of disease for 18 months.

[A case of advanced genital tuberculosis--differential diagnostics and surgical aspects].

The authors report a case of advanced genital tuberculosis. The diagnostic difficulties and treatment are discussed.

Genital and peritoneal tuberculosis: potential role of laparoscopy in diagnosis and management.

Genital and peritoneal tuberculosis are rare in developed countries and can mimic ovarian cancer. We report two different cases that came to our attention, both in a month. The first patient was referred to us for an asymptomatic pelvic mass. The second patient came to us because of weight loss, abdominal swelling, and ascites. Unfortunately, the imaging findings were misleading, and the laboratory analyses were not helpful. Only the laparoscopic approach was useful for final diagnosis. We conclude that the symptoms of abdominal tuberculosis vary greatly, and laparoscopy can be essential for its diagnosis and management.

Genital tuberculosis in a menopausal woman. A case report.

We have analysed the role played by genital tuberculosis (TBC) in Italy today, and in particular in L'Aquila, in the light of a worrying recrudescence. We report the case of a 64-year-old patient, in menopause for the past 11 years or so, referred to the Gynecology and Obstetrics Clinic of the University of L'Aquila, with an anamnesis of menometrorrhagia since the age of 55. The patient was studied from a gynecological and internist profile including the following procedures: gynecological examination and pap-test, colposcopy, transvaginal scan, chest X-ray, abdominal and pelvic CAT, laboratory tests and Mantoux reaction. The uterus was found to be fibromatous during the gynecological examination and scan, whereas colposcopy revealed a small ectropion and the presence of very adherent yellowish mucus. The Mantoux test was positive. CAT showed cicatricial sequelae in the pulmonary parenchyma. It was decided to perform curettage, but this was prevented by the presence of pyometra. The patient was treated with specific chemotherapy and then underwent total laparohysterectomy with bilateral adnexectomy. The histological findings confirmed genital TBC. Genital TBC is now undergoing a worrying recrudescence. We need to have a full knowledge of the pathology, the diagnostic means with which to discover it and the correct therapeutic instruments to overcome it.