Middle East Fertility Society Journal (2013) xxx, xxxxxx

Middle East Fertility Society

Middle East Fertility Society Journal

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CASE REPORT

Tuberculous cervicitis mimicking cancer cervix: A

case study
Eman Elkattan *, Mona AbdElBadei, Hatem Hettow, Eman Hussein, Jina Assaad
Department of Obstetrics and Gynecology, Cairo University, Cairo, Egypt
Received 1 April 2013; accepted 7 May 2013

KEYWORDS
Tuberculosis;
Cervical smear;
Colposcopy;
Tubercuolous cervicitis

Abstract Background: Primary Tuberculosis of the uterine cervix is an unusual event, with only a
few cases reported in the English literature.
Case report: A 25 year old nulligravid woman was referred to our hospital with suspected
cervical carcinoma. General, gynecologic, colposcopic and microbiologic assessments were done.
Diagnosis of cervical tuberculosis was conrmed on histologic examination. The patient received
anti-tuberculous therapy and has been disease free for 12 months.
Conclusion: Cervical tuberculosis may mimic cervical carcinoma and should be included in the
differential diagnosis especially in endemic countries.
2013 Production and hosting by Elsevier B.V. on behalf of Middle East Fertility Society.

1. Introduction
Tuberculous infection (TB), which is now uncommon in Western society, is still frequently observed in Third World countries in Africa and Asia. The cervix is involved in 0.10.65%
of all cases of tuberculosis and 510% of cases in female genital tract. Tuberculous involvement of the female genital tract
in almost all cases is secondary to extragenital tuberculosis.
Affectation of the female genitalia has been reported as a rare
event (1). TB is usually secondary to a primary focus elsewhere
in the body most commonly from lungs. Spread to cervix is
* Corresponding author. Tel.: +20 1222854159.
E-mail addresses: emyelkattan@gmail.com (E. Elkattan), monanayel
2010@hotmail.com
(M. AbdElBadei), hiae09@yahoo.com
(H. Hettow), emanalyhussein@yahoo.com (E. Hussein).
Peer review under responsibility of Middle East Fertility Society.

Production and hosting by Elsevier

either by hematogenous, lymphatic dissemination or by direct

extension (2). The lesion on the cervix can be either exophytic,
ulcerative although interstitial and endocervical polypoid form
may also occur (3).
We presented this case as the cervical tuberculosis is rare and
can be easily misinterpreted clinically as cervical malignancy.
2. Case report
A 25-year-old nulligravid Egyptian housewife, was referred to
our clinic with a 5 year history of primary infertility and 8 year
history of oligomenorrhea. She has been experiencing postcoital
bleeding for 2 years. She denied any history of chronic cough or
loss of weight. She had no history of immunodeciency diseases
or was on immunosuppressant medication. The fertility team
referred her to the colposcopy clinic. There was no history of
personal or family exposure to tuberculosis. There was no
history of genital malignancy in the family. The patient was a
non-smoker. She had no signicant past medical history. On
abdominal examination, no signicant ndings were found.

1110-5690 2013 Production and hosting by Elsevier B.V. on behalf of Middle East Fertility Society.
http://dx.doi.org/10.1016/j.mefs.2013.05.005

Please cite this article in press as: Elkattan E et al. Tuberculous cervicitis mimicking cancer cervix: A case study, Middle East
Fertil Soc J (2013), http://dx.doi.org/10.1016/j.mefs.2013.05.005

E. Elkattan et al.
analysis were negative. Tuberculin skin test was not done.
The patient was referred to the department of chest diseases.
Antituberculous medications were prescribed in the form of
isoniazid (5 mg/kg), Rifampicin (10 mg/kg), Pyrazinamide
(25 mg/Kg) and ethambutol (15 mg/kg). The treatment continued for 6 months.
Her cervical smear follow ups were negative up to 1 year
following treatment. There was no history of postcoital bleeding after the cone biopsy. Unfortunately, we did not have bacterial evidence on the cone biopsy but as tuberculosis was
suggested by the pathologist and the fact that the patient improved on antituberculous treatment made it more likely that
it is tuberculosis. A signed consent form from the patient had
been obtained.
2.1. Discussion

Figure 1 Colposcopy picture of the cervix after applying acetic

acid showing the irregular cervical mass with acetowhite changes
on applying the acetic acid.

Figure 2 Histopathology of the cone showing the extensive

epithelioid granulomata, Langhans giant cells and central necrosis suggesting tuberculous cervicitis.

Inspection of the vulva revealed no abnormality. On speculum

examination: abnormally looking cervix was noted. There was
an irregular cervical mass, which bled on touch. A smear was
taken as well as endocervical swab for chlamydia and vaginal
swab for vaginal infection. Bimanual examination showed a
normal-sized, anteverted, anteexed, mobile uterus with no
palpable adnexal masses or tenderness; and conrmed the
presence of a non-tender mass on the cervix. Fornices were
normal and per rectal examination revealed no abnormality.
Colposcopic examination showed increased vascularity with
mild acetowhite changes (Fig. 1) and iodine negative areas.
Multiple colposcopically guided punch biopsies were taken
from the cervical growth and the acetowhite areas. The smear
showed extensive inammation without cervical intraepithelial
lesion or malignancy, the swabs for infection revealed no
abnormality and the biopsies revealed chronic cervicitis.
As the patient continued to bleed, the decision was taken by
the colposcopy team to do cone biopsy, which suggested TB
cervicitis (extensive epithelioid granuloma, Langhans giant
cells and central necrosis) (Fig. 2). Chest X-ray and sputum

In 2011, 8.7 million people fell ill with TB and 1.4 million died
from TB. The Incidence of tuberculosis (per 100,000 people) in
Egypt was last reported as 19 in 2011, according to a World
Bank report published in 2012 (4). The incidence of TB has
been increased recently especially in areas where HIV and
TB are prevalent (5).
Genitourinary tuberculosis (TB) is more prevalent in developing countries. Fallopian tubes and ovaries are commonly involved. Rarely, other pelvic organs like the vagina, vulva,
myometrium and cervix may be involved. Cervical TB accounts for 0.10.65% of all cases of TB and 524% of genital
tract TB (6). In rare cases, cervical TB may be a primary infection introduced from a partner with tuberculous epididymitis
or other genitourinary diseases (7). Sputum used, as a sexual
lubricant may also be a mode of transmission of genitourinary
tuberculosis (1). Cervix is relatively resistant to tuberculosis
infection because the stratied squamous epithelium of the
ectocervix prevents bacterial penetration. In addition, cervical
mucus is known to have antibacterial action.
50% of patients remain asymptomatic. Symptomatic genital tract TB usually presents with abnormal vaginal bleeding,
menstrual irregularities, abdominal pain, and constitutional
symptoms (3,8). The diagnosis of cervical TB is usually made
by histological examination of a cervical biopsy specimen.
Staining for acid-fast bacilli may not be very useful in making
a diagnosis (9). Although isolation of mycobacterium is the
gold standard for diagnosis, one third of cases are culture negative, therefore the presence of typical granulomata is sufcient for diagnosis if other causes of granulomatous cervicitis
are excluded. New modalities and diagnostic tests could be
considered such as Serodiagnosis by enzyme linked immunosorbent assay (ELISA), which increases the detection rate
(10). PCR (Polymerase chain reaction) technique is also one
of the recent advances for rapid detection of tuberculosis
(11). Surgery is rarely indicated, usually in drug resistant cases.
A case similar to present case, which had been confused with
cervical malignancy, has been reported (8,12).
2.2. Educational message
The possibility of Tuberculous cervicitis should be kept in
mind in the differential diagnosis of suspicious cervix especially in areas where Tuberculosis is prevalent, taking into consideration the difculty in the diagnosis of genital tuberculosis.

Please cite this article in press as: Elkattan E et al. Tuberculous cervicitis mimicking cancer cervix: A case study, Middle East
Fertil Soc J (2013), http://dx.doi.org/10.1016/j.mefs.2013.05.005

Tuberculous cervicitis mimicking cancer cervix: Acase study

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Please cite this article in press as: Elkattan E et al. Tuberculous cervicitis mimicking cancer cervix: A case study, Middle East
Fertil Soc J (2013), http://dx.doi.org/10.1016/j.mefs.2013.05.005