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  IN THIS Article
 ::  Abstract
 ::  Introduction
 ::  Case report
 ::  Discussion
 ::  References

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CASE REPORTS
Year : 1992  |  Volume : 38  |  Issue : 4  |  Page : 204-5

Cytodiagnosis for pelvic tuberculosis.


Dept of Gynaecology and Obstetrics, Seth GS Medical College, Bombay, Maharashtra.

Correspondence Address:
P Khilanani
Dept of Gynaecology and Obstetrics, Seth GS Medical College, Bombay, Maharashtra.

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Source of Support: None, Conflict of Interest: None


PMID: 0001307598

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 :: Abstract 

A 25 yr old married woman with complaints of lower abdominal pain for 2 months, was found to have a irregular nontender mass in pelvis, adherent to uterus. Her Papanicolaou smear was inflammatory. To confirm the diagnosis of either ovarian malignancy or pelvic tuberculosis made on the basis of observations during exploratory laparotomy, ovarian biopsy was taken. The imprint cytodiagnosis was tuberculosis. The patient was then managed surgically and the previous diagnosis was reconfirmed by histopathology. Imprint cytodiagnosis appears to be a valuable technique whenever facilities for frozen section are not available.


Keywords: Adult, Biopsy, Case Report, Cytodiagnosis, methods,Female, Human, Pelvis, Tuberculosis, Female Genital, pathology,surgery,Uterine Diseases, microbiology,pathology,surgery,Vaginal Smears,


How to cite this article:
Khilanani P, Parulekar S. Cytodiagnosis for pelvic tuberculosis. J Postgrad Med 1992;38:204

How to cite this URL:
Khilanani P, Parulekar S. Cytodiagnosis for pelvic tuberculosis. J Postgrad Med [serial online] 1992 [cited 2019 Nov 13];38:204. Available from: http://www.jpgmonline.com/text.asp?1992/38/4/204/667





  ::   Introduction Top


Pelvic tuberculosis in a woman is a common disease in our country. Most of the times the lesions are characteristic enough to permit a diagnosis by inspection alone, to be confirmed by histopathological study. Rarely, lessions are encountered which may be mistaken for pelvic malignancy like ovarian carcinoma.

One such case is presented, which was surgically managed, based on the results of impression cytology of pelvic lesions, obtained at the time of a laparotomy.


  ::   Case report Top


Mrs K, a 25 year old woman, married for 9 years, gravida 4, para 3 with history of one abortion, presented with lower abdominal pain for two months. Her menstrual cycles were regular, the last period being 10 days before the day of presentation. Her past history was not contributory.

On examination, her general condition was fair, vital parameters were within normal limits, and there was no abnormality on systemic examination. Abdominal examination revealed a lump arising from the pelvis, extending 4 cm above the pubis. It was irregular, fixed, non-tender. On pelvic examination, the uterus could not be felt separate from the mass.

Her hemogram, fasting blood sugar, blood urea nitrogen, and chest radiogram did not reveal any abnormality. Her Papanicolaou smear was inflammatory.

On exploratory laparotomy following observations were made - 1. omental adhesions covering the Uterus, 2. an irregular mass replacing both the ovaries and extending behind the uterus, and 3. multiple nodules covering the bowel, liver and parietal peritoneum. In order to distinguish between an ovarian cancer and pelvic tuberculosis, the best way would have been to perform a frozen section. However, it was not possible without prior preparation. A piece of the ovarian mass was cut and impression smears were made from the cut surface. These slides were stained by fast Papanicolaou staining technique[1]. They showed abundant epithelioid cells, lymphocytes, polymorphs, and Langhans giant cells based on which a diagnosis of pelvic tuberculosis was made. The ovarian mass was separated from the uterus, and excised, leaving behind the uterus and a small portion of the right ovary. Omental adhesions were separated. Bowel involvement like adhesions or strictures was ruled out by exploring the entire bowel. The diagnosis was confirmed by histopathology. The patient made an uneventful recovery and was put on antituberculous therapy.


  ::   Discussion Top


The importance of diagnosis of pelvic tumours prior to or during surgery need not be stressed. If one is not prepared for a frozen section, the only alternative is wet film or imprint cytodiagnosis, which is equally reliable but much more economical[2],[3]. It takes ten minutes for fixation and staining of the slide, and thus, is as rapid as the frozen section.

In the case presented, facilities for frozen section were not available. Since the differential diagnosis was tuberculosis or ovarian malignancy, and both require different therapeutic approaches, we had to resort to imprint cytodiagnosis.

All the slides showed cellular features of tuberculosis, viz. epitheloid cells, Langhans' giant cells and lymphocytes with no evidence of malignancy.

Aust et al[2] studied lymph node imprint smears and did not miss a single case of tumor, but did wrongly report 205 cases of tuberculosis as simple lymphadenitis. Though we did not study the lymph nodes, same technique was employed for pelvic mass and therefore it is possible that equal number of cases may be misdiagnosed during this study.

However, imprint cytodiagnosis appears to be a valuable tool in the management of pelvic masses when facilities for frozen section are not available.

 
 :: References Top

1. Caya J, Blowry LJ, Wollingberg NI, Guenther GF. Fast Papanicolaou stain. Am J Clin Pathol 1985; 83:132  Back to cited text no. 1    
2.Aust R, Stahle J, Stenkvit B. Imprint metlid for cytodiagnosis of lymphadenoptthies and tumors of head and neck. Acta Cytol 1971; 15:123-127.  Back to cited text no. 2    
3.Godwin JT. Rapid cytologic diagnosis of surgical specimens. Acta Cytol 1975; 20:111-118.   Back to cited text no. 3    




 

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Online since 12th February '04
2004 - Journal of Postgraduate Medicine
Official Publication of the Staff Society of the Seth GS Medical College and KEM Hospital, Mumbai, India
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