1 / 30

AN UNUSUAL DIAGNOSIS MADE ON PAP SMEAR

AN UNUSUAL DIAGNOSIS MADE ON PAP SMEAR. HISTOPATHOLOGY DEPARTMENT HOLY FAMILY HOSPITAL DR. HAJRA AZHAR. The pap test ; Effective way to screen women for squamous dysplasia and carcinoma of uterine cervix. Primarily used to detect epithelial abnormalities,

orli
Download Presentation

AN UNUSUAL DIAGNOSIS MADE ON PAP SMEAR

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. AN UNUSUAL DIAGNOSIS MADE ON PAP SMEAR HISTOPATHOLOGY DEPARTMENT HOLY FAMILY HOSPITAL DR. HAJRA AZHAR

  2. The pap test ; • Effective way to screen women for squamous dysplasia and carcinoma of uterine cervix. • Primarily used to detect epithelial abnormalities, • Certain infections can easily be detected by Pap smear.

  3. Pap smear…. • In the year 2015 ; • A total of 469 cases of cytology were received in the department of Histopathology, Holy Family Hospital • Out of these , 287cases were Pap smears. • we are presenting today, a rare and interesting case of an infectious disease that we picked on Pap smear.

  4. HISTORY A 40 years old female presented in gynaeOPD with the complaints of : • Foul smelling vaginal discharge • Abdominal distension • Abdominal pain Four months • Vomiting • Loss of appetite

  5. HISTORY….. No history of : • Bleeding per vagina • Itching • Weight loss • Fever • Night sweats • Tuberculosis in the family or • Past history of tuberculosis.

  6. MENSTRUAL HISTORY • She has secondary amenorrhea for the last 10 years. • GYNAECOLOGICAL HISTORY • Post coital bleeding, superficial dyspareunia • PAST MEDICAL AND SURGICAL HISTORY • FAMILY HISTORY NOT SIGNIFICANT • PERSONAL HISTORY

  7. EXAMINATION • GENERAL PHYSICAL EXAMINATION A middle aged lady with normal vital signs. • BP = 110/70 • PULSE = 84/min • TEMP = 98.6 º F • R/R = 24/min • Pallor + • Jaundice º • Cyanosis º • Clubbing º • Oedema º • Lymph nodes º

  8. PER SPECULUM EXAMINATION; PER SPECULUM EXAMINATION; • An unhealthy looking cervix , grossly erythematous, congested and bled on touch. • There was white colored , foul smelling discharge. • On Vaginal examination; • A normal sized retroverted uterus, which was freely mobile. • No adnexal mass or forniceal tenderness.

  9. Rest of the systemic examination; • unremarkable.

  10. INVESTIGATION PLAN Considering the state of cervix, investigations planned by gyne dept. were : • All baseline investigations • Pap Smear • HVS C/S • Abdomino - pelvic ultrasound • CT Scan • Examination under anesthesia & cervical biopsy

  11. BASELINE INVESTIGATIONS…. • Blood CP ; • TLC 10,000 /ul • RBC 413,000 /ul • Hb 9.4 g/dl • Plts 778/ul • MCV 66 fl • MCH 22.7 pg • MCHC 34.5 g/dl

  12. BASELINE INVESTIGATIONS…. Cont… • LFTs • ALT 12 IU/l • ALP 89 IU/l • TOTAL BILIRUBIN 4 umol/l • RFTs • SERUM UREA 15mg/dl • SERUM CREAT 0.7mg/dl • URIC ACID 2.3mg/dl

  13. BASELINE INVESTIGATIONS…. • PT/APTT • PT 15/14 • APTT 40/32 VIRAL SEROLOGY • Anti HbsAg Negative • Anti HCV Negative

  14. HVS C/S • No growth wasobtained after 24 hours at 37ºC Aerobic Incubation.

  15. ABDOMINOPELVIC ULTRASOUND • Cervix • Cervix appeared irregular. An echomixed area measuring 3.3 x 2.6cm was seen. • CUL- DE-SAC • Free fluid was seen. • IMPRESSION • Normal Abdominal ultrasound • Cervical growth

  16. CT SCAN • Heterogeneously enhancing circumferential thickening of cervical canal is seen resulting in near total occlusion of cervical canal suggesting cervical growth. • A well-defined, dense calcified lesion in the pelvis, in cul-de-sac closely abutting uterine wall is also seen ( Could be a calcified lymph node / calcified fibroid).

  17. EXAMINATION UNDER ANESTHESIA • UTERUS - • 14 weeks size, freely mobile • A nodular growth occupying whole of the endocervical canal is present. Cervical lips appear normal. • Clinically the lesion is most likely ADENOCARCINOMA OF CERVIX. • ADENEXA - • Clear • Pap smear - was taken & sent to lab • Biopsy - was taken from several points of growth and sent for histopathology.

  18. PAP SMEAR MORPHOLOGICAL FEATURES; Smear is adequate for interpretation and shows marked inflammation. Multiple epitheloid granulomas and multinucleated giant cells are also present. No dysplastic cells seen. • CYTOLOGICAL DIAGNOSIS: - CONSISTENT WITH TUBERCULOUS CERVICITIS

  19. PAP SMEAR

  20. CERVICAL BIOPSY

  21. FINAL DIAGNOSIS; CERVICAL TUBERCULOSIS

  22. DISCUSSION

  23. GENITAL TUBERCULOSIS • Genital tuberculosis (TB) in females is not uncommon, particularly in communities where pulmonary or other forms of extragenital TB are common. • TB can affect any organ in the body, can exist without any clinical manifestation, and can recur. • Female genital TB is typically understood as a disease of young women, with 80% to 90% of cases diagnosed in patients 20–40 years old, often during workup for infertility.

  24. INCIDENCE ; • Varies with geographic location & range from 10.3% inIndia to less than 1%in America & Sweden • Increasing in developed countries due to its association with HIV. • World wide incidence of genital tuberculosis in infertile womenis 5 – 10 %, A study in Pakistan shows 20%. • The frequency of involvement of various genital organs : • Fallopian tube 90-100% • Endometrium 50-60% • Ovaries 20-30% • Cervix 5-15% • Vulva and vagina 1%

  25. PATHOGENESIS ; Pelvic tuberculosis ; • Is produced by - Mycobacterium tuberculosis or Mycobacterium bovis. • Pelvic organs - are infected from a primary focus, (usually chest), by hematogenousspread. • The cervix can be infected by; • lymphatic spread or bydirect extension. • In rare cases, cervical TB may be a primary infection, introduced by a partner with tuberculous epididymitis

  26. SIGNS AND SYMPTOMS • Abnormal vaginal bleeding • Menstrual irregularities • Abdominal pain • Constitutional symptoms The macroscopic findings ;- • Papillary or vegetative growths & ulceration • May be misinterpreted as invasive carcinoma of cervix.

  27. DIAGNOSIS • Diagnosis of cervical TB : • Histopathology - caseating granulomas are diagnostic. • Staining for acid fast bacilli – may not be very useful • Isolation of mycobacterium on culture - gold standard • one third of cases - are culture negative, So, presence of typical granulomata is considered sufficient for diagnosis. • Newer modalities like ELISA - can aid in the diagnosis.

  28. Take home message; • Tuberculous cervicitis ; - can be clinically , misdiagnosed as cervical carcinoma. • Pap smear – • Is mostly used for the detection of early cervical carcinoma , • it can also diagnose tuberculosis of cervix and certain other infections. • Recognition of these rare conditions : • will decrease the potential for misdiagnosis and • expedite appropriate management of pts with these conditions.

  29. REFERENCES • Chowdhury NN. Overview of tuberculosis of the female genital tract. J Indian Med Assoc. 1996;94:345–6. 361. [PubMed] • 2. Carter JR. Unusual presentations of genital tract tuberculosis. Int J Gynaecol Obstet. 1990;33:171–6.[PubMed] • 3. Bhalla A, Mannan R, Bhasin TS. Tubercular cervicitis clinically mimicking as carcinoma cervix: Two case reports. J ClinDiagn Res. 2010;4:2083–86. • 4. Sinha A, Banerjee N, Roy KK, Takkar D. Cervical tuberculosis mimicking carcinoma cervix. J ObstetGynecol India. 2002;52:154. • 5. Singhal SR, Chaudhry P, Nanda S. Genital tuberculosis with predominant involvement of cervix: A case report. Clin Rev Opin. 2011;3:55–6. • 6. Nabi U, Umber F, Nafees M, Khurshid N. Tuberculosis of cervix: A rare clinical entity. Int J Pathol.2012;10:41–3. • 7. Lamba H, Byrne M, Goldin R, Jenkins C. Tuberculosis of the cervix: Case presentation and a review of the literature. Sex Transm Infect. 2002;78:62–3. [PMC free article] [PubMed]

More Related