This case is of a 35 year old multiparous woman who was first seen in gynecological Clinic with a 5 months history of unprovoked irregular vaginal bleeding associated with passage of blood clots which necessitated blood transfusion and had 3 units of blood. There was no previous history of post-coital bleeding prior the onset of symptoms. Her last menstrual period dated back to prior to her last child birth two years earlier. She also observed that she was losing weight but no history of pelvic pain, chronic cough or contact with a case of pulmonary tuberculosis. On examination the cervix appeared hyperemic ad irregular in outline, ulcerated, with vegetations. She had bilateral inguinal lymphadenopathies.
Antibody tests for HIV and VDRL infections were negative and the chest x-ray was normal. Pelvic ultrasonography revealed a small uterus and bilateral adnexae devoid of masses or collection. Sputum, urine and cervical secretions were negative for acid-fast bacilli and culture was unhelpful. The erythrocyte sedimentation rate (ESR) at 2 hours was 85 and Mantoux test was 12mm. A diagnosis of cervical cancer was entertained and punch biopsy of the lesion was performed.
Histological examination showed an ulcerated endocervical epithelium overlying a lesion composed of granulomata with central areas of caseous necrosis which are composed of epithelioid cells with surrounding lymphocytes and plasma cells.
There are numerous Langhan's giant cells. A special stain for mycobacterium was negative. Tuberculosis was considered as the most probable diagnosis. She had six months of anti tuberculosis therapy and after completion there was complete response. There was general improvement of physical condition and the cervix had a normal appearance. She is currently on follow up.