Hysteroscopic endometrial morphological changes in infertile patients with tuberculosis

DONG Xiao-yu, FENG Yang-zi, WEI Han, WANG Xiang-ge, WANG Rong-qin

Chinese Journal of Practical Gynecology and Obstetrics ›› 2025, Vol. 41 ›› Issue (12) : 1240-1244.

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Chinese Journal of Practical Gynecology and Obstetrics ›› 2025, Vol. 41 ›› Issue (12) : 1240-1244. DOI: 10.19538/j.fk2025120117

Hysteroscopic endometrial morphological changes in infertile patients with tuberculosis

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Abstract

Objective To evaluate the value of hysteroscopy in the diagnosis of endometrial lesions in infertile patients with tuberculosis,and to analyze the hysteroscopic morphological features,histopathological findings,and expression of CD38 and CD138. Methods A total of 75 infertile patients with tuberculosis who underwent hysteroscopic examination at Hebei Provincial Chest Hospital from January 2020 to December 2023 were included.Endometrial morphological characteristics were observed,intrauterine adhesions were classified,and targeted biopsies of suspicious lesions were performed.Tissue specimens were subjected to histopathological examination and immunohistochemical staining for CD38 and CD138. Results Hysteroscopic findings showed that the incidence of intrauterine adhesions was 57.3%(43/75),mostly moderate to severe(65.1%).Tuberculosis-specific changes(such as tuberculous proliferative nodules,caseous necrosis,or paving-stone-like nodules)were observed in 36.0%(27/75)of patients.Patchy endometrial congestion was seen in 89.3%(67/75)of patients,indicating widespread secondary endometrial injury.Endometrial polypoid changes were found in 32.0%(24/75)of patients,and significant endometrial thinning-suggesting irreversible damage to the basal layer-was noted in 52.0%(39/75).Histopathologically,granulomatous lesions were confirmed in 52.0%(39/75)of cases.The diagnostic concordance rate between hysteroscopy and pathology was 64.1%.Immunohistochemistry revealed an overall CD38/CD138 positivity rate of 88.0%,indicating a high prevalence of chronic endometritis. Conclusions Hysteroscopy plays a crucial role in the diagnosis of endometrial tuberculosis by enabling early detection of characteristic changes,comprehensive evaluation of the uterine cavity,adhesion grading,and precise targeting of biopsies for histopathological confirmation.When combined with histopathology and immunohistochemistry(e.g.,CD38/CD138),hysteroscopy significantly improves diagnostic accuracy,overcomes limitations of conventional methods,and provides valuable guidance for treatment and reproductive prognosis.

Key words

endometrial tuberculosis / infertility / hysteroscopy / chronic endometritis / CD38 / CD138

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DONG Xiao-yu , FENG Yang-zi , WEI Han , et al . Hysteroscopic endometrial morphological changes in infertile patients with tuberculosis[J]. Chinese Journal of Practical Gynecology and Obstetrics. 2025, 41(12): 1240-1244 https://doi.org/10.19538/j.fk2025120117

References

[1]
Global tuberculosis report 2024. Geneva:World Health Organization,2024. Licence:CC BY-NC-SA 3.0 IGO.[EB/OL].[2025-10-23]. https://www.who.int/teams/global-programme-on-tuberculosis-and-lung-health/tb-reports/global-tuberculosis-report-2024.
[2]
Sharma JB, Singh UB, Kriplani A, et al. Hysteroscopic observations in 348 consecutive cases of female genital tuberculosis: A prospective study[J]. Indian J Tuberc, 2022, 69(1):48-57.DOI:10.1016/j.ijtb.2021.02.010.
To evaluate the hysteroscopic findings in female genital tuberculosis.It was a prospective study of hysteroscopic findings performed on 348 cases of female genital tuberculosis (FGTB).It was a prospective cross-sectional study in a tertiary referral centre.A total of 348 patients with infertility with FGTB on various tests.A total of 348 patients of infertility found to have FGTB on various investigations were enrolled in the study. A detailed history was taken. Clinical examination, endometrial sampling and diagnostic laparoscopy were performed was also performed in selected cases. All patients underwent hysteroscopy as part of evaluation for infertility and tuberculosis (TB) findings.The mean age, parity, body mass index and duration of infertility was 28.2 years, 0.31,23.1kg/m and 3.44 years respectively. Infertility was primary in 81.03% and secondary in 18.96% cases. Diagnosis of FGTB was made by endometrial aspirate findings of positive AFB on microscopy (4.02%), positive culture (4.88%), positive PCR (83.90%), epithelioid granuloma (14.65%), positive AFB on microscopy or culture of peritoneal cytology (1.14%) or epithelioid granuloma on peritoneal biopsy (1.72%), definitive findings of TB on laparoscopy (41.95%) or probable findings of TB on laparoscopy (58.05%). Various hysteroscopic findings observed were normal findings (28.16%), pale endometrial cavity (54.31%), features of active TB (7.47%), features of chronic TB (19.54%), features of TB sequelae like obstructed ostia (both ostia in 13.79%, one ostia 14.94%, periostial fibrosis; (bilateral 4.59%, unilateral 5.17%), endometrial glands atrophy (12.35%), small shrunken cavity (6.32%), distorted cavity (5.17%), various grades of intrauterine adhesions (29.88%). Hysteroscopy in FGTB was associated with increased difficulties and complications like failed procedures, difficult visualisation, false passage and uterine perforation.Hysteroscopy is useful modality to detect endometrial TB but is associated with increased difficulty and complications.Copyright © 2021 Tuberculosis Association of India. Published by Elsevier B.V. All rights reserved.
[3]
Ahmed MAE, Mohammed AAA, Ilesanmi AO, et al. Female Genital Tuberculosis Among Infertile Women and Its Contributions to Primary and Secondary Infertility: A systematic review and meta-analysis[J]. Sultan Qaboos Univ Med J, 2022, 22(3):314-324.DOI:10.18295/squmj.1.2022.003.
Female genital tuberculosis (FGTB) is a widespread infectious disease among young women. This meta-analysis aimed to investigate the prevalence of FGTB among infertile women and its contribution to primary and secondary infertility. PubMed, MEDLINE, WorldCat, The Lens, direct Google search, Google Scholar and ResearchGate were searched from 1971 to July 17, 2021 using the following terms: "prevalence", "epidemiology", "urogenital tuberculosis", "FGTB", "infertile women", "infertility complaints" and "FGTB testing methods". Data were extracted and a meta-analysis was performed. A total of 42 studies were selected with a total of 30,918 infertile women. Of these, the pooled prevalence of FGTB was 20% (95% confidence interval: 15-25%, I = 99.94%) and the prevalence of overall infertility, primary infertility and secondary infertility among FGTB population were 88%, 66% and 34%, respectively. The proportion of FGTB is remarkable among infertile women globally. The biggest burden of the disease is present in low-income countries followed by lower-to-middle- and upper-to-middle-income countries.© Copyright 2022, Sultan Qaboos University Medical Journal, All Rights Reserved.
[4]
Vijay A, Tiwari N, Sharma A, et al. Correlation of Female Genital Tuberculosis and Infertility:A Comprehensive Systematic Review,Meta-analysis,and Female Genital Tuberculosis Infertility Pathway Analysis[J]. J Midlife Health, 2023, 14(3):165-169. DOI:10.4103/jmh.jmh_151_23.
[5]
Kim JY, Song JH, Jun JH, et al. Outcome of in Vitro fertilization and embro transfer(IVF-ET)in patients with pelvic tuberculosis[J]. Fertil Steril, 2000, 74:S168. DOI:10.1016/S0015-0282(00)01205-X.
[6]
Tjahyadi D, Ropii B, Tjandraprawira KD, et al. Female Genital Tuberculosis: Clinical Presentation,Current Diagnosis,and Treatment[J]. Infect Dis Obstet Gynecol, 2022, 2022:3548190.DOI:10.1155/2022/3548190.
[7]
The American Fertility Society. The American Fertility Society classifications of adnexal adhesions,distal tubal occlusion,tubal occlusion secondary to tubal ligation,tubal pregnancies,müllerian anomalies and intrauterine adhesions[J]. Fertil Steril, 1988, 49(6):944-955. DOI:10.1016/s0015-0282(16)59942-7.
[8]
Kumar A. Early Hysteroscopic Diagnosis of Endometrial Tuberculosis[J]. J Minim Invasive Gynecol, 2017, 24:S119. DOI:10.1016/J.JMIG.2017.08.381.
[9]
Harzif AK, Anggraeni TD, Syaharutsa DM, et al. Hysteroscopy Role for Female Genital Tuberculosis[J]. Gynecol Minim Invasive Ther, 2021, 10(4):243-246.DOI:10.4103/GMIT.GMIT_151_20.
Female genital tuberculosis affects the quality of women's lives. One of the symptoms is amenorrhea. In our country, it is still underdiagnosed due to limited resources. Hysteroscopy is known as one of the diagnostic tools for this condition. We performed hysteroscopy and endometrial biopsy in four cases. Hysteroscopy findings show various signs. Histopathological examination showed typical features of tuberculosis in some cases. We also learned that hysteroscopy could evaluate the condition of the endometrium when ongoing and after treatment is accomplished. It is useful for further explanation to the client. Hysteroscopy can be utilized as a diagnostic tool for endometrial sampling, evaluate intracavity condition after treatment, and prognostic tool for future reproductive function.Copyright: © 2021 Gynecology and Minimally Invasive Therapy.
[10]
刘琳琳, 黄晓武, 夏恩兰. 子宫内膜结核的宫腔镜检查和组织病理学诊断分析[J]. 国际妇产科学杂志, 2018, 45(2):203-206.
[11]
中国优生科学协会女性生殖道疾病诊治分会, 中华医学会妇产科学分会感染性疾病协作组.与生育相关的慢性子宫内膜炎诊治专家共识(2025年版)[J]. 中国实用妇科与产科杂志, 2025, 41(7):715-722.DOI:10.19538/j.fk2025070111.
[12]
姜雯雯, 徐勇胜. 结核分枝杆菌潜伏感染筛查方法研究进展[J]. 中国实用儿科杂志, 2023, 38(12):948-952.DOI:10.19538/j.ek2023120615.
[13]
董晓瑜, 王柱, 王惠兰. 少见子宫颈感染[J]. 中国实用妇科与产科杂志, 2024, 40(7):708-711.DOI:10.19538/j.fk2024070110.
[14]
郑丹蕾, 李蓉. 慢性子宫内膜炎的诊断方法及争议[J]. 中国实用妇科与产科杂志, 2021, 37(12):1265-1268.DOI:10.19538/j.fk2021120121.
[15]
Moreno I, Cicinelli E, Garcia-Grau I, et al. The diagnosis of chronic endometritis in infertile asymptomatic women:A comparative study of histology,microbial cultures,hysteroscopy,and molecular microbiology[J]. Am J Obstet Gynecol, 2018, 218(6):602.e1-602.e16.DOI:10.1016/j.ajog.2018.02.012.
[16]
蒋建发, 徐大宝, 杨益民. 子宫内膜结核所致宫腔粘连的宫腔镜手术治疗及生育结局(英文)[J/OL]. 中南大学学报(医学版),(2025-03-24).[2025-10-23]. https://link.cnki.net/urlid/43.1427.R.20250324.0920.004.
[17]
宋家美, 孟昱时, 陈静思, 等. 不同FET方案对子宫内膜结核患者内膜厚度、内膜血流及妊娠结局的影响[J]. 昆明医科大学学报, 2023, 44(9):93-99.DOI:10.12259/j.issn.2095-610X.S20230911.
[18]
刘敏, 古航. 应对妊娠结核病的挑战:早期发现和对应管理策略[J]. 中国实用妇科与产科杂志, 2024, 40(12):1191-1194.DOI:10.19538/j.fk2024120111.
[19]
蒋甜, 许红梅. 结核分枝杆菌耐药机制和耐多药结核抗菌治疗研究进展[J]. 中国实用儿科杂志, 2019, 34(9):789-792.DOI:10.19538/j.ek2019090615.
[20]
冯力民, 丁冬. 宫腔镜技术的现状与展望[J]. 中国实用妇科与产科杂志, 2025, 41(3):291-296.DOI:10.19538/j.fk2025030109.

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Funding

Key Medical Research Project Plan of Hebei Province(20220946)
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