Incidence, etiopathogenesis and pathological aspects of genitourinary tuberculosis in India: A journey revisited

Abstract

Background: Tuberculosis is one of the major health problems in India. Genitourinary tuberculosis comprises 20% of all extrapulmonary tuberculosis, and is the most common extrapulmonary system to be affected by this disease. The recent surge in the incidence of HIV-infected patients in India has further ignited the fury. Though the members of the Mycobacterium species are well identified, the incidence could not be controlled due to its complex etiopathogenesis and genetic background.

Pathological spectrum: The spectrum of pathological changes of genitourinary tuberculosis is wide, which varies from normal morphology to markedly scarred kidney, bladder, and epididymis with autocystectomy. A thorough knowledge is required to prevent the end-stage complications. The sequel can be detrimental for the patient's physical, behavioral, psychological, and financial health.

Diagnostic dilemmas: Though culture and polymerase chain reaction are available for the detection of tuberculosis, the sensitivity and specificity varies widely and one should be aware.

Conclusions: A thorough knowledge of epidemiology, immunopathogenesis, spectrum of the disease and the possible sequels, will help better and effective management of the disease.

Keywords: Cervix; India; endometrium; etiopathogenesis; genitourinary tract; kidney; sequel; tuberculosis.

Figure 1

Gross photograph of kidney shows multiple necrotic areas involving the medulla and at places destroying renal calyces [Figure 1a]. Chronic TB pyelonephritis with destroyed renal calyces [Figure 1b]. Epithelioid cell granulomas with dense chronic inflammatory infiltrate in renal cortex. [Figures 1c, d, H and E, ×100]. Focal formation of lymphoid follicles [Figure 1e, H and E, ×40]. Cross-section of ureter showing ulcerated urothelium by a granulomatous process [Figure 1f, H and E, ×40]

Figure 2

Photomicrograph demonstrates dense endometrial infiltration by plasma cells and lymphocytes [Figure 2a, H and E, ×200] with epithelioid cell granulomas [Figure 2b, H and E, ×40 and 2c, H and E, ×100] and Langhan's giant cells in endometrial tuberculosis [Figure 2d, H and E, ×100]

Figure 3

Photomicrograph shows epithelioid cell granulomas involving ovarian stroma [Figure 3a, H and E, ×40]. Granulomatous inflammation affecting myometrium [Figure 3b, H and E, ×40] and ectocervix [Figure 3c, H and E, ×40 and 3d, H and E, ×100]

Figure 4

Photomicrograph of prostate trucut biopsy, showing collection of epithelioid granulomas with loss of prostatic glands and fibrosis [Figure 3a, H and E, ×40 and 4b, H and E, ×100]