TUBERCULOSIS OF THE UTERUS.
Tuberculosis of the uterus is not a very rare disease. In this respect
it differs from tuberculosis of the cervix, which, as has already been
said, is a most unusual site for the appearance of tuberculosis. Even
in advanced cases of tuberculosis of the body of the uterus it is very
rare that the condition extends below the internal os.
Tuberculosis of the uterus is often found post-mortem in women who have
died of phthisis or other form of tubercular disease. It has also been
recognized during life, and operation has been performed for its relief.
Tuberculosis of the uterus seems most frequently to be secondary to a
tubercular lesion in some other part of the body. It often begins in
the Fallopian tubes, and extends thence to the endometrium; or it may
be primary in the endometrium, caused by infection through the genital
tract.
The disease first attacks the endometrium, and in the late stages
extends to the muscular coat.
Tuberculosis of the endometrium may occur in three forms--miliary
tuberculosis, chronic diffuse tuberculosis (caseous endometritis), and
chronic fibroid tuberculosis.
_Miliary tuberculosis_ of the uterus may be part of a general miliary
tuberculosis. Typical miliary tubercles are found scattered throughout
the endometrium, usually situated immediately beneath the epithelium
(Fig. 136).
_Chronic diffuse tuberculosis_ is the most frequent form. The uterine
cavity is filled with cheesy material. The mucous membrane is the
seat of irregularly shaped ulcers and tubercles in various stages of
development. When the disease has extended to the muscular coat of the
uterus, the whole organ becomes considerably enlarged. Degeneration and
softening of the uterine wall may be so extensive as to cause rupture.
The internal os may become closed, and a pyometra may be produced.
[Illustration: FIG. 136.--Miliary tuberculosis of the endometrium and
glandular endometritis (Beyea).]
[Illustration: FIG. 137.--Advanced fibroid tuberculosis of the
endometrium (Beyea).]
_Chronic fibroid tuberculosis_ of the endometrium seems to be the
rarest form of the disease. A microscopic section of this form of
tuberculosis is shown in Fig. 137. The endometrial tissue was almost
entirely destroyed, and was replaced by a mass of typical miliary
tubercles. There were no traces of glandular tissue. The tubercles
were separated from each other by a very extensive small round-cell
infiltration and a small amount of remaining stroma tissue. To the
naked eye the endometrium did not appear to be diseased.
Tuberculosis of the uterus may occur at any period of life. It is most
often found between the twentieth and fortieth years.
The =symptoms= of tuberculosis of the uterus are not at all
characteristic. In the early stages they resemble those of
non-tubercular endometritis. There is sometimes a very profuse
leucorrhea, which may contain the characteristic cheesy material. The
body of the uterus may be considerably hypertrophied. If the condition
follows tuberculosis elsewhere, or if any form of genital tuberculosis
exists in the husband, the physician would be led to suspect
tuberculosis of the uterus.
The =diagnosis= can be made only by thorough curetting of the uterine
cavity and the microscopic examination of the tissue removed. The
tubercle bacillus has not often been found, but the other microscopic
appearances are frequently characteristic. In the case from which the
section shown in Fig. 137 was taken the diagnosis of tuberculosis of
the endometrium was made by such curetting and examination.
The =treatment= of tuberculosis of the uterus is hysterectomy. The
operation is indicated in every case except those in which there is
present in some other part of the body an incurable tubercular lesion.