CASE HISTORY

Patient was admitted complaining of 12 years sterility and 8 weeks lower abdominal pain. She had been investigated elsewhere for her sterility but no cause found. 8 weeks before admission she had an acute attack of lower abdominal pain with dysuria and frequency. This was diagnosed as urinary infection and responded to chemotherapy. 10 days later she had another attack which came on suddenly and wore off over the course of a few days. Following this she attended outpatients when a pelvic mass was noted and she was admitted for investigation. Her general condition was good and there were no physical signs outside the pelvis. There was a mobile firm irregular tumour arising from the pelvis and just palpable above the symphysis. The uterus was ante-verted and mobile and there was a large mass, apparently continuous with the fundus. This was firm, mobile and not tender. The adnexae could not be defined. A provisional diagnosis of uterine myoma was made a laparotomy was, therefore, carried. At operation the pelvic organs were found to be involved in an extensive chronic inflammatory reaction and the pelvic peritoneum was studded with pinhead white spots. A panhysterectomy and bilateral salpingo-oophorectomy were carried out. The patient was treated post-operatively with streptomycin and PAS and her convalescence was satisfactory.

PATHOLOGY

The specimen consists of the uterus and appendages viewed from the front. The uterus and cervix are macroscopically normal. The right tube and ovary are bound together in a mass and a slice has been removed from the front to expose a cavity. This is irregular and contains debris and blood clot but in the upper part of its wall a few small foci of opaque white caseation can be clearly seen. Above and slightly to the left of this is a similar foci of inflammatory reaction in which further foci of white caseation are visible. The left tube and ovary are also bound together and a vertical cut has been made through them. In the middle of the exposed surface, in what was originally the ovary, there is a small multilocular serous cystadenoma containing small wart-like growths in its wall. Below this is a cross section of the tube. The cut end attached to the uterus shows two opaque white streaks of caseation. Distal to this, in the segment that has been partly separated, the tube is distended by a tuberculous abscess. This is lined by greyish purulent material but in the wall outside / over foci of caseation can just be seen.