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.

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.