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.
Fig. 136.—Miliary tuberculosis of the endometrium and glandular endometritis (Beyea).
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.