Disseminated endometrial tuberculosis simulating endometrial cancer in an immunocompetent patient: a case report

The case of a 58-year-old immunocompetent woman with no relevant medical history, presenting with pelvic pain and postmenopausal bleeding, is reported. Imaging studies revealed findings compatible with disseminated endometrial cancer, including pulmonary lesions suspicious for metastasis, for which advanced gynecological cancer was initially presumed; however, endometrial biopsy showed necrotizing granulomas with acid-fast bacilli, confirming endometrial tuberculosis (TB). Likewise, pulmonary TB involvement was evidenced (positive sputum smear), establishing the final diagnosis of disseminated TBsimulating a gynecological cancer. The patient received standard anti-TB treatment for six months, with complete remission of symptoms. A post-treatment follow-up biopsy was negative for TB. This case emphasizes the importance of considering genital TB in the differential diagnosis of gynecological neoplasms, even in immunocompetent postmenopausal patients, especially in TB-endemic regions, to ensure timely diagnosis and management.