Cervix
Inflammatory / infectious
Granuloma inguinale
Authors: John K.S.S. Philip, M.D., Ziyan T. Salih, M.D.
Last author update: 1 January 2015
Last staff update: 8 April 2024
Copyright: 2003-2024, PathologyOutlines.com, Inc.
PubMed Search: Granuloma inguinale [title] cervix
Table of Contents
Definition / general | Terminology | Epidemiology | Sites | Etiology | Clinical features | Diagnosis | Case reports | Treatment | Microscopic (histologic) description | Positive stains | Negative stains | Electron microscopy description | Differential diagnosis | Additional referencesCite this page: Philip J, Salih Z. Granuloma inguinale. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/cervixgranulomainguinale.html. Accessed April 20th, 2024.
Definition / general
- Sexually transmitted infection caused by gram negative rod Klebsiella granulomatis, formerly called Calymmatobacterium granulomatis, which has characteristic bipolar staining
- Sexually transmitted disease which affects genital skin and mucosa and causes inguinal lymphadenopathy; rarely becomes disseminated
- May occur in children of infected mothers via birth canal (Am J Clin Pathol 1997;108:510)
- May mimic carcinoma (Genitourin Med 1990;66:380)
Terminology
- Also called granuloma venereum, donovanosis
Epidemiology
- Endemic in tropical and developing areas, including India, Guyana, New Guinea, central Australia, southern Africa
- Rare in USA and Europe
Sites
- Anogenital skin, rarely oral mucosa or pharynx
- In females, vulva and perianal area are frequent sites; only rarely affects uterus, fallopian tubes, ovaries
Etiology
- Due to Klebsiella granulomatis, an intracellular gram negative coccobacillus, previously termed Calymmatobacterium granulomatis and Donovania granulomatis
Clinical features
- Begins as a raised papular lesion, which eventually ulcerates with a beefy red, friable granulation tissue at the base
- Abundant granulation tissue accumulates and forms a protuberant, soft, painless mass that may mimic carcinoma (Genitourin Med 1990;66:380)
- Regional lymph nodes are spared or show only nonspecific reactive changes, in contrast to chancroid and lymphogranuloma venereum
- Untreated cases may develop extensive scarring, often associated with lymphatic obstruction and lymphedema (elephantiasis) of the external genitalia (Robbins & Cotran Pathologic Basis of Disease, 9th Edition, Chapter 8)
Diagnosis
- Microscopic examination of smears from ulcer base or histologic sections of ulcer is preferred
- Culture is difficult to perform and not routinely available
- Does not grow on artificial solid media but has been cultured in chicken embryonic yolk sacs, on human monocytes and on human epithelial (Hep - 2) cells
- A serologic test, based on indirect immunofluorescence, is more useful in confirming the diagnosis in long - standing lesions, less useful in early disease
- A diagnostic PCR test has been developed
- Electron microscopic examination may be helpful
Case reports
- 18 year old woman with primary endometrial and endocervical granuloma inguinale (Br J Vener Dis 1983;59:198)
- 27 year old woman with donovanosis as incidental finding on Pap test (J Cytol 2013;30:217)
- 27 and 36 year old women with concomitant malacoplakia and granuloma inguinale of cervix (Int J Gynecol Pathol 2008;27:282)
- Donovanosis affecting cervix, uterus and adnexae (Am J Trop Med Hyg 1984;33:632)
- Granuloma inguinale of cervix (Genitourin Med 1990;66:380)
Treatment
- Doxycycline 100 mg orally twice a day for at least 3 weeks and until all lesions have completely healed
Microscopic (histologic) description
- Inflammatory cells, mainly neutrophils and some macrophages
- Plump histiocytes with thin walled vacuoles containing multiple bacteria
- Bacteria appear as straight or curved dumbbell shaped rods with prominent bipolar granules (Donovan bodies), resembling a "safety pin"
- This classic "safety pin" appearance is more evident in Giemsa stain and not so apparent in alcohol fixed smears
- Epithelioid histiocytes may be seen, but giant cells are not seen (Pantanowitz: Cytopathology of Infectious Diseases, page 106)
- Relative paucity of epithelial cells
- Intact capillaries may be seen in scrapings and conventional pap smears (Diagn Cytopathol 1986;2:138)
Positive stains
- Giemsa and Warthin-Starry silver stains highlight Donovan bodies
Negative stains
- Ziehl-Neelsen stain - to rule out mycobacteria
- Gomori's methenamine silver stain - to rule out histoplasm
Electron microscopy description
- Prominent electron dense granules are present in periphery of cytoplasm
- Typical gram negative cell wall structure and surrounding electron dense capsule layer (J Med Microbiol 1997;46:579, J Med Microbiol 1998;47:1069)
Differential diagnosis
- Follicular cervicitis: accompanying inflammatory infiltrate is lymphoid predominant and not neutrophilic
- Malakoplakia: Michaelis-Gutmann bodies are more dense and round with concentric lamination, compared with donovan bodies (Cytopathology 1991;2:271)
Additional references
