Structure of a radiate pseudocolony associated with an intrauterine contraceptive device.

Transmission electron microscopy of a radiate pseudocolony associated with an intrauterine contraceptive device (IUCD) showed central bundles of extracellular fibers averaging 35 nm in diameter, surrounded by layered mantles of electron-dense, amorphous granular material. No bacterial, viral, or fungal structures were present. X-ray microanalysis revealed copper, sulfur, chloride, iron, and phosphorus; no calcium was found. It is postulated that these structures and histologically identical non-IUCD-associated granules from the female genital tract, as well as similar structures from other body locations, including those reported in colloid cysts of the third ventricle, are of lipofuscin origin.

Pseudo-sulfur granules associated with intrauterine contraceptive devices.

A structure resembling a sulfur granule found in histologic sections of endometrium from patients with intrauterine contraceptive devices is described. It is distinguished from a true sulfur granule on morphologic grounds and is further characterized as a foreign substance, most probably fragments of the synthetic contraceptive device. It is not associated with clinical disease. Microbiologic cultures of removed intrauterine contraceptive devices show no consistent or predominant growth pattern.

PIP: Microscopic slides of 235 samples of endometrial curettings obtained when an IUD was removed were reviewed for the presence of sulfur granule-like structures and IUD-associated material. Where such structures were present, the following stains were done: Gram, Ziehl-Neelsen, periodic acid-Schiff, Grocott's modification of Gomori's methenamine silver, and von Kossa's stain for calcium. A prospective study was conducted in an effort to determine a possible microbiologic origin of the "granules." 50 IUDs removed at the time of dilatation and curettage were cultured. The technics used are described. In 235 endometrial samples examined histologically, 17, or 7.2%, showed the presence of granular structures. 1 true actinomycotic granule was identified. There were 16, or 6.8%, examples of pseudo-sulfur granule; 71 endometria (30%) contained IUD-associated material. All of the pseudo-sulfur granules were found in samples containing the IUD-associated material. The finding of IUD associated material and granules was not related to the type of IUD that was removed. On histologic examination, the most common type of sulfur granule-like structure found showed a glassy eosinophilic color, a radiate appearance, and peripheral clubbing. 14 (28%) of the IUDs cultured yielded no growth, and 17 (34%) grew normal vaginal flora. 19 of the cultures yielded a variety of organisms not normally considered part of the vaginal flora; there was no association with a particular type of IUD. Of the 50 IUDs cultured, 3 had pseudo-sulfur granules in the histologic sections of the corresponding endometrial curettings. 33% of patients with pseudo-sulfur granules and 52% of patients without these granules sought removal of the IUD because of symptoms. The most common type of granule encountered is classified as a psuedo-sulfur granule and is nonpathogenic.