Mammary tuberculosis: report on 52 cases

Breast tuberculosis- clinical spectrum and management

Objective of the study was to report the clinical spectrum, investigative profile and management of breast tuberculosis patients attending a tertiary care hospital. Breast tuberculosis is an uncommon form of tuberculosis. Knowledge of its varied clinical presentation and diagnostic modalities help in diagnosing this easily treatable disease. Retrospective data of 63 consecutive patients with breast tuberculosis was analyzed and information regarding demographic details, clinical presentation, cytology, histopathology and management was noted. Breast tuberculosis is essentially a disease of females (98.41%). 49.20% patients were below 30 years of age and 68.25% were from rural areas. Incidence of tubercular mastitis increases with parity (71.42% with p > 2). Commonest presentation was with painless lump (73%). Nodulocaseous tubercular disease was found in 74.60% patients whereas, 6.3% were of disseminated variety. Primary focus was detected in lungs in 11.1% patients, while 46.03% presented with loco-regional lymph nodes. FNAC was found to be a sensitive tool of diagnosis in 74.60% patients; however 25.39% cases were diagnosed with biopsy. ATT remained mainstay of treatment with surgical intervention as and when required. Breast tuberculosis despite being uncommon is not rare. Although diagnosis is not difficult but one should know where to suspect. Once confirmed treatment outcome is often rewarding.

Tuberculosis of the breast

Tuberculosis of the breast is an uncommon disease even in countries where the incidence of pulmonary and extrapulmonary tuberculosis is high. Clinical presentation is usually of a solitary, ill-defined, unilateral hard lump situated in the upper outer quadrant of the breast. This disease can present a diagnostic problem on radiological and microbiological investigations, and thus a high index of suspicion is needed. Incorporating a highly sensitive technique like polymerase chain reaction (PCR) may be helpful in establishing the usefulness of such technology and can aid in conforming the diagnosis early. The disease is curable with antitubercular drugs, and surgery is rarely required

Breast Tuberculosis in Southeast Turkey: Report of 27 Cases

BACKGROUND: Breast tuberculosis (TB) is a very rare form of TB. Case series on breast TB are scarce. PATIENTS AND METHODS: The patients with breast TB treated between 2004 and 2008 at our hospital were retrospectively investigated. RESULTS: All patients were female (mean age 31.5 ± 8.4 years). All but 1 patient were new cases. Patients presented with swelling of the breast (48.1%), mass and fluctuation (each, 40.7%), and breast pain (18.5%). The mean treatment duration was significantly shorter in 14 patients who received directly observed therapy (DOT) compared with those (n = 12) who did not (6.7 ± 1.7 months vs. 8.5 ± 1.6 months, respectively; p = 0.01). Seven patients underwent segmental mastektomy as complementary surgery. The highest rate of breast TB was seen in 2007 (37.1% compared with 14.8% between 2004 and 2006). CONCLUSIONS: Breast TB should be considered in patients with breast neoplasia, swelling, and discharge, and can be successfully treated by DOT with shorter treatment duration.

Tuberculosis of the breast with erythema nodosum: a case report

Introduction

There has been an increasing number of tuberculosis cases worldwide, but tuberculosis of the breast remains rare. In rare cases this is seen with a cutaneous manifestation of erythema nodosum.

Case presentation

We report the case of a 33-year-old Chinese woman with tuberculosis of the left breast accompanied by erythema nodosum on the anterior aspect of both lower legs. Due to her poor clinical response to conventional therapy, and the histopathological findings of fine needle aspiration cytology, there were strong indications of tuberculosis. Her clinical diagnosis was confirmed by molecular detection of Mycobacterium tuberculosis complex by polymerase chain reaction. The diagnosis was further confirmed by a second polymerase chain reaction test of erythema nodosum which tested positive for Mycobacterium tuberculosis complex. She received anti-tuberculous therapy for 18 months, and finally underwent residual lumpectomy. During her follow-up examination after 12 months, no evidence of either residual or recurrent disease was present.

Conclusion

Histopathological features and a high index of clinical suspicion are necessary to confirm a diagnosis of tuberculosis of the breast. Anti-tuberculous therapy with or without simple surgical intervention is the core treatment.

[Radiological aspects of primary tuberculosis in the breast: a case report and review of the literature]

Mammary tuberculosis is an illness accounting for less than 0.1% of breast lesions. We present a case from our service and discuss the radiological findings from mammography, ultrasound scan and magnetic resonance, including kinetic curves. Mammary tuberculosis is an unusual condition and such reports are important in relation to the differential diagnoses versus breast cancer and pyogenic abscess.

Tuberculosis of the breast: analysis of 20 cases and a literature review

Tuberculosis (TB) of the breast is a very rare pathology. The clinical presentations of this disease are manifold, often mimicking carcinoma of the breast. We conducted a retrospective analysis of 20 women with TB of the breast receiving care at the mastology clinic at Getúlio Vargas Hospital, PI, Brazil, between 1994 and 2007. The clinical presentation of the disease, the diagnosis and the response to specific treatment were analyzed. Most of the patients were of reproductive age, with the disease affecting the right breast in eleven patients (55%) and the left breast in nine patients (45%). Palpable nodules were present in five patients (25%) and fistulae in 15 (75%). The mean time between onset of symptoms and diagnosis was 7.7 months (range 3-12 months). Skin testing with purified protein derivative of tuberculin was strongly reactive in all patients, six (30%) of whom were breastfeeding. Diagnosis was confirmed by histopathology and all patients were satisfactorily treated with a combination of rifampicin, isoniazid and pyrazinamide. In the present study, TB of the breast presented predominantly as breast abscesses and fistulae and responded satisfactorily to treatment with anti-TB drugs.

[Primary tuberculosis of the breast: a case report]

Tuberculosis of the breast is an uncommon disease. The authors present a case of an asymptomatic 64 year-old patient whose mammography showed a right breast nodule which needed aetiological investigation. Complementary diagnostic exams did not lead to a differential diagnosis between granulomatous lesion and breast carcinoma; nodule aspiration results suggested tuberculosis of the breast but were unclear and so tuberculosis antibiotics were initiated. No other tuberculosis infectious focus was found at clinical- laboratory evaluation. Imagiology progress was favourable, so patient continued treatment. The authors highlight the low rate of primary tuberculosis of the breast and make a brief reference to the pathology, which has a low rate of microbiological and pathological- anatomical identification.

Bilateral Mammary Tuberculosis Associated with a Borderline Ovarian Tumor

BACKGROUND: Mammary tuberculosis is rare in the Western world. It has no defined clinical or imaging features, and has to be differentiated from breast cancer and an abscess. CASE REPORT: We present a case of mammary tuberculosis combined with borderline ovarian cancer. The bilateral breast tuberculosis was the first and only symptom of underlying tuberculosis with Ziehl-Neelsen-positive para-aortic lymph nodes. During further exploration, an asymptomatic pelvic mass was discovered, which appeared later to be a borderline ovarian tumor. The patient was treated with tuberculostatic therapy for 6 months, resulting in a complete regression of the breast lesions. She also underwent hysterectomy with bilateral salpingo-oophorectomy and lymph node dissection for her ovarian cancer. CONCLUSIONS: This case report emphasizes that breast tuberculosis should be included in the differential diagnosis of any atypical breast mass.

Tubercular mastitis in men: case report and systematic review

BACKGROUND

Tuberculous mastitis is usually reported in multiparous postpartum women and is an unusual cause of gynecomastia in adolescent men.

METHODS

We describe an illustrative case and review all cases of tubercular mastitis reported in men in the English literature.

RESULTS

Our search yielded 24 cases of male tubercular mastitis. Most presented with an isolated breast lump. Constitutional symptoms were rare (21.4%), and associated tuberculosis foci, mostly inactive, were seen in 43.8%. Breast parenchymal involvement, chest wall masses, pectoral muscle abscesses, cold abscesses tracking through the chest wall, and empyema necessitatis presented as breast lumps. Fine-needle aspiration cytology was the most common diagnostic modality, and acid-fast bacilli were demonstrable in a minority (33%). A combination of granulomatous mastitis, necrosis, and clinical response to antitubercular therapy was the most common mode of establishing the diagnosis. Most patients responded to antitubercular therapy alone.

CONCLUSION

Tubercular mastitis is a rare cause of breast masses in men, and a high index of suspicion can prevent diagnostic delays. Most patients respond to antitubercular therapy alone.

Mammary tuberculosis mimicking breast cancer: a case report

Introduction

The incidence of tuberculosis is rising worldwide and rare manifestations of the past are seen more often nowadays. Mammary tuberculosis is a rare clinical entity, often mimicking breast cancer or abscesses of benign or malignant origin. Clinical awareness is necessary during diagnostic work-up for establishing the correct diagnosis and treatment.

Case presentation

We present a case of breast tuberculosis diagnosed in a 73 year old woman at our institution. The patient presented with a palpable mass of the right breast with clinical, laboratory and mammographic findings indicative of breast carcinoma. The patient underwent lumpectomy and sentinel lymph node biopsy. Frozen section of the tumor and the sentinel node revealed "granulomatous inflammation", while gross examination confirmed the diagnosis of tuberculous mastitis. The patient received anti-tuberculosis therapy for six months with no side effects or any further complications.

Conclusion

Breast tuberculosis is an obscure disease often mistaken for carcinoma or pyogenic abscess of the breast, especially if well-defined clinical features are absent. A high index of suspicion is required because the disease can usually be treated conservatively with current antituberculous modalities while surgical intervention is reserved for rare cases only.

Old masters as clinical photographers: multifocal breast cancer diagnosed 400 years ago

It is common belief among physicians the idea that breast cancer was not diagnosed centuries ago. Nevertheless, there are reports suggesting that old masters and even common people knew this dramatic disease. In the 16th and 17th centuries, famous artists painted things exactly as they saw them. This allows the detection of breast tumours, as have been previously published. We have discovered a new case of breast cancer in an engraving after Titian's painting. The woman in the painting shows two tumour masses in her right breast, with skin and nipple retraction to the homo lateral axila, suggesting a multifocal breast cancer. Other diagnostic options, such as breast tuberculosis or Mondor's disease, have to be established. The findings suggest that this is the first imaging report of a multifocal breast cancer. Old masters acted, in fact, as clinical photographers.

Primary tuberculous infection of breast: experiences of surgical resection for aged patients and review of literature

Primary mammary tuberculosis is a rare entity that usually occurs in female of reproductive age. Herein three such patients including two males with ages over 80 years, who underwent surgical resection, are reported. Fine needle biopsy failed to achieve specific diagnosis before surgical operation. All of their conditions got satisfactory improvement and anti-tuberculosis chemotherapy was administered postoperatively. Previous literature related to the epidemiology, diagnosis and treatment for mammary tuberculosis will be also reviewed. Mammary tuberculosis is usually related to breast feeding women and is extremely rare in aged man. The possible mechanisms resulting in this disease in our three patients, including direct extension, reactivation, or transmitted by staffs or peers of the nursing home, would also be discussed.

Breast and osteoarticular tuberculosis in a male patient

Breast tuberculosis is an uncommon illness. It is predominant in young women. To our knowledge, only 7 cases of tuberculous mastitis in men have been reported in the English literature since 1945. Furthermore, there are no male patients who have breast and osteoarticular tuberculosis in the literature. We presented a 41-year-old man who was admitted with a fixed tender mass in the right retromammary region and pain in the right hip. Mycobacterium tuberculosis colonies were isolated from the semisolid mass of breast. Histopathologic examination revealed caseous granulomatous infection in the right hip synovial tissue. He was treated successfully with only antituberculous drugs.

Mammary tuberculosis -- importance of recognition and differentiation from that of a breast malignancy: report of three cases and review of the literature

Background

While tuberculosis of the breast is an extremely uncommon entity seen in western populations, it accounts for up to 3% of all treatable breast lesions in developing countries.

Case presentations

We reviewed three female cases of mammary tuberculosis that were diagnosed and treated in Turkey during the same calendar year. All three patients presented with a painful breast mass. In all cases, fine needle aspiration was nondiagnostic for mammary tuberculosis. However, the diagnosis of mammary tuberculosis was confirmed by histopathologic evaluation at the time of open surgical biopsy. All three patients were treated with antituberculous therapy for six months. At the end of the treatment period, each patient appeared to be clinically and radiologically without evidence of residual disease.

Conclusion

The diagnosis of mammary tuberculosis rests on the appropriate clinical suspicion and the histopathologic findings of the breast lesion. Its recognition and differentiation from that of a breast malignancy is absolutely necessary. Antituberculous chemotherapy, initiated immediately upon diagnosis, forms the mainstay of treatment for mammary tuberculosis.

Mammary tuberculosis: analysis of thirty-eight patients

Thirty-eight patients with mammary gland tuberculosis were evaluated over a 5-year period presenting to the surgical unit of our institution. Unilateral involvement of the breast in a woman presenting at an average age of 29 years was the commonest observation. A lump in the breast with or without discharging sinuses was the most common clinical presentation. Ten (26%) of these patients had breast pain with or without increased breast nodularity. Axillary lymph nodal involvement was evident in 14 (36%) of our patients. Only five patients had associated pulmonary tuberculosis, the rest having an isolated involvement of the breast. Fine-needle aspiration cytology was the most reliable diagnostic modality. Medical therapy with antitubercular drugs ranging from 6 to 9 months was the mainstay of treatment. Surgical intervention was reserved for selected refractory cases.

Granulomatous mastitis: a clinicopathological review of 26 cases

AIMS

Twenty-six cases of granulomatous mastitis were examined to determine the common histological and clinical features and the possible association with micro-organisms.

METHODS

A retrospective review of the clinical and histological features of these cases was undertaken, including granuloma, inflammatory cell infiltrate, multinucleated giant cells, necrosis and lymphocytic lobulitis, as well as special stains for micro-organisms including Mycobacterium, other bacteria and fungus. PCR for Mycobacterium tuberculosis DNA was also performed in 19 cases.

RESULTS

Granulomas were present in all cases (100%) while multinucleated giant cells were seen in 17 cases (65%), background inflammatory cell infiltrate in 23 cases (88%), predominantly lymphocytes in 18 cases (69%), significant lymphocytic lobulitis in 13 of 19 cases (68%) and necrosis in three cases (11%). Special stains and cultures for micro-organisms were all negative. Clinically, four cases (15%) were associated with duct ectasia, eight (31%) with abscess, and there was no such association in 14 cases (54%). Of the 19 cases with PCR for tuberculosis, one case showed Mycobacterium DNA in the sample, raising the possibility of occult tuberculosis infection.

CONCLUSIONS

Granulomatous mastitis is a heterogeneous group of diseases with a diverse clinical picture and association. Most idiopathic cases are not associated with specific micro-organisms.