Tuberculous mastitis

Case series on variable presentations of tuberculosis of the breast

Tuberculosis (TB) of the breast is extremely rare and is often mistaken for benign or malignant lesions of the breast. They are rare even in countries which are endemic for TB, like India. The most common type of clinical presentation is a vague lump in the breast, but there are even other types of presentations which are documented. In olden days, there was a lot of dilemma and challenge in diagnosing TB of the breast, but thanks to improved pathological knowledge and the advent of investigations such as QuantiFERON-TB gold and GeneXpert, TB can be diagnosed early nowadays and treated accordingly. In this study series, we report 10 cases of TB of the breast with variable clinical presentations as fibroadenosis, breast abscess, duct ectasia and breast lump on evaluation, and the challenges encountered in establishing the diagnosis.

Tuberculosis of the breast: analysis of 17 cases

Tuberculosis constitutes a major public health problem in the world. Certain extra-pulmonary locations of tuberculosis disease are very exceptional. Amongst these, tuberculosis of the breast is rare even in countries where this infection is endemic. This form of tuberculosis is characterized by clinical and radiological polymorphisms and might mimic other diseases, especially breast cancer. This retrospective study is entailing seventeen patients treated in the Onco-Gynecology Department of the Mohammed VI Cancer Treatment Center, in the Ibn Rochd University Hospital of Casablanca, for breast tuberculosis, over a period of three years. We report the epidemiological, clinical and paraclinical aspects and we specify the treatment and evolution of the patients.

Breast Tuberculosis in Women: A Systematic Review

Breast tuberculosis (TB) is rarely reported and poorly described. This review aims to update the existing literature on risk factors, clinical presentations, constitutional symptoms, diagnostic procedures, and medical and surgical treatments for breast TB. In all, 1,478 cases of breast TB were collected. Previous history of TB was reported in 19% of cases. The most common clinical appearance of the lesion was breast lump (75%). The most common associated finding was axillary lymphadenitis (33%) followed by sinus or fistula (24%). The most common symptoms were pain and fever, reported in 42% and 28% of cases, respectively. The most used diagnostic method was fine-needle aspiration cytology (32%), followed by biopsy (27%), acid-fast bacteria Ziehl-Neelsen stain (26%), culture (13%), and polymerase chain reaction (2%). These tested positive in 64%, 93%, 27%, 26%, and 58% of cases, respectively. The majority (69%) of patients received a 6-month anti-TB treatment (isoniazid, rifampicin, pyrazinamide, and ethambutol). Surgery consisted of excision in 39% of cases, drainage in 23%, and mastectomy in 5%. The great majority of patients had a positive outcome. It often mimics breast cancer, which makes it difficult to diagnose. Most patients, when diagnosed in time, respond to antitubercular therapy alone.

Tuberculosis of the breast: an uncommon presentation of an old disease

Breast tuberculosis (TB) is considered an uncommon disease with an estimated incidence of 0.1% of all breast lesions reported in developed countries. A 53-year-old Caucasian woman, with a medical history of Crohn's disease, previously treated with infliximab for 3 months suspended due to a presumptive diagnosis of TB for which antitubercular regimen was started. Five months after, a painful lump in the left breast was identified by the patient. Mammary ultrasound confirmed left breast nodules and axillary adenopathies. Histology and microbiology of both lesions confirmed breast TB. Molecular drug susceptibility testing in both samples revealed no resistance to first line anti-TB drugs and the regimen was maintained for 1 year, with clinical and radiological improvement. Mammary gland involvement usually results from lymphatic extension and differential diagnosis frequently includes breast cancer or bacterial abscess.

Breast tuberculosis cases rising in Sicily

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Mammary tuberculosis (TM) is an extremely rare condition.

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The differential diagnosis between breast cancer and breast tuberculosis is very important.

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It was possible to identify the Mycobacterium tuberculosis in between nucleic acid probes and PCR.

Introduction

Our work has been reported in line with the SCARE criteria [21].

Mammary tuberculosis (TM) is an extremely rare condition (Khanna et al., 2000 [1]). It has been estimated to be 0.1% of breast lesions examined histologically, but it reaches 3–4% in countries such as India and Africa where the disease shows a high incidence. This disease can present a diagnostic problem in radiological and microbiological investigations, and thus extreme caution is necessary.

Presentation of case

A 26 year-old Eritrean female with a personal history of HIV infection came to our Emergency Department showing generalized limphoadenopathy and weakness in addition to a huge right breast mass. Our examination revealed a tender mass measuring 12 × 10 cm that involved all right breast. Her skin was not erythematous and local temperature was normal. She was painless.

Fine needle aspiration (FNA) showed a milky and greenish shaded fluid.

Conclusions

Nowadays the differential diagnosis between breast cancer and breast tuberculosis is very important, mostly in Italy and in particular in Sicily, where the massive influx of immigrants has compelled physicians to reconsider the presence of !tuberculosis.

A Rare Manifestation of Tuberculosis Presenting in the United States

A 64-year-old Bangladeshi female presented to her primary care physician with a tender right breast lump that had been present for 4-5 days along with subjective fevers and malaise. Initial biopsy revealed granulomas, but Ziehl-Neelsen and Gram stain were negative for TB so antibiotics were prescribed for abscess until culture came positive for tuberculosis. She was started on triple therapy for extrapulmonary tuberculosis, an exceedingly rare presentation that requires high clinical suspicion in the Western world.

Tuberculous cold abscess of breast: an unusual presentation in a male patient

Tuberculosis (TB) of breast is a rare condition especially presentation as a cold abscess. We present a case of male patient with TB of lung and meninges with a cold abscess in the breast. The abscess was incidental finding on the computed tomography (CT) scan. This was further managed by a combination of anti-tuberculous chemotherapy treatment and surgical drainage. We reviewed the current literature related to mammary TB, its presentations and treatment.

Breast tuberculosis in northeast Iran: review of 22 cases

Background

Breast tuberculosis (breast TB) is an extremely rare disease, so case reviews are also rare.

Methods

This study is a retrospective review of patients with breast TB who were treated between 2002 and 2012 at the Health Center of Gorgan City.

Results

All 22 patients were females, their mean age was 32.4 years, and all were new cases. Patients presented with swelling of the breast (22%), lump (55%) and excretion from the involved breast (27%), and breast pain (55%). The highest rate of breast TB occurred in 2011 (27%). All patients received the DOTS regimen for a mean duration of 7.3 ± 0.7 months; in addition, segmental resection was performed on 11 patients (50%).

Conclusions

The findings confirmed that breast TB in Iran should be considered as a differential diagnosis of breast masses. All patients in our study received the daily and ‘Directly Observed Treatment Short-course’ (DOTS) regimens. Anti-tubercular therapy for six months with or without minimal surgical intervention currently is the main treatment.

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.

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.