Tuberculosis of the breast

Primary Breast Tuberculosis Concealed Behind Granulomatous Mastitis

Granulomatous mastitis is an inflammatory disease that often affects women with a history of breastfeeding. The pathogenesis is still unclear and several factors have been incriminated, such as trauma, metabolic and hormonal disorders, infections, and autoimmunity. This poses a diagnostic issue, given that there are several different diagnoses, particularly carcinomatous mastitis. We report the case of a 32-year-old woman, with a history of breastfeeding, who presented with inflammatory left breast. The physical examination has objectified a 10/10 cm painless mass and a 3 cm homolateral axillary lymphadenopathy. A sonomammography revealed inflammatory left breast infiltration with multiple collections associated with homolateral axillary lymphadenopathies. A Trucut biopsy was performed, revealing granulomatous mastitis without signs of malignancy. Interferon-gamma measurement and Koch Bacillus (BK) search by polymerase chain reaction (PCR) in the breast collection were all negative. The patient was put on non-specific antibiotics with no response and clinical worsening; therefore, we were obliged to start bacillary treatment. The evolution was marked by a total drought and the disappearance of inflammatory signs within a few weeks. Mammary tuberculosis poses a diagnostic issue given the difficulty to identify the bacteria in the samples. This is why tuberculosis should never be excluded despite negative results, especially in endemic countries.

Fine-needle aspiration cytology-based accurate and rapid diagnosis of breast tuberculosis mimicking an abscess

A case of breast tuberculosis was initially misdiagnosed as a breast abscess and diagnosed definitively by minimally invasive fine-needle aspiration cytology. This definitive diagnosis enabled us to prevent widespread infection by early initiation of the standard anti-tuberculosis regimen. The patient recovered, and no disease recurrence was noted during follow-ups.

Mastitis and More: A Pictorial Review of the Red, Swollen, and Painful Breast

Clinically, acute mastitis presents as a red, swollen, and painful breast. Targeted ultrasound can be performed to evaluate the extent of infection and for an underlying abscess. Noncomplicated mastitis or a small fluid collection may respond to oral antibiotics without further intervention, but a larger or more complex abscess may require single or serial percutaneous aspiration. Breast infections, particularly those complicated by an abscess, can have a prolonged clinical course, and close follow-up is required. Since the clinical presentation and imaging features of acute infectious mastitis can overlap with other etiologies, such as inflammatory breast cancer and idiopathic granulomatous mastitis, a percutaneous biopsy may be indicated to accurately diagnose patients.

Can Fine Needle Aspiration Cytology be Used as a "Proxy Gold Standard" to Diagnose Tuberculous Mastitis?

Objective

To assess the performance of fine needle aspiration cytology (FNAC) in the diagnosis of tuberculosis mastitis.

Materials and Methods

Diagnostic test performance evaluation using two methods-as compared to an alloyed gold standard as well as in the absence of a gold standard. Alloyed gold standard combined the results of acid fast bacilli in cytology smears, histopathological confirmation, and response to treatment. Bayesian estimation of test parameters was done in the absence of the gold standard.

Results

FNAC was carried out in 6,496 consecutive cases of breast lump and 104 cases of granulomatous mastitis were detected. Both methods of test parameter estimation identified a high specificity of FNAC for the diagnosis of tuberculosis mastitis (98.9% and 98.4%, respectively). Estimation of sensitivity was falsely high (100%) using the alloyed gold standard because of a workup bias and falsely low (8.41%) using the Bayesian estimation because of low prevalence. Likelihood ratios by both methods suggested that FNAC has good discriminatory capability.

Conclusion

In situations where prevalence of tuberculosis is high and where facilities for histopathological evaluation do not exist, FNAC can offer an optional alternative to base the therapeutic decision for starting antitubercular treatment.

Breast tuberculosis

Tuberculosis (TB) of breast is an uncommon entity even in endemic regions. Moreover, it is seldom reported. It often presents in young lactating females as a painless breast lump and confused with breast malignancy or pyogenic abscess. A high index of suspicion is required. Fine needle aspiration cytology is important to direct the patient to further tests pertaining to TB. New diagnostic modalities based on detection of nucleic acids have improved the accuracy and cut down the time to diagnosis. Anti-tubercular chemotherapy remains the standard of care. Surgical intervention is seldom required. The fact that the disease being rare, having symptom overlap with commonly prevalent breast malignancy and potentially curable, it becomes important to analyze the presentation, available investigative modalities for early goal directed treatment.

Systemic granulomatous diseases associated with multiple palpable masses that may involve the breast: case presentation and an approach to the differential diagnosis

Palpable mass is a common complaint presented to the breast surgeon. It is very uncommon for patients to report breast mass associated with palpable masses in other superficial structures. When these masses are related to systemic granulomatous diseases, the diagnosis and initiation of specific therapy can be challenging. The purpose of this paper is to report a case initially assessed by the breast surgeon and ultimately diagnosed as granulomatous variant of T-cell lymphoma, and discuss the main systemic granulomatous diseases associated with palpable masses involving the breast.

Tuberculosis infection of the breast mistaken for granulomatous mastitis: a case report

BACKGROUND

Tuberculosis of the breast is an uncommon disease with non-specific clinical, radiological and histological findings. Misdiagnosis is common as biopsy specimens are pauci-bacillary and investigations such as microscopy and culture are frequently negative.

CASE PRESENTATION

We report a case of a breast abscess in a 34-year old Bangladeshi woman attributed to tuberculosis infection. Equivocal histology, negative Ziehl-Neelsen stain and culture for acid-fast bacilli resulted in the abscess initially being diagnosed as granulomatous mastitis and treated accordingly. However failure to respond to therapy raised suspicion of culture negative breast tuberculosis. Treatment with standard antituberculosis drugs was associated with complete resolution of the breast abscess.

CONCLUSION

This case highlights the difficulty in differentiating culture negative tuberculosis from granulomatous mastitis and the importance of a high index of clinical suspicion.