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Babamahmoodi F, Babamahmoodi A, Barzegar R, Sadr M, Rezaei M, Marjani M. Breast Tuberculosis in Iran: A Comprehensive Review. Int J Mycobacteriol 2024; 13:1-6. [PMID: 38771272 DOI: 10.4103/ijmy.ijmy_32_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 02/27/2024] [Indexed: 05/22/2024] Open
Abstract
ABSTRACT Tuberculosis (TB) remains a significant global health concern and kills millions of people every year. While TB can affect any organ in the body, breast TB is relatively uncommon. This study presents a comprehensive review of literature spanning 23 years, with a focus on cases of breast TB in Iran. Among the 96 cases found, the majority (89.6%) fell within the age range of 20-60, with a striking prevalence among women (98.9%). Common symptoms included pain and palpable mass, each presenting in approximately 60.4% of cases. Notably, only a quarter of patients had a confirmed history of exposure to a known TB case. Left breast involvement was more prevalent (58.3%), with ipsilateral lymph node enlargement observed in 40.6% of cases. Given the clinical presentation of breast TB, which often leads to misdiagnosis, a significant proportion of cases (68.7%) were diagnosed through excisional biopsy. Following a standard 6-month regimen of anti-TB drugs, relapse occurred in only 4.2% of cases. This study highlights the need for heightened awareness and vigilance in diagnosing breast TB, especially in regions with a high burden. Although breast TB poses diagnostic challenges, with prompt identification and treatment, the prognosis is generally favorable, with a low incidence of relapse.
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Affiliation(s)
- Farhang Babamahmoodi
- Antimicrobial Resistance Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Abdolreza Babamahmoodi
- Antimicrobial Resistance Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
- Genomic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Rahim Barzegar
- Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Makan Sadr
- Virology Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mitra Rezaei
- Genomic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Pathology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Majid Marjani
- Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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2
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Olmesdahl NP, Nel C, Mannell A, Fatman L. A Retrospective Analysis of the Clinicopathological Features of Patients with Tuberculous Mastitis: A Single Institution's Experience. Acta Cytol 2023; 67:573-582. [PMID: 37729886 DOI: 10.1159/000534193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 09/17/2023] [Indexed: 09/22/2023]
Abstract
INTRODUCTION Tuberculosis remains a global health burden, especially in low- and middle-income countries. Breast tuberculosis is a rare disease with minimal research available. This disease produces a diagnostic challenge as the clinical presentation is variable, and diagnosis often requires additional investigations. This study was undertaken to determine the efficacy of cytology and histology, together with ancillary studies, in diagnosing tuberculous mastitis. METHODS This retrospective study was conducted in a Johannesburg Hospital over 5 years. Thirty-two patients with confirmed tuberculous mastitis were included. The patients were considered positive for tuberculous mastitis if histological or cytological findings were confirmed with either a positive tuberculosis culture, Ziehl-Neelsen stain, or polymerase chain reaction examination/GeneXpert. RESULTS This case series comprises 3 males and 29 females with a mean age of 35.66. A breast mass was the most common presentation. Over these 5 years, more biopsies were performed on inflammatory breast lesions than fine needle aspirations. There was a higher confirmation rate for cytology diagnoses compared to histology diagnoses. CONCLUSION This study supports using fine needle aspiration combined with GeneXpert as the primary diagnostic modality in diagnosing tuberculous mastitis. This test combination is advantageous in resource- and financially constrained environments as it is relatively simple to perform, cost-effective, and has a rapid turnaround time.
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Affiliation(s)
- Nine-Paula Olmesdahl
- Registrar, Anatomical Pathology, Department of Anatomical Pathology, Faculty of Health Sciences, University of the Witwatersrand, and National Health Laboratory Services (NHLS), Johannesburg, South Africa
| | - Carolina Nel
- Consultant Anatomical Pathologist, Department of Anatomical Pathology, Faculty of Health Sciences, University of the Witwatersrand, and National Health Laboratory Services (NHLS), Johannesburg, South Africa
| | - Aylwyn Mannell
- Consultant Surgeon, Department of Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Luvo Fatman
- Medical Officer, Department of Cytology, National Health Laboratory Services (NHLS), Johannesburg, South Africa
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3
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Yadav S. Primary Tubercular Breast Abscess in an Indian Female: A Rare Case. Cureus 2023; 15:e41586. [PMID: 37559857 PMCID: PMC10407965 DOI: 10.7759/cureus.41586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2023] [Indexed: 08/11/2023] Open
Abstract
Tuberculosis is widespread in developing countries, which usually presents as pulmonary tuberculosis. However, cases of extrapulmonary tuberculosis at sites other than the lungs are also reported. The present case is a rare variety of extrapulmonary tuberculosis presenting as a primary tubercular breast abscess in an Indian female with no pulmonary involvement and no history of tuberculosis. A detailed clinical workup led to the final diagnosis, and she was put on anti-tuberculous treatment per the national guidelines.
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Affiliation(s)
- Sankalp Yadav
- Medicine, Shri Madan Lal Khurana Chest Clinic, New Delhi, IND
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4
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Köseoğlu Hİ, Daşıran MF, Köseoğlu RD, Çelikyay ZRY, Kalelioğlu MB. Is it tuberculosis mastitis or granulomatous mastitis? A thirteen-year experience at a university hospital. Turk J Med Sci 2023; 53:744-751. [PMID: 37476888 PMCID: PMC10387850 DOI: 10.55730/1300-0144.5637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 04/04/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Granulomatous mastitis (GM) is a rare inflammatory disease of the breast. Tuberculosis mastitis (TM), one of the causes of GM, is a rare form of extrapulmonary tuberculosis. The clinical, radiological, and histopathological findings of TM and GM are similar, and sometimes it is difficult to make a distinction between these disease states. In this study, we aimed to evaluate the clinical and radiological features, diagnostic techniques, treatment modalities and treatment outcomes of the patients with GM and TM. METHODS The data of the patients with confirmed GM by histopathologic examination of biopsy specimens between 2007 and 2020 were retrospectively analyzed. Demographic features, main complaints, physical findings, radiological and laboratory data, treatment modalities, and treatment outcomes were recorded. RESULTS Sixty-eight GM patients with a mean age of 35.8 (18-63) years were evaluated. The patients had a mass lesion, pain, ulceration,and abscess in their breasts. All of the cases were female. Ultrasonographic examinations were performed on 62 cases. Abscess and/or sinus tract formation was detected in 34, heterogeneous hypoechoic mass in 15, heterogeneous parenchyma or parenchymal edema in 15, axillary lymphadenopathy in 18 and cysts in 13 patients. A total of 10 patients were lost to follow-up. Twenty-six patients underwent surgery for their breast lesions or had antibiotherapy (n = 13) or corticosteroid therapy (n = 7). Eleven (16.1%) patients were diagnosed with TM. These patients were evaluated by clinical examination, chest radiography, and tuberculin skin test. Acid-fast bacilli (AFB) staining and culture were negative in all cases. The diagnosis of TM was based on histopathological evaluation results. Eight of the 11 patients achieved complete remission with antituberculosis treatment. DISCUSSION The etiological diagnosis of GM must be based on a multidisciplinary approach. Tuberculosis mastitis should become a part of differential diagnosis of breast diseases in populations with high incidence of tuberculosis.
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Affiliation(s)
- Handan İnönü Köseoğlu
- Department of Pulmonary Diseases, Faculty of Medicine, Tokat Gaziosmanpaşa University, Tokat, Turkey
| | - Mehmet Fatih Daşıran
- Department of General Surgery, Faculty of Medicine, Tokat Gaziosmanpaşa University, Tokat, Turkey
| | - Reşit Doğan Köseoğlu
- Department of Medical Pathology, Faculty of Medicine, Tokat Gaziosmanpaşa University, Tokat, Turkey
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Lamrissi A, Madri F, Bouab M, Bensouda M, Jalal M, Bouhya S. Tuberculosis of the breast neoplastic-like about two report cases: A rare often unrecognized diagnosis. Int J Surg Case Rep 2022; 96:107242. [PMID: 35777336 PMCID: PMC9283992 DOI: 10.1016/j.ijscr.2022.107242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/10/2022] [Accepted: 05/21/2022] [Indexed: 02/07/2023] Open
Abstract
Tuberculosis of the breast is a very rare infection; it occurs chiefly in women of childbearing potential, usually as an apparently primary infection and constitutes a diagnosis and therapeutic challenge. Administration of antituberculous agents is the mainstay of therapy. Surgery is required in some cases. We report tow cases of breast tuberculosis. The diagnosis has been established on histology. Outcome was favorable under anti bacillary treatment. Through the literature data we recall the epidemiological, clinical, diagnostic and treatment of this pathology.
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Affiliation(s)
- A. Lamrissi
- Maternity Service, Mother and Child Hospital Abderrahim Harouchi, University Hospital IBN ROCHD of Casablanca, Morocco,Gynecology Obstetric Department, Faculty of Medicine and Pharmacy of Casablanca, Hassan 2 University of Casablanca, Morocco,Biology and Health Laboratory (LBS), Hassan 2 University of Casablanca, Morocco,Corresponding author at: Maternity Service, Mother and Child Hospital Abderrahim Harouchi, University Hospital IBN ROCHD of Casablanca, Morocco.
| | - F. Madri
- Maternity Service, Mother and Child Hospital Abderrahim Harouchi, University Hospital IBN ROCHD of Casablanca, Morocco,Gynecology Obstetric Department, Faculty of Medicine and Pharmacy of Casablanca, Hassan 2 University of Casablanca, Morocco
| | - M. Bouab
- Maternity Service, Mother and Child Hospital Abderrahim Harouchi, University Hospital IBN ROCHD of Casablanca, Morocco,Gynecology Obstetric Department, Faculty of Medicine and Pharmacy of Casablanca, Hassan 2 University of Casablanca, Morocco
| | - M. Bensouda
- Maternity Service, Mother and Child Hospital Abderrahim Harouchi, University Hospital IBN ROCHD of Casablanca, Morocco,Gynecology Obstetric Department, Faculty of Medicine and Pharmacy of Casablanca, Hassan 2 University of Casablanca, Morocco
| | - M. Jalal
- Maternity Service, Mother and Child Hospital Abderrahim Harouchi, University Hospital IBN ROCHD of Casablanca, Morocco,Gynecology Obstetric Department, Faculty of Medicine and Pharmacy of Casablanca, Hassan 2 University of Casablanca, Morocco
| | - S. Bouhya
- Maternity Service, Mother and Child Hospital Abderrahim Harouchi, University Hospital IBN ROCHD of Casablanca, Morocco,Gynecology Obstetric Department, Faculty of Medicine and Pharmacy of Casablanca, Hassan 2 University of Casablanca, Morocco,Biology and Health Laboratory (LBS), Hassan 2 University of Casablanca, Morocco
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6
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Dluzewski S, Brown A, Musaddaq B, Hogben RKF, Malhotra A. Co-existent breast malignancy and contralateral primary axillary tuberculosis. BJR Case Rep 2022; 8:20210071. [PMID: 36101732 PMCID: PMC9461741 DOI: 10.1259/bjrcr.20210071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 12/26/2021] [Accepted: 01/09/2022] [Indexed: 11/23/2022] Open
Abstract
Breast tuberculosis is an extremely rare entity representing less than 0.1% of all breast disease in developed countries. Tuberculous infections within the United Kingdom have seen a steady decline with the highest rates present within North West London where infection rates reach 24.8 per 100,000. The presentation can mimic malignancy and lymphatic involvement of the breast both clinically and mammographically, with nodules within the upper outer quadrant, making accurate diagnosis challenging. Approximately, 30% of breast TB cases present with axillary lymphadenopathy and a recent case series review of approximately 44 cases in London found that the most common presenting feature was a solitary breast lump in 87% of cases.4 We present a case of a patient presenting with primary malignancy and contralateral nodal disease highly suspicious for breast malignancy. Subsequent investigation led to the identification of synchronous localized cancer and tuberculous lymphadenitis. Synchronous presentation is uncommon and recognition and differentiation is vital as axillary lymph node metastasis is the most important factor in the staging of breast carcinoma and determining the subsequent oncological and surgical management.
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Affiliation(s)
- Sam Dluzewski
- Department of Radiology, Royal Free Hospital, Pond St, London, UK
| | - Adam Brown
- Department of Radiology, Royal Free Hospital, Pond St, London, UK
| | - Besma Musaddaq
- Department of Radiology, Royal Free Hospital, Pond St, London, UK
| | - Rosalyn KF Hogben
- Department of Surgery, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Anmol Malhotra
- Department of Radiology, Royal Free Hospital, Pond St, London, UK
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7
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TUNA T, COŞKUN S. Breast tuberculosis: analysis of 24 patients. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.1005328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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8
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Pandya J, Tiwari AR, Thareja V. Role of GeneXpert MTB/RIF Assay for Diagnosis of Tuberculous Mastitis. Indian J Surg 2021. [DOI: 10.1007/s12262-019-02006-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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9
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Sagara Y, Hatakeyama S, Kumabe A, Sakuragi M, Matsumura M. Breast tuberculosis presenting with intractable mastitis: a case report. J Med Case Rep 2021; 15:101. [PMID: 33658078 PMCID: PMC7931525 DOI: 10.1186/s13256-021-02712-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 01/31/2021] [Indexed: 11/26/2022] Open
Abstract
Background Breast tuberculosis, also known as tuberculous mastitis, is an extremely rare form of tuberculosis. It accounts for <0.1% of all breast diseases and <2% of all cases of tuberculosis. It is often misdiagnosed as breast cancer, which can potentially lead to a delayed diagnosis. Case presentation A 69-year-old Japanese woman presented with a tumor-mimicking lesion in her right breast, followed by intractable mastitis with a fistula formation. The time until the correct diagnosis of tuberculosis of the breast and sternal bone was 14 months. Conclusions Although rare, it is important to recognize that tuberculous mastitis can present as refractory abscesses/mastitis or mass lesions that mimic carcinomas in women of reproductive age and elderly people. Breast tuberculosis should always be considered in the differential diagnoses, particularly in patients with a history of tuberculosis and those living in areas where tuberculosis is endemic.
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Affiliation(s)
- Yuka Sagara
- Division of General Internal Medicine, Jichi Medical University Hospital, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi, 329-0498, Japan
| | - Shuji Hatakeyama
- Division of General Internal Medicine, Jichi Medical University Hospital, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi, 329-0498, Japan. .,Division of Infectious Diseases, Jichi Medical University Hospital, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi, 329-0498, Japan.
| | - Ayako Kumabe
- Division of General Internal Medicine, Jichi Medical University Hospital, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi, 329-0498, Japan
| | - Masako Sakuragi
- Division of Breast Surgery, Jichi Medical University Hospital, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi, 329-0498, Japan
| | - Masami Matsumura
- Division of General Internal Medicine, Jichi Medical University Hospital, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi, 329-0498, Japan
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10
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Hammami F, Koubaa M, Hentati Y, Chakroun A, Rekik K, Marrakchi C, Mnif Z, Smaoui F, Jemaa MB. Breast tuberculosis: a diagnosis not to be forgotten. J Turk Ger Gynecol Assoc 2021; 22:107-111. [PMID: 33631876 PMCID: PMC8187975 DOI: 10.4274/jtgga.galenos.2021.2020.0213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective: To study the clinical characteristics and imaging features of breast tuberculosis (TB) and to describe treatment. Material and Methods: A retrospective study including all patients hospitalized in the infectious diseases department for breast TB between 1997 and 2018. Results: Twenty-two women, with a mean age of 39±12 years, were identified. In total, 18 patients were multiparous (81.8%). Both lump and mastalgia were the presenting symptoms in 19 cases (86.3%). Ipsilateral axillary lymphadenopathy was noted in 14 cases (63.6%). The most common finding on ultrasound was a well or poorly defined mass lesion, noted in 17 cases (77.2%), followed by fistulous tracts in seven cases (31.8%). Mammography showed focal, asymmetric breast density in 17 cases (89.5%) and diffuse in two cases (10.5%). The diagnosis was confirmed based on the presence of epithelioid cell granulomas and caseous necrosis in 13 cases (59.1%). Patients received antitubercular therapy for a mean duration of 11±5 months. The disease evolution was favorable in 20 cases (91%). There were two relapsing cases (9%). Conclusion: Breast TB should be considered in the differential diagnosis of young patients presenting with palpable lump with axillary lymphadenopathy, especially in endemic regions. The diagnosis confirmation usually requires an excision biopsy providing histological or bacteriological evidence.
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Affiliation(s)
- Fatma Hammami
- Department of Infectious Diseases, University of Sfax, Hedi Chaker University Hospital, Sfax, Tunisia,Extra-pulmonary Research Unity UR17SP12, Hedi Chaker University Hospital, Sfax, Tunisia
| | - Makram Koubaa
- Department of Infectious Diseases, University of Sfax, Hedi Chaker University Hospital, Sfax, Tunisia,Extra-pulmonary Research Unity UR17SP12, Hedi Chaker University Hospital, Sfax, Tunisia
| | - Yosr Hentati
- Department of Radiology, University of Sfax, Hedi Chaker University Hospital, Sfax, Tunisia
| | - Amal Chakroun
- Department of Infectious Diseases, University of Sfax, Hedi Chaker University Hospital, Sfax, Tunisia,Extra-pulmonary Research Unity UR17SP12, Hedi Chaker University Hospital, Sfax, Tunisia
| | - Khaoula Rekik
- Department of Infectious Diseases, University of Sfax, Hedi Chaker University Hospital, Sfax, Tunisia,Extra-pulmonary Research Unity UR17SP12, Hedi Chaker University Hospital, Sfax, Tunisia
| | - Chakib Marrakchi
- Department of Infectious Diseases, University of Sfax, Hedi Chaker University Hospital, Sfax, Tunisia,Extra-pulmonary Research Unity UR17SP12, Hedi Chaker University Hospital, Sfax, Tunisia
| | - Zeineb Mnif
- Department of Radiology, University of Sfax, Hedi Chaker University Hospital, Sfax, Tunisia
| | - Fatma Smaoui
- Department of Infectious Diseases, University of Sfax, Hedi Chaker University Hospital, Sfax, Tunisia,Extra-pulmonary Research Unity UR17SP12, Hedi Chaker University Hospital, Sfax, Tunisia
| | - Mounir Ben Jemaa
- Department of Infectious Diseases, University of Sfax, Hedi Chaker University Hospital, Sfax, Tunisia,Extra-pulmonary Research Unity UR17SP12, Hedi Chaker University Hospital, Sfax, Tunisia
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11
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Baykan AH, Sayiner HS, Inan I, Aydin E, Erturk SM. Primary breast tuberculosis: imaging findings of a rare disease. Insights Imaging 2021; 12:19. [PMID: 33587199 PMCID: PMC7884561 DOI: 10.1186/s13244-021-00961-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 01/04/2021] [Indexed: 11/23/2022] Open
Abstract
Breast tuberculosis is a rare form of extrapulmonary tuberculosis which tends to affect females of reproductive age, and is much rarer in males, postmenopausal women, and pre-pubescent girls. It is difficult to diagnose because it can mimic benign conditions such as a fibroadenoma, as well as malignant diseases like a carcinoma. It is also particularly difficult to distinguish breast tuberculosis from granulomatous mastitis, so other possible diagnoses should be ruled out first. The diagnosis of breast tuberculosis has three essential pillars: clinical examination, radiological evaluations, and histopathological sampling. Radiological evaluations are not only critical in diagnosis but are also important in the planning of the treatment and during the follow-up. This paper aims to review the imaging findings and the differential diagnosis of breast tuberculosis.
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Affiliation(s)
- Ali H Baykan
- Department of Radiology, Faculty of Medicine, Adiyaman University, Yunus Emre Mahallesi 1164 Sokak No:13, 02200, Merkez/Adiyaman, Turkey.
| | - Hakan S Sayiner
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Adiyaman University, Adiyaman, Turkey
| | - Ibrahim Inan
- Department of Radiology, Biruni University Hospital, Istanbul, Turkey
| | - Elcin Aydin
- Zubeyde Hanim Hospital Izmir, Faculty of Medicine, Baskent University, Izmir, Turkey
| | - Sukru M Erturk
- Department of Radiology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
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12
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Bouziyane A, Benaguida H, Lamsisi M, Khoaja A, Benayad S, Ennachit M, Elkarroumi M, Benhessou M, Ennaji MM. Tuberculosis of the breast: analysis of 17 cases. Pan Afr Med J 2020; 37:282. [PMID: 33654509 PMCID: PMC7896522 DOI: 10.11604/pamj.2020.37.282.26583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 11/09/2020] [Indexed: 11/30/2022] Open
Abstract
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.
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Affiliation(s)
- Amal Bouziyane
- Mohamed VI University of Health Sciences, Casablanca, Morocco.,Laboratory of Virology, Microbiology, Quality and Biotechnologies/ETB, Faculty of Science and Techniques, Hassan II University of Casablanca, Mohammedia, Morocco
| | - Hicham Benaguida
- Mohammed VI Center for Cancer Treatment, University Hospital Ibn Rochd, Casablanca, Morocco
| | - Maryame Lamsisi
- Laboratory of Virology, Microbiology, Quality and Biotechnologies/ETB, Faculty of Science and Techniques, Hassan II University of Casablanca, Mohammedia, Morocco
| | - Ayoub Khoaja
- Department of Anatomopathology, University Hospital Ibn Rochd, Casablanca, Morocco
| | - Samira Benayad
- Department of Anatomopathology, University Hospital Ibn Rochd, Casablanca, Morocco
| | - Mohammed Ennachit
- Mohammed VI Center for Cancer Treatment, University Hospital Ibn Rochd, Casablanca, Morocco
| | - Mohamed Elkarroumi
- Mohammed VI Center for Cancer Treatment, University Hospital Ibn Rochd, Casablanca, Morocco
| | - Mustapha Benhessou
- Mohamed VI University of Health Sciences, Casablanca, Morocco.,Laboratory of Virology, Microbiology, Quality and Biotechnologies/ETB, Faculty of Science and Techniques, Hassan II University of Casablanca, Mohammedia, Morocco.,Mohammed VI Center for Cancer Treatment, University Hospital Ibn Rochd, Casablanca, Morocco
| | - Moulay Mustapha Ennaji
- Laboratory of Virology, Microbiology, Quality and Biotechnologies/ETB, Faculty of Science and Techniques, Hassan II University of Casablanca, Mohammedia, Morocco
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13
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Zhang W, Zhang Y, Yang G, Yu T. Features of breast tuberculosis determined by ultrasound imaging: report of 45 cases. J Int Med Res 2020; 48:300060520910891. [PMID: 32727242 PMCID: PMC7394031 DOI: 10.1177/0300060520910891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective This study aimed to characterize the ultrasound (US) imaging features of breast tuberculosis (BTB) to clarify the process of disease progression and provide valuable clinical information. Methods We retrospectively reviewed 45 patients with pathologically or GeneXpert-confirmed BTB from January 2010 to December 2017. We assessed the US features of target lesions including size, shape, orientation, margin, echogenicity, calcification, posterior acoustic features, and blood-flow signal. Results The patients were classified with nodular (55.5%, 25/45), abscess (15.6%, 7/45), or sinus (28.9%, 13/45) type according to their US features. Forty lesions (88.9%, 40/45) extended in a parallel orientation and five extended in a non-parallel orientation. Calcifications were found in eight cases, including six macrocalcifications and two microcalcifications. Enlarged axillary lymph nodes were observed in three cases (6.7%, 3/45). In addition, 44 of the 45 cases (97.8%, 44/45) exhibited hypovascularity or avascularity according to color Doppler flow imaging (CDFI). Conclusion BTB lesions can be classified as nodular, abscess, or sinus type according to their US imaging features. Poor blood supply detected by CDFI might be a common US feature of BTB. Characterization of its US features may facilitate the clinical diagnosis of BTB.
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Affiliation(s)
- Wenzhi Zhang
- Department of Ultrasonography, Chinese and Western Hospital of Zhejiang Province (Hangzhou Red Cross Hospital), Hangzhou, Zhejiang, P.R. China
| | - Ying Zhang
- Department of Ultrasonography, Chinese and Western Hospital of Zhejiang Province (Hangzhou Red Cross Hospital), Hangzhou, Zhejiang, P.R. China
| | - Gaoyi Yang
- Department of Ultrasonography, Chinese and Western Hospital of Zhejiang Province (Hangzhou Red Cross Hospital), Hangzhou, Zhejiang, P.R. China
| | - Tianzhuo Yu
- Department of Ultrasonography, Chinese and Western Hospital of Zhejiang Province (Hangzhou Red Cross Hospital), Hangzhou, Zhejiang, P.R. China
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14
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Chandanwale S, Naragude P, Shetty A, Sawadkar M, Raj A, Bhide A, Singh M. Cytomorphological Spectrum of Granulomatous Mastitis: A Study of 33 Cases. Eur J Breast Health 2020; 16:146-151. [PMID: 32285037 DOI: 10.5152/ejbh.2020.5185] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 01/05/2020] [Indexed: 12/24/2022]
Abstract
Objective Granulomatous mastitis is an uncommon benign breast disease. Varied aetiologies such as tuberculosis, foreign body reactions, sarcoidosis, fungal and parasitic infections and autoimmunity have been suggested. Pre-operative definitive diagnosis is essential for proper treatment. In developing countries like India, fine needle aspiration is still widely used as a reliable technique for preoperative evaluation of palpable breast lumps. The objective of this study is to study the cytomorphological features of different forms of granulomatous mastitis and correlate with other clinical findings including histological features. Materials and Methods A total of 33 cases of granulomatous mastitis were reviewed. The patients underwent fine needle aspiration. Cytomorphological features were studied in detail and correlated with histopathological features and other clinical findings. Results All the 33 patients showed varied cytomorphological features which included epithelioid cells/granuloma with lymphocytes/plasma cells/polymorphs with or without necrosis/caseous necrosis and with or without giant cells. Ziehl Nelson stain showed acid fast bacilli in 13 smears. Out of 17 cases, the eight cases showed positive acid fast bacilli culture. Fungal stain such as Grocott-Gommeri Methane amine did not show fungi. Based on cytomorphological features in aspiration smears, they were grouped into 4 Groups. A total of 27 breast lesions were diagnosed as tuberculous mastitis, the four lesions were diagnosed as idiopathic granulomatous lobular mastitis and two lesions were diagnosed as foreign body granulomatous mastitis. Grocott-Gommeri Methane amine did not showed fungi. Based on cytomorphological features in aspiration smears, they were grouped into 4 Groups. A total of 27 breast lesions were diagnosed as tuberculous mastitis, the four lesions were diagnosed as idiopathic granulomatous lobular mastitis and two lesions were diagnosed as foreign body granulomatous mastitis. Conclusion Epithelioid granulomas with caseous necrosis with or without acid fast bacilli in cytology smears are diagnostic of tuberculosis. Cytology smears showing epithelioid granulomas with predominant polymorphs without necrosis and acid fast bacilli, a diagnosis of idiopathic granulomatous lobular mastitis must be considered. Histopathological examination is essential for definitive diagnosis in these cases.
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Affiliation(s)
- Shirish Chandanwale
- Department of Pathology, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pimpri Pune, India
| | - Piyusha Naragude
- Department of Pathology, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pimpri Pune, India
| | - Abhinav Shetty
- Department of Pathology, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pimpri Pune, India
| | - Manoj Sawadkar
- Department of Pathology, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pimpri Pune, India
| | - Akshi Raj
- Department of Pathology, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pimpri Pune, India
| | - Aniket Bhide
- Department of Pathology, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pimpri Pune, India
| | - Madhuri Singh
- Department of Pathology, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pimpri Pune, India
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15
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Quaglio G, Pizzol D, Isaakidis P, Bortolani A, Tognon F, Marotta C, Di Gennaro F, Putoto G, Olliaro PL. Breast Tuberculosis in Women: A Systematic Review. Am J Trop Med Hyg 2020; 101:12-21. [PMID: 31115305 DOI: 10.4269/ajtmh.19-0061] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
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.
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Affiliation(s)
- Gianluca Quaglio
- Department of International Health, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine, and Life Sciences, University of Maastricht, Maastricht, The Netherlands.,Operational Research Unit, Doctors with Africa, Collegio Universitario Aspiranti e Medici Missionari (CUAMM), Padua, Italy.,European Parliamentary Research Services (EPRS), European Parliament, Brussels, Belgium
| | - Damiano Pizzol
- Operational Research Unit, Doctors with Africa CUAMM, Beira, Mozambique
| | - Petros Isaakidis
- Médecins Sans Frontières, Southern Africa Medical Unit (SAMU), Cape Town, South Africa
| | - Arianna Bortolani
- Operational Research Unit, Doctors with Africa, Collegio Universitario Aspiranti e Medici Missionari (CUAMM), Padua, Italy
| | - Francesca Tognon
- Operational Research Unit, Doctors with Africa, Collegio Universitario Aspiranti e Medici Missionari (CUAMM), Padua, Italy
| | - Claudia Marotta
- Operational Research Unit, Doctors with Africa, Collegio Universitario Aspiranti e Medici Missionari (CUAMM), Padua, Italy
| | | | - Giovanni Putoto
- Operational Research Unit, Doctors with Africa, Collegio Universitario Aspiranti e Medici Missionari (CUAMM), Padua, Italy
| | - Piero L Olliaro
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom.,Special Programme for Research and Training in Tropical Diseases, World Health Organization (WHO/TDR), Geneva, Switzerland
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16
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Tazzioli G, Macolino A, Combi F, Palma E, Papi S, Codeluppi M, Mussini C. Breast tuberculosis: A case report of primary type mammary tuberculosis. Clin Case Rep 2019; 7:2346-2348. [PMID: 31893055 PMCID: PMC6935674 DOI: 10.1002/ccr3.2486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 08/23/2019] [Accepted: 09/10/2019] [Indexed: 11/10/2022] Open
Abstract
Mammary tuberculosis is exceptional in developed countries. It can mimic an abscess or a granulomatous mastitis. In subjects coming from endemic areas, it is necessary to suspect a tuberculosis infection in case of recurrent mastitis refractory to antibiotics. Positivity of Quantiferon-TB Gold assay can help to confirm the clinical suspicion.
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Affiliation(s)
- Giovanni Tazzioli
- Breast Surgery UnitUniversity Hospital of ModenaAzienda Ospedaliero Universitaria Policlinico di ModenaModenaItaly
| | - Antonella Macolino
- Breast Surgery UnitUniversity Hospital of ModenaAzienda Ospedaliero Universitaria Policlinico di ModenaModenaItaly
| | - Francesca Combi
- Breast Surgery UnitUniversity Hospital of ModenaAzienda Ospedaliero Universitaria Policlinico di ModenaModenaItaly
| | - Enza Palma
- Breast Surgery UnitUniversity Hospital of ModenaAzienda Ospedaliero Universitaria Policlinico di ModenaModenaItaly
| | - Simona Papi
- Breast Surgery UnitUniversity Hospital of ModenaAzienda Ospedaliero Universitaria Policlinico di ModenaModenaItaly
| | - Mauro Codeluppi
- Clinic of Infectious DiseasesUniversity Hospital of ModenaAzienda Ospedaliero Universitaria Policlinico di ModenaModenaItaly
| | - Cristina Mussini
- Clinic of Infectious DiseasesUniversity Hospital of ModenaAzienda Ospedaliero Universitaria Policlinico di ModenaModenaItaly
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17
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Asjad BZ, Ali MA, Naeem BK, Khan M, Ahmed Abbasi U, Nehal Z, Siddiqui S. Breast Abcess and Tuberculosis and its Diagnostic Challenges: A Two-Year Prospective Study in Karachi, Pakistan. Cureus 2019; 11:e5909. [PMID: 31788369 PMCID: PMC6855998 DOI: 10.7759/cureus.5909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 10/15/2019] [Indexed: 11/05/2022] Open
Abstract
Breast tuberculosis (TB) is rare among extrapulmonary tuberculosis cases, and the diagnosis is usually preceded by a high index of suspicion and findings of granulomatous lesions. We conducted this study to evaluate different clinical presentations of breast TB, including its diagnosis and association with lactation. We also examined the association of breast TB with TB elsewhere in the body and contact history. This prospective, descriptive study was conducted at a tertiary care hospital in Karachi, Pakistan from March 2017 to March 2019. The study population consisted of 100 women of age ranging from 30 to 39 years after 10 patients were lost to follow-up. After providing informed written consent and a histopathology or culture report, participants completed a proforma. We used IBM SPSS Statistics for Windows, Version 22.0 (IBM Corp., Armonk, NY) to analyze the data, which were kept confidential. Twenty-four patients had diabetes, while 36 patients had no comorbidities. The most consistent symptoms were breast pain (98%), breast lump (89%), fever (83%), and discharge (45%). Of the 100 women, 34 were diagnosed with TB, while 66 women had nonspecific inflammation. Sixty-nine women were lactating, and 31 were nonlactating. Of the 69 lactating women, 21 had been diagnosed with TB while 48 had nonspecific inflammation. TB represents a great burden in underdeveloped countries like Pakistan. Therefore, concerned departments must take necessary action to facilitate early diagnosis and prompt treatment.
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Affiliation(s)
| | | | - Bushra K Naeem
- General Surgery, Jinnah Post Graduate Medical College, Karachi, PAK
| | - Mehmood Khan
- Surgery, Hamdard University Hospital, Karachi, PAK
| | | | - Zakia Nehal
- Surgery, Jinnah Postgraduate Medical Centre, Karachi, PAK
| | - Sara Siddiqui
- Surgery, Jinnah Postgraduate Medical Centre, Karachi, PAK
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18
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McGuire E, Carey L, Tiberi S, Rahman A, Jayasekera N, White V, Kunst H. Breast tuberculosis in East London: A 13-year retrospective observational study. Breast J 2019; 26:235-239. [PMID: 31486176 DOI: 10.1111/tbj.13517] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 04/30/2019] [Accepted: 05/02/2019] [Indexed: 11/29/2022]
Abstract
SETTING Breast tuberculosis (TB) is rare in Western Europe, and its diagnosis may be delayed through lack of awareness of presenting features. Our institution serves a large East London population with a high incidence of TB. OBJECTIVE To characterize presenting features and avoidable diagnostic delay in breast TB patients. DESIGN We conducted a 13-year retrospective study of breast TB patients treated at our institution including demographic, clinical, microbiology, and pathology data. RESULTS Forty-seven cases were included; 44 (94%) were female, with a median age of 33 years (IQR 28.5-39.5). The main presenting feature was a breast lump in 41 cases (87%); which were predominantly solitary unilateral lesions (25, 61%) and frequently located in the upper outer quadrant (28, 68%). Where performed, Mycobacterium tuberculosis was cultured in 15/36 (42%) cases. Granulomata were present on biopsy or aspirate in 21 (47%) and 17 (36%) cases, respectively. The median duration between symptom onset and treatment was 20 weeks (IQR 15-30). Forty-six (98%) completed treatment successfully and one relapsed. CONCLUSION A high index of suspicion for TB is required for individuals presenting with breast symptoms from countries where TB is endemic. Development of standardized pathways may improve detection and management of breast TB may reduce diagnostic delay.
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Affiliation(s)
- Emma McGuire
- Department of Infection, Barts Health NHS Trust, London, UK
| | - Laura Carey
- Department of Respiratory Medicine, Barts Health NHS Trust, London, UK
| | - Simon Tiberi
- Department of Infection, Barts Health NHS Trust, London, UK.,Blizard Institute, Queen Mary University of London, London, UK
| | - Ananna Rahman
- Department of Respiratory Medicine, Barts Health NHS Trust, London, UK
| | | | - Veronica White
- Department of Respiratory Medicine, Barts Health NHS Trust, London, UK
| | - Heinke Kunst
- Department of Respiratory Medicine, Barts Health NHS Trust, London, UK.,Blizard Institute, Queen Mary University of London, London, UK
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19
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Farrokh D, Alamdaran A, Feyzi Laeen A, Fallah Rastegar Y, Abbasi B. Tuberculous mastitis: A review of 32 cases. Int J Infect Dis 2019; 87:135-142. [PMID: 31442629 DOI: 10.1016/j.ijid.2019.08.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 08/08/2019] [Accepted: 08/14/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Breast tuberculosis (TB) is a rare disease, still present in endemic areas. The significance of breast TB is due to its rare occurrence and its resemblance to malignant breast lesions. The objective of this study was to study various clinical presentations and imaging features of different forms of tuberculous mastitis. METHODS A retrospective study was conducted over a 10-year period. Thirty-two consecutive patients diagnosed with tuberculous mastitis were included. RESULTS There was only one male patient in this series. The patients ranged in age from 25 to 60 years (mean age was 33.69 years). A solitary breast mass was the most common clinical presentation, which was associated with inflammatory findings in the majority of cases. The most common mammographic finding was diffusely increased density and the most common pathological finding was solitary mass. The most common appearance on ultrasound was of multiple intercommunicating breast masses with axillary lymphadenopathy. CONCLUSIONS Breast TB should be considered in the differential diagnosis in the presence of a painful breast mass, discharging sinuses, mastitis, or a breast abscess that does not respond to conventional medical treatment. A multidisciplinary approach is required to aid timely diagnosis and to provide appropriate management and treatment in order to avoid complications.
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Affiliation(s)
- Donya Farrokh
- Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Alamdaran
- Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Feyzi Laeen
- Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Bita Abbasi
- Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
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20
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Almeida S, Valentim M, Neto C, Cerol M, Boticário M, Santos MI, Gameiro A. Extrapulmonary Tuberculosis Presenting as a Suspected Case of Metastatic Breast Cancer. Eur J Case Rep Intern Med 2019; 6:001062. [PMID: 30931280 PMCID: PMC6438115 DOI: 10.12890/2019_001062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 02/13/2019] [Indexed: 11/05/2022] Open
Abstract
Extrapulmonary tuberculosis (TB) represents a diagnostic challenge. Bone TB is an uncommon and important presentation of extrapulmonary TB, which can lead to bone destruction, deformity and even paraplegia. Breast TB is rare and often confused with neoplasia, since the clinical and imaging presentations are not specific. Any of these extrapulmonary TB presentations, in the absence of cultural isolation of mycobacteria, oblige the exclusion of other diseases (secondary or infectious diseases). The authors report a case of multifocal extrapulmonary TB, as an example of the problem with the differential diagnosis of the disease. LEARNING POINTS Extrapulmonary TB remains a diagnostic challenge.Consider breast TB as a differential diagnosis of mammary nodules.A high level of suspicion is necessary to make an early diagnosis and start appropriate treatment before irreversible damage takes place.
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Affiliation(s)
- Sonia Almeida
- Hospital Distrital De Santarem E.P.E., Santarém, Portugal
| | - Marta Valentim
- Hospital Distrital De Santarem E.P.E., Santarém, Portugal
| | - Catarina Neto
- Hospital Distrital De Santarem E.P.E., Santarém, Portugal
| | - Marta Cerol
- Hospital Distrital De Santarem E.P.E., Santarém, Portugal
| | | | | | - Ana Gameiro
- Hospital Distrital De Santarem E.P.E., Santarém, Portugal
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21
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Strazzanti A, Trovato C, Gangi S, Basile F. Breast tuberculosis cases rising in Sicily. Int J Surg Case Rep 2018; 53:9-12. [PMID: 30366176 PMCID: PMC6205060 DOI: 10.1016/j.ijscr.2018.09.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 09/21/2018] [Accepted: 09/28/2018] [Indexed: 11/19/2022] Open
Abstract
Mammary tuberculosis (TM) is an extremely rare condition. The differential diagnosis between breast cancer and breast tuberculosis is very important. 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.
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Affiliation(s)
- Angela Strazzanti
- Departement of General Surgery, Senology University Hospital of Catania, Catania, Italy.
| | - Claudio Trovato
- Departement of General Surgery, Senology University Hospital of Catania, Catania, Italy.
| | - Santi Gangi
- Departement of General Surgery, Senology University Hospital of Catania, Catania, Italy.
| | - Francesco Basile
- Departement of General Surgery, Senology University Hospital of Catania, Catania, Italy.
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22
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Russu MC, Nastasia Ş, Degeratu D, Stănculescu RV. Breast and Cervix Uteri: Rare Locations for Mycobacterium Tuberculosis Infections and Complications-Cases Report and Literature Review. Tuberculosis (Edinb) 2018. [DOI: 10.5772/intechopen.75044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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23
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Abstract
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.
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Affiliation(s)
| | - Rahul
- Surgical Gastroenterology, SGPGI, Lucknow, U.P, India
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24
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Quaglio G, Pizzol D, Bortolani A, Manenti F, Isaakidis P, Putoto G, Olliaro PL. Breast tuberculosis in men: A systematic review. PLoS One 2018; 13:e0194766. [PMID: 29614082 PMCID: PMC5882116 DOI: 10.1371/journal.pone.0194766] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 03/10/2018] [Indexed: 02/01/2023] Open
Abstract
Setting Breast tuberculosis in male is a rarely reported and poorly described condition. Objective To quantify the number of breast tuberculosis in men, to describe clinical presentation and to present the diagnostic and therapeutic procedures applied. Design A systematic review of the literature including reports published in English, Spanish and French until December 2017. Results The search yielded 26 cases of male breast tuberculosis, median age 56.5 years. Most presented with an isolated breast lump (89%), associated with axillary lymphadenitis (27.8%) and skin inflammation (33.3%). The most common constitutional symptoms were pain (64.7%) and fever (35.3%). Fine-needle aspiration cytology and culture were the most common diagnostic modality (61.5%). Standard anti-tuberculosis regimen was the main treatment, alone or accompanied or preceded by incision and drainage. Conclusions The risk of breast tuberculosis in men appears to be low, but the condition can be difficult to diagnose and the diagnostic delays can be long. Overall prognosis is good following standard anti-tuberculosis regimen with or without incision/drainage.
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Affiliation(s)
- GianLuca Quaglio
- European Parliamentary Research Services (EPRS), European Parliament, Brussels, Belgium
- Department of Internal Medicine, Verona University Hospital, Verona, Italy
| | - Damiano Pizzol
- Doctors with Africa CUAMM, Operational Research Unit, Beira, Mozambique
- * E-mail:
| | - Anna Bortolani
- Doctors with Africa CUAMM, Operational Research Unit, Padua, Italy
| | - Fabio Manenti
- Doctors with Africa CUAMM, Operational Research Unit, Padua, Italy
| | - Petros Isaakidis
- Médecins Sans Frontières, Southern Africa Medical Unit (SAMU), Cape Town, South Africa
| | - Giovanni Putoto
- Doctors with Africa CUAMM, Operational Research Unit, Padua, Italy
| | - Piero L. Olliaro
- Special Programme for Research and Training in Tropical Diseases, World Health Organization (WHO/TDR), Geneva, Switzerland
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
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25
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Affiliation(s)
- G Miles
- Departments of Medicine and Surgery, Queen Mary's Sidcup NHS Trust, Sidcup DA14 6LT, UK
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26
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Abstract
Bilateral involvement of the breast with tuberculosis is extremely rare. It most commonly affects young lactating multiparous females, although rarely it may be reported in prepubescent males also. We present a case of a 27-year-old nulliparous female who presented with a history of multiple pus discharging sinuses around both areolae and was diagnosed as a case of bilateral tubercular mastitis. Tubercular mastitis being a paucibacillary disease, diagnosis is often difficult. Treatment consists of antitubercular therapy with or without surgery.
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Affiliation(s)
- Archit Gupta
- General Surgery, Indira Gandhi Medical College, Shimla
| | - Mudita Gupta
- Dermatology, Indira Gandhi Medical College, Shimla
| | - Jagdish Gupta
- General Surgery, Indira Gandhi Medical College, Shimla
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27
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Ail DA, Bhayekar P, Joshi A, Pandya N, Nasare A, Lengare P, Narkhede KA. Clinical and Cytological Spectrum of Granulomatous Mastitis and Utility of FNAC in Picking up Tubercular Mastitis: An Eight-Year Study. J Clin Diagn Res 2017; 11:EC45-EC49. [PMID: 28511395 DOI: 10.7860/jcdr/2017/25635.9591] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 01/09/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Granulomatous Mastitis (GM) is a rare, benign, inflammatory disease of the breast. It is a well known mimicker of malignancy, clinically and radiologically. Patients are often subjected to number of tests for the right diagnosis. Non-specific Granulomatous Mastitis (NGM) and Tubercular Mastitis (TBM) are chief among the various causes of GM. They are important to be diagnosed early as their treatment varies significantly. Fine Needle Aspiration Cytology (FNAC) is simple, patient friendly and primary investigation modality in cases of lump in breast. AIM To find out the utility of FNAC in differentiating NGM and TBM. MATERIALS AND METHODS All cases of granulomatous mastitis diagnosed on cytology over eight years were retrospectively retrieved. The clinical and radiological history was obtained from the patient file. The slides were stained with haematoxylin and eosin stain as well as Leishman stains. Special stains like Periodic Acid Schiff (PAS) and Ziehl Neelsen (ZN) stain were used for fungus and Mycobacteriumtuberculosis respectively. Histopathological correlation of the available cases was done. Clinical presentation and cytological morphology of individual cases was studied in detail. RESULTS Twenty one cases of GM obtained, of which 16 were NGM and five were TBM. Both diseases were common among young reproductive women who presented with unilateral breast lump of varying duration. Almost 25% of NGM and 60% of TBM has clinical suspicion of malignancy. About 30% had radiological suspicion of malignancy. Nearly 62.5% of NGM patients had painful swelling and none of tubercular mastitis patients had pain. About 31% of NGM patients underwent prior abscess drainage and 40% of TBM patients gave history of tuberculosis. Almost 6.25% of NGM and 60% of TBM had axillary lymphadenopathy. Cytologically epithelioid cells were identified in 100% of patients whereas, granulomas were seen in 62.5% and 80% of NGM and TBM smears respectively. Langhans giant cells were frequent among TBM and foreign body giant cell among NGM. Caseous necrosis was seen in 60% of TBM and absent in NGM smears. CONCLUSION Though, NGM and TBM is said to have overlapping features, our study highlights few clinical and cytological differences which aid in differentiating the two entities at primary level. FNAC along with special stain must be advocated as the primary tool of diagnosis in cases of GM.
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Affiliation(s)
- Divya Achutha Ail
- Assistant Professor, Department of Pathology, Smt. Kashibai Navale Medical College and Hospital, Narhe, Pune, Maharashtra, India
| | - Pallavi Bhayekar
- Assistant Professor, Department of Pathology, Smt. Kashibai Navale Medical College and Hospital, Narhe, Pune, Maharashtra, India
| | - Avinash Joshi
- Professor and Head, Department of Pathology, Smt. Kashibai Navale Medical College and Hospital, Narhe, Pune, Maharashtra, India
| | - Nidhi Pandya
- Junior Resident, Department of Pathology, Smt. Kashibai Navale Medical College and Hospital, Narhe, Pune, Maharashtra, India
| | - Anuja Nasare
- Junior Resident, Department of Pathology, Smt. Kashibai Navale Medical College and Hospital, Narhe, Pune, Maharashtra, India
| | - Pranoti Lengare
- Junior Resident, Department of Pathology, Smt. Kashibai Navale Medical College and Hospital, Narhe, Pune, Maharashtra, India
| | - Ketan Ashok Narkhede
- Junior Resident, Department of Pathology, Smt. Kashibai Navale Medical College and Hospital, Narhe, Pune, Maharashtra, India
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28
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The Coexistence of Carcinoma and Tuberculosis in One Breast: A Case Report and Literature Review. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2017. [DOI: 10.5812/ijcm.6185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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29
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Çakar B, Çiledağ A. Retrospective analysis of seven breast tuberculosis cases. Exp Ther Med 2016; 12:3053-3057. [PMID: 27882115 DOI: 10.3892/etm.2016.3705] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 02/04/2016] [Indexed: 11/06/2022] Open
Abstract
The present study aimed to evaluate the demographic data, diagnostic methods, therapeutic regimens and duration of therapy in 7 breast tuberculosis (BTB) cases. The data of BTB cases treated between January 2006 and December 2013 were retrospectively evaluated, with a total of 648 tuberculosis (TB) cases recorded during the 8-year period. Among these cases, 296 patients (50%) suffered from pulmonary TB, 278 (43%) from non-pulmonary TB and 45 (7%) from PTB plus NPTB. In total, 7 BTB were diagnosed, which constituted 1.08% (7/648) of all TB cases and 2.51% (7/278) of all NPTB cases. The mean age of patients was 34±9.46 years, with no pregnant or lactating women. Bilateral breast involvement was detected in only 1 case, while all cases had a BCG scar, and obtained a mean tuberculin skin test (TST) result of 14.28±6.79 mm (range, 7-26 mm). The symptoms included presence of a mass, tenderness, pain, swelling and fluctuation in the breast, with or without discharging sinuses. In 1 case, history of contact with TB was found. All patients were newly-diagnosed BTB cases, with no other organ involvement. Upon histopathological examination of breast tissue, granulomatous inflammation with typical caseous necrosis was observed in 1 case, non-caseous necrosis inflammation was detected in 2 cases, granulomatous inflammation was observed in 3 cases, and mastitis and fat necrosis inflammation was observed in 1 case. Acid-fast bacilli (AFB) staining was positive in only 2 cases, and all patient were treated with anti-TB drugs with a successful outcome and no recurrence. In conclusion, BTB is a rare form of TB and the present retrospective study reported 7 cases of BTB along with the results of histopathological examination, microbiological examination and treatment. TB must be considered when there is presence of breast masses presenting with tenderness, pain, swelling and fluctuation, with or without discharging sinuses.
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Affiliation(s)
- Beyhan Çakar
- Department of Chest Diseases, Ankara Tuberculosis Control Dispensary No. 7, 06100 Ankara, Turkey
| | - Aydin Çiledağ
- Department of Chest Diseases, Ankara University School of Medicine, 01710 Ankara, Turkey
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Schwingel R, Almeida O, Ferreira TDS. Fat necrosis associated with the use of oral anticoagulant therapy: atypical mammographic findings. Radiol Bras 2016; 49:269-270. [PMID: 27777484 PMCID: PMC5073397 DOI: 10.1590/0100-3984.2015.0007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Ricardo Schwingel
- Faculdade de Ciências Médicas da Universidade Estadual de Campinas (FCM-Unicamp), Campinas, SP, Brazil
| | - Orlando Almeida
- Faculdade de Ciências Médicas da Universidade Estadual de Campinas (FCM-Unicamp), Campinas, SP, Brazil
| | - Tiago Dos Santos Ferreira
- Faculdade de Ciências Médicas da Universidade Estadual de Campinas (FCM-Unicamp), Campinas, SP, Brazil
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Brown S, Thekkinkattil DK. Tuberculous cold abscess of breast: an unusual presentation in a male patient. Gland Surg 2016; 5:361-5. [PMID: 27294045 DOI: 10.21037/gs.2016.01.02] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
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.
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Affiliation(s)
- Sarah Brown
- Department of Oncoplastic Breast Surgery, United Lincolnshire Hospitals NHS Trust, UK
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Clinical, diagnostic and therapeutic management of patients with breast tuberculosis: Analysis of 46 Cases. Kaohsiung J Med Sci 2016; 32:27-31. [PMID: 26853172 DOI: 10.1016/j.kjms.2015.12.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 12/04/2015] [Accepted: 12/18/2015] [Indexed: 02/06/2023] Open
Abstract
Breast tuberculosis is a rare form of extrapulmonary tubercular infection. Our aim is to highlight the nonspecific clinical presentations, diagnostic difficulties and therapeutic approaches of mammarian tuberculosis. Forty-six patients diagnosed with breast tuberculosis between 2005 and 2015 were reviewed retrospectively. Clinical features, all diagnostic methods, and the outcomes of treatment were analysed. All cases were female with a mean age of 36.4 years. Breast mass and pain were the most common complaints. While 34.8% of the cases had a physical examination with suspicions for malignancy, 43.5% of the patients had Breast Imaging Reporting and Data System (BI-RADS) 4 or 5 lesions suggested malignancy radiologically. Definitive diagnosis was based on histopathologic examination through core needle biopsy (n = 29), excisional biopsy (n = 12), and open biopsy (n = 5) taken from the abscess wall during drainage. Standard antiTB therapy for 6 months was given to all cases. Thirty-three patients recovered with standard 6-month therapy while extended treatment for 9-12 months was needed in 13 (28.2%) cases. Surgery was carried out in 17 cases. Two patients developed recurrence. Breast tuberculosis can be easily confused with breast cancer, suppurative abscess, and other causes of granulomatous mastitis, both clinically and radiologically. A multidisciplinary approach is required to prevent diagnostic delays and unnecessary surgical interventions. Although antiTB therapy is the mainstay treatment of breast TB, surgery is usually indicated in patients refractory to medical treatment.
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Korkut E, Akcay MN, Karadeniz E, Subasi ID, Gursan N. Granulomatous Mastitis: A Ten-Year Experience at a University Hospital. Eurasian J Med 2015; 47:165-73. [PMID: 26644764 DOI: 10.5152/eurasianjmed.2015.118] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE In this study we aimed to define clinical, radiologic and pathological specialties of patients who applied to General Surgery Department of Atatürk University Medical Faculty with granulomatous mastitis and show medical and surgical treatment results. With the help of this study we will be able to make our own clinical algorithm for diagnosis and treatment. MATERIALS AND METHODS We searched retrospectively addresses, phone numbers and clinical files of 93 patients whom diagnosed granulomatous mastitis between a decade of January 2001 - December 2010. We noted demographic specialties, ages, gender, medical family history, main complaints, physical findings, radiological and laboratory findings, medical treatments, postoperative complications and surgical procedures if they were operated; morbidity, recurrence and success ratios, complications after treatment for patients discussed above. RESULTS In this study we evaluated 93 patients, 91 females and 2 males, with granulomatous mastitis retrospectively who applied to General Surgery Department of Atatürk University Medical Faculty between January 2001 and December 2010. Mean age was 34.4 years. The diagnosis was confirmed by histopathologic examination of the lesions. Seventy three patients had idiopathic granulomatous lobular mastitis and 20 patients had specific granulomatous mastitis IGM (18 tuberculosis mastitis, 1 alveolar echinococcosis and 1 silk reaction). All the patients had surgical debridement or antibiotic, and anti-inflammatory treatment with results bad clinical response before applied our clinic. CONCLUSION Empiric antibiotic therapy and drainage of the breast lesions are not enough for complete remission of idiopathic granulomatous mastitis. The lesion must be excised completely. In selected patients, corticosteroid therapy can be useful. In the patients with tuberculous mastitis, abscess drainage and antituberculous therapy can be useful, but wide excision must be chosen for the patients with recurrent disease.
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Affiliation(s)
- Ercan Korkut
- Department of General Surgery, Atatürk University Faculty of Medicine, Erzurum, Turkey
| | - Mufide Nuran Akcay
- Department of General Surgery, Atatürk University Faculty of Medicine, Erzurum, Turkey
| | - Erdem Karadeniz
- Department of General Surgery, Atatürk University Faculty of Medicine, Erzurum, Turkey
| | - Irmak Durur Subasi
- Department of Radiology, Atatürk University Faculty of Medicine, Erzurum, Turkey
| | - Nesrin Gursan
- Department of Pathology, Atatürk University Faculty of Medicine, Erzurum, Turkey
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Laas E, Touboul C, Kerdraon O, Catteau-Jonard S. Mastites inflammatoires et infectieuses du sein en dehors de la grossesse et de la période d’allaitement : recommandations. ACTA ACUST UNITED AC 2015; 44:996-1016. [DOI: 10.1016/j.jgyn.2015.09.055] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Revised: 09/25/2015] [Accepted: 09/25/2015] [Indexed: 10/22/2022]
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El Hammoumi M, Ktaibi A, El Oueriachi F, Arsalane A, Kabiri EH. [Breast cancer-mimicking tuberculosis with pacchypleurite in male]. REVUE DE PNEUMOLOGIE CLINIQUE 2015; 71:249-251. [PMID: 24932505 DOI: 10.1016/j.pneumo.2014.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 03/06/2014] [Accepted: 03/26/2014] [Indexed: 06/03/2023]
Affiliation(s)
- M El Hammoumi
- Département de chirurgie thoracique, hôpital militaire d'instruction Mohammed-V, Riad 10100 Rabat, Maroc; Faculté de médecine et de pharmacie, université Mohamed-V, Souissi, 10100 Rabat, Maroc.
| | - A Ktaibi
- Faculté de médecine et de pharmacie, université Mohamed-V, Souissi, 10100 Rabat, Maroc; Département d'anatomie pathologique, hôpital militaire d'instruction Mohammed-V, Rabat, Maroc
| | - F El Oueriachi
- Département de chirurgie thoracique, hôpital militaire d'instruction Mohammed-V, Riad 10100 Rabat, Maroc; Faculté de médecine et de pharmacie, université Mohamed-V, Souissi, 10100 Rabat, Maroc
| | - A Arsalane
- Département de chirurgie thoracique, hôpital militaire d'instruction Mohammed-V, Riad 10100 Rabat, Maroc; Faculté de médecine et de pharmacie, université Mohamed-V, Souissi, 10100 Rabat, Maroc
| | - E H Kabiri
- Département de chirurgie thoracique, hôpital militaire d'instruction Mohammed-V, Riad 10100 Rabat, Maroc; Faculté de médecine et de pharmacie, université Mohamed-V, Souissi, 10100 Rabat, Maroc
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Thimmappa D, Mallikarjuna MN, Vijayakumar A. Breast Tuberculosis. Indian J Surg 2015; 77:1378-84. [PMID: 27011568 DOI: 10.1007/s12262-015-1272-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 04/14/2015] [Indexed: 11/25/2022] Open
Abstract
Tuberculosis affects over a billion people worldwide. There is a raise in incidence of extrapulmonary tuberculosis in recent years. Mammary tuberculosis has been estimated to be 0.1 % of breast lesions examined histologically, and it constitutes about 3-4.5 % of surgically treated breast diseases in developing countries. Breast tuberculosis is paucibacillary and routine diagnostic tests such as microscopy, culture, and nucleic acid amplification tests such as polymerase chain reaction techniques do not have the same diagnostic utility as they do in pulmonary tuberculosis. Also, the histology resembles various other granulomatous mastitis. The coexistence of carcinoma and breast tuberculosis adds challenge to diagnosis. Correct diagnosis of tuberculous mastitis is important as the treatment of differential disease varies from steroid to surgery which can have devastating consequences in patients suffering from breast tuberculosis.
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Affiliation(s)
- Durganna Thimmappa
- Department of General Surgery Victoria Hospital, Bangalore Medical College and Research Institute, Bangalore, 560002 India
| | - M N Mallikarjuna
- Department of General Surgery Victoria Hospital, Bangalore Medical College and Research Institute, Bangalore, 560002 India
| | - Abhishek Vijayakumar
- Department of General Surgery Victoria Hospital, Bangalore Medical College and Research Institute, Bangalore, 560002 India
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Abstract
Tuberculosis (TB) is a major public health issue in India. Although dual infection with tuberculosis and bacteria/fungi has been reported in immunocompromised patients, their co-occurrence in individuals with preserved immunity may complicate the clinical presentation, leading to inadequate treatment and unsatisfactory outcomes. In patients with pulmonary tuberculosis, the occurrence of tubercular lesions in atypical locations may further confound the clinical picture if only one of the pathogens is isolated, initially leading to a suboptimal therapeutic response. A strong index of suspicion and additional diagnostic testing may be required for diagnosis and treatment of the second infection. We report three unusual cases of concurrent tubercular and bacterial infection, of which two are pulmonary and one is extrapulmonary.
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Affiliation(s)
- Anshum Aneja Arora
- Department of Pulmonary Medicine, MS Ramaiah Medical College, Bangalore, Karnataka, India
| | | | - Riyaz P Moideen
- Department of Pulmonary Medicine, MS Ramaiah Medical College, Bangalore, Karnataka, India
| | - Mantha Satya Padmaja
- Department of Pulmonary Medicine, MS Ramaiah Medical College, Bangalore, Karnataka, India
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Systemic granulomatous diseases associated with multiple palpable masses that may involve the breast: case presentation and an approach to the differential diagnosis. Case Rep Med 2014; 2014:146956. [PMID: 25342951 PMCID: PMC4197888 DOI: 10.1155/2014/146956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 09/11/2014] [Indexed: 12/05/2022] Open
Abstract
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.
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Brouwer A, Degrieck N, Rasschaert M, Lockefeer F, Huizing M, Tjalma W. Tuberculous mastitis presenting as a lump: a mimicking disease in a pregnant woman case report and review of literature. Acta Clin Belg 2014; 69:389-94. [PMID: 25056489 DOI: 10.1179/2295333714y.0000000048] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Tuberculosis (TB) of the breast is a rare entity, and can be confused with many other breast disorders, like mamma carcinoma or inflammatory breast cancer. When finding granulomatous mastitis (GM) on histology, it is important to make a differential diagnosis and seek actively for clues on the presence of tuberculosis, sarcoidosis, Wegener's granulomatosis, or idiopathic granulomatous mastitis, since treatment strategies differ and maltreatment has major implications on morbidity and mortality. An extensive clinical evaluation, laboratory work up, and imaging will lead in most cases to the right diagnosis. Anti-tuberculous therapy is the core treatment for breast TB, and surgery is indicated for extensive or persistent residual disease. Here we present a case of tuberculous mastitis and a review of literature on GM.
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40
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Kirbas A, Biberoglu E, Dede H, Uygur D. Primary tubercular mastitis in a pregnancy. Case Rep Womens Health 2014. [DOI: 10.1016/j.crwh.2014.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Khodabakhshi B, Mehravar F. Breast tuberculosis in northeast Iran: review of 22 cases. BMC WOMENS HEALTH 2014; 14:72. [PMID: 24886570 PMCID: PMC4059880 DOI: 10.1186/1472-6874-14-72] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Accepted: 05/22/2014] [Indexed: 12/02/2022]
Abstract
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.
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Affiliation(s)
| | - Fatemeh Mehravar
- School of Public Health, Epidemiology and Biostatistics Department, Tehran University of Medical Sciences, 5TH Floor, Poorsina St, Keshavarz Ave, Postal Box: 14155-6446, Tehran, Iran.
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Bouti K, Soualhi M, Marc K, Zahraoui R, Benamor J, Bourkadi JE, Iraqi G. Postmenopausal breast tuberculosis - report of 4 cases. ACTA ACUST UNITED AC 2014; 7:411-3. [PMID: 24647782 DOI: 10.1159/000343613] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Breast tuberculosis is an uncommon disease even in countries where the incidence of tuberculosis is high. CASE REPORT This is a case series concerning 4 postmenopausal breast tuberculosis cases encountered in Moulay Youssef Hospital between January 2007 and December 2010. Breast tuberculosis represents 0.25% of all hospitalized tuberculosis patients in our department. The mean age of our patients was 62.5 ± 5.8 years. Clinical findings were heterogeneous; 1 case was multifocal tuberculosis, and another case was coexistent tuberculosis and malignancy of the breast. Mammography and ultrasonography findings were suspicious for malignancy in all 4 cases. Fine needle aspiration was negative in 3 cases. The diagnosis was made in all patients by histological examination of biopsy specimens, which revealed typical tuberculous lesions. Anti-tuberculosis therapy formed the mainstay of treatment. CONCLUSION The clinical and radiological features of mammary tuberculosis can be very confusing and easily mistaken for breast cancer. Symptoms suggestive of tuberculosis warrant a biopsy to exclude possible cancer.
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Affiliation(s)
- Khalid Bouti
- Department of Respiratory Diseases, Moulay Youssef Hospital, Rabat, Morocco
| | - Mouna Soualhi
- Department of Respiratory Diseases, Moulay Youssef Hospital, Rabat, Morocco
| | - Karima Marc
- Department of Respiratory Diseases, Moulay Youssef Hospital, Rabat, Morocco
| | - Rachida Zahraoui
- Department of Respiratory Diseases, Moulay Youssef Hospital, Rabat, Morocco
| | - Jouda Benamor
- Department of Respiratory Diseases, Moulay Youssef Hospital, Rabat, Morocco
| | | | - Ghali Iraqi
- Department of Respiratory Diseases, Moulay Youssef Hospital, Rabat, Morocco
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Singal R, Dalal AK, Dalal U, Attri AK. Primary tuberculosis of the breast presented as multiple discharge sinuses. Indian J Surg 2012; 75:66-7. [PMID: 24426392 DOI: 10.1007/s12262-012-0767-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2009] [Accepted: 10/11/2009] [Indexed: 11/30/2022] Open
Abstract
Breast tuberculosis is a rare form of tuberculosis (TB). It is mainly classified as primary and secondary forms. Primary form is rare. We are reporting a case of primary TB breast with history of breast lump and multiple sinuses. TB was diagnosed on FNAC. Patient was put on anti-tubercular drugs.
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Affiliation(s)
- Rikki Singal
- Department of Surgery, Gian Sagar Medical College and Hospital, Patiala, Punjab India
| | - A K Dalal
- Department of Surgery, Government Medical College and Hospital, sector-32, Chandigarh, Punjab India
| | - Usha Dalal
- Department of Surgery, Government Medical College and Hospital, sector-32, Chandigarh, Punjab India
| | - Ashok K Attri
- Department of Surgery, Government Medical College and Hospital, sector-32, Chandigarh, Punjab India
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Kumar M, Chand G, Nag VL, Maurya AK, Rao RN, Agarwal S, Babu SS, Dhole TN. Breast tuberculosis in immunocompetent patients at tertiary care center: A case series. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2012; 17:199-202. [PMID: 23264799 PMCID: PMC3525043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Revised: 11/25/2011] [Accepted: 01/10/2012] [Indexed: 11/04/2022]
Abstract
The breast tuberculosis (TB) is an extremely rare manifestation for the reason that mammary cells offer great resistance to the survival and multiplication of Mycobacterium infection. The diagnosis is difficult because of nonspecific clinical and radiological findings. It is usually suspected in a multiparous, reproductive woman. We report three cases of tubercular infection of breast confirmed by either mycobacteriology, pathology or both. We described their diagnostic confirmation and six month follow-up after antitubercular treatment (ATT).
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Affiliation(s)
- Manoj Kumar
- PhD Student, Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Gyan Chand
- Associate Professor, Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.,Address for correspondence: Dr. Gyan Chand, Associate Professor, Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India. E-mail:
| | - Vijaya Lakshmi Nag
- Assistant Professor, Department of Pathology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Anand Kumar Maurya
- PhD Student, Department of Pulmonary Medicine, Chhatrapati Shahuji Maharaj Medical University UP (Erstwhile King George Medical University), Lucknow, India
| | - Ram Nawal Rao
- Associate Professor, Department of Pathology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Shudhi Agarwal
- Senior Resident, Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Sunil S Babu
- Assistant Professor, Department of Biotechnology, Babasaheb Bhimrao Ambedkar University, Lucknow, India
| | - Tapan N Dhole
- Professor and Head, Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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Al-Khawari HAT, Al-Manfouhi HA, Madda JP, Kovacs A, Sheikh M, Roberts O. Radiologic features of granulomatous mastitis. Breast J 2011; 17:645-50. [PMID: 21929558 DOI: 10.1111/j.1524-4741.2011.01154.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Granulomatous mastitis (GM) is a recognized, but an uncommon cause of breast mass. Awareness of this condition is important, because it can clinically as well as radiologically mimic breast carcinoma. In this study, we present the imaging features of a series of 10 cases with proved diagnosis of granulomatous mastitis with emphasis on magnetic resonance (MR) findings. All those patients who were histologically proven to have GM of the breast were analyzed. Their files were reviewed and data recorded for demographic, clinical presentation and imaging appearances. The imaging features of the lesions by mammography, ultrasound, and magnetic resonance imaging were analyzed. Of the 305 patients who were surgically treated, 10 (3%) cases proved to have GM. All the patients were females with age ranging from 27 to 53 years (average 38 years and median age 36 years). Guided core biopsy was performed in all cases for confirmation of diagnosis followed by either excision biopsy (in five cases) or lumpectomy (in five cases). The final histopathologic results were chronic granulomatous inflammation consistent with tuberculosis in four cases and GM with acute inflammation, but unknown etiology in four cases and GM due to duct ectasia in two cases. GM, a rare breast condition, should be considered in the differential diagnosis of patients with a breast mass associated with inflammatory change. Routine breast imaging with US, MG, or MRI, the condition from malignant lesions and biopsy, still remains the only method of definite diagnosis.
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Affiliation(s)
- Hanaa A T Al-Khawari
- Department of Clinical Radiology, Faculty of Medicine, Kuwait University, Kuwait.
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Yanamandra U, Pathak N, Naithani N, Grover N, Nair V. Tuberculosis of breast: unusual manifestation of tuberculosis. J Infect Chemother 2011; 18:109-11. [PMID: 21879305 DOI: 10.1007/s10156-011-0296-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Accepted: 08/11/2011] [Indexed: 10/17/2022]
Abstract
Tuberculosis affects almost every organ of the body, and the breast is no exception. However, tuberculosis of the breast is rare, and the varied presentation requires a high index of suspicion, especially in middle-aged women for whom a clinical diagnosis of malignancy is likely to be made. We report two cases of primary tuberculosis of breast with different manifestations. One case presented as tuberculous mastitis and the other presented with a lump masquerading as breast carcinoma. The diagnosis in both cases was based on demonstration of acid-fast bacilli on histopathological examination. Resolution was complete with antitubercular therapy, and major surgical intervention was not necessary.
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Affiliation(s)
- Uday Yanamandra
- Department of Internal Medicine, Armed Forces Medical College, Pune, 411040, Maharashtra, India.
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Old enemy on a difficult terrain: tuberculosis in rheumatology practice with focus on uncommon extrapulmonary affection. INDIAN JOURNAL OF RHEUMATOLOGY 2011. [DOI: 10.1016/s0973-3698(11)60030-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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