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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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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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Febery A, Bennett I. Sonographic features of inflammatory conditions of the breast. Australas J Ultrasound Med 2019; 22:165-173. [PMID: 34760553 DOI: 10.1002/ajum.12170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Inflammatory conditions of the breast can be a diagnostic challenge, and ultrasound is a proven valuable tool in this setting. In acute infective conditions, ultrasound is often a superior tool to mammography due to the impracticality of applying compression to the breast and the increased parenchymal density of these often younger patients. Although infective processes comprise the majority of inflammatory conditions in the breast, not infrequently other various disease processes can masquerade as infections. In particular, inflammatory breast cancer can be easily misdiagnosed as an infective process and sonography can play an important role in expediting the correct diagnosis. Furthermore, aspiration, drainage and biopsy are frequently required in managing breast inflammation and breast disease generally, and ultrasound is the most practical imaging modality facilitating such interventions. This article provides a review of the ultrasound characteristics of some of the more frequently encountered inflammatory disorders of the breast which span a spectrum of acute to chronic conditions. The various conditions in this report are described in terms of their specific sonographic imaging features as well as pathogenesis, common clinical presentations, and aspects of management are outlined where appropriate.
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Affiliation(s)
- Alice Febery
- Department of Surgery, University of Queensland Princess Alexandra Hospital 199 Ipswich Road Woolloongabba, Brisbane Queensland Australia
| | - Ian Bennett
- Department of Surgery, University of Queensland Princess Alexandra Hospital 199 Ipswich Road Woolloongabba, Brisbane Queensland Australia
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4
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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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5
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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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6
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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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7
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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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Polkam N, Rayam P, Anireddy JS, Yennam S, Anantaraju HS, Dharmarajan S, Perumal Y, Kotapalli SS, Ummanni R, Balasubramanian S. Synthesis, in vitro anticancer and antimycobacterial evaluation of new 5-(2,5-dimethoxyphenyl)-1,3,4-thiadiazole-2-amino derivatives. Bioorg Med Chem Lett 2015; 25:1398-402. [PMID: 25765907 DOI: 10.1016/j.bmcl.2015.02.052] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 02/07/2015] [Accepted: 02/20/2015] [Indexed: 11/19/2022]
Abstract
A series of 2,5-disubstituted-1,3,4-thiadiazole derivatives 5a-5l, 7a-7e and 9 have been synthesised and screened for in vitro antimycobacterial activity against Mycobacterium smegmatis MC-155. In addition these compounds have also been screened for cytotoxic activity against cancer cell lines HT-29, MDA-MB-231 by MTT colorimetric assay. The compounds are well characterized by spectral analysis viz. (1)H NMR, (13)C NMR, FT-IR, mass and HRMS. Screening results indicate that compounds 5g, 7a possess good antitubercular activity with MIC value 65.74 and 40.86, respectively, compounds 5g, 7a, 7b, 7d, 7e and 9 displayed promising cytotoxic activity against the cell lines tested. 5g and 7a stand out to be potent antimycobacterial and anticancer agents among the tested series. Further the title compounds were also tested on human normal cells HEK293T and are found to be safer with lesser cytotoxicity. It is interesting to observe that compound 5g has come out to be safer, potent anticancer and antimycobacterial agent.
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Affiliation(s)
- Naveen Polkam
- Centre for Chemical Sciences and Technology, IST, Jawaharlal Nehru Technological University Hyderabad, Kukatpally, Hyderabad 500085, T.S., India
| | - Parsharamulu Rayam
- Centre for Chemical Sciences and Technology, IST, Jawaharlal Nehru Technological University Hyderabad, Kukatpally, Hyderabad 500085, T.S., India
| | - Jaya Shree Anireddy
- Centre for Chemical Sciences and Technology, IST, Jawaharlal Nehru Technological University Hyderabad, Kukatpally, Hyderabad 500085, T.S., India.
| | - Satyanarayana Yennam
- Department of Medicinal Chemistry, GVK Biosciences Pvt. Ltd, IDA, Nacharam, Hyderabad 500076, T.S., India
| | - Hasitha Shilpa Anantaraju
- Department of Pharmacy, Birla Institute of Technology and Science, Pilani, Hyderabad Campus, Jawahar Nagar 500078, T.S., India
| | - Sriram Dharmarajan
- Department of Pharmacy, Birla Institute of Technology and Science, Pilani, Hyderabad Campus, Jawahar Nagar 500078, T.S., India
| | - Yogeeswari Perumal
- Department of Pharmacy, Birla Institute of Technology and Science, Pilani, Hyderabad Campus, Jawahar Nagar 500078, T.S., India
| | - Sudha Sravanti Kotapalli
- Center for Chemical Biology, CSIR-Indian Institute of Chemical Technology, Tarnaka, Hyderabad 500007, T.S., India
| | - Ramesh Ummanni
- Center for Chemical Biology, CSIR-Indian Institute of Chemical Technology, Tarnaka, Hyderabad 500007, T.S., India
| | - Sridhar Balasubramanian
- Laboratory of X-ray Crystallography, CSIR-Indian Institute of Chemical Technology, Tarnaka, Hyderabad 500007, T.S., India
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Pandey P, Dixit A, Tanwar A, Mahajan NC. Infiltrating ductal carcinoma breast, metastatic to ipsilateral axillary lymph nodes harbouring primary tuberculous lymphadenitis: a case report. Pan Afr Med J 2014; 18:167. [PMID: 25422685 PMCID: PMC4239443 DOI: 10.11604/pamj.2014.18.167.1494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Accepted: 01/21/2013] [Indexed: 11/16/2022] Open
Abstract
The coexistence of breast cancer and tuberculosis has been described in over 100 cases; however its coexistence in the axillary lymph node is rare with only a handful cases have been reported in the literature. We report a case of infiltrating ductal carcinoma of the left breast, metastatic to ipsilateral axillary lymph nodes harbouring tuberculous lymphadenitis without primary mammary or pulmonary tuberculosis. The case is presented for its rarity and illustrates that the simultaneous occurrence of tuberculosis and carcinoma can create a dilemma in the diagnosis and treatment, so surgeons and pathologists should keep such a combination on the back of their mind, especially in endemic areas.
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Affiliation(s)
- Pinki Pandey
- Departments of Pathology, M M Institute of Medical Sciences and Research, Mullana, Ambala. 133203. Haryana, India
| | - Alok Dixit
- Departments of Pharmacology, M M Institute of Medical Sciences and Research, Mullana, Ambala. 133203. Haryana, India
| | - Aparna Tanwar
- Departments of Pathology, M M Institute of Medical Sciences and Research, Mullana, Ambala. 133203. Haryana, India
| | - N C Mahajan
- Departments of Pathology, M M Institute of Medical Sciences and Research, Mullana, Ambala. 133203. Haryana, India
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Marinopoulos S, Lourantou D, Gatzionis T, Dimitrakakis C, Papaspyrou I, Antsaklis A. Breast tuberculosis: Diagnosis, management and treatment. Int J Surg Case Rep 2012; 3:548-50. [PMID: 22918083 DOI: 10.1016/j.ijscr.2012.07.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2012] [Revised: 06/29/2012] [Accepted: 07/06/2012] [Indexed: 10/28/2022] Open
Abstract
INTRODUCTION Mammary (breast) tuberculosis is a rare manifestation of extra-pulmonary localization of the disease which accounts for less than 0.1% of breast conditions in developed countries, but reaches 3-4% in regions where the disease presents with high incidence (India, Africa). It appears mostly in women of reproductive age, multiparous, lactating. It has been scarcely reported to infect male patients, mainly before puberty, as well as women of older age. The most common presentation is that of a tumor in the middle or upper-outer quadrant of the breast, with multifocal involvement being rarely documented. The differential diagnosis includes breast cancer and abscess formation. PRESENTATION OF CASE We report a case of breast tuberculosis that was treated in the Breast Unit of our hospital. Differential diagnosis, imaging methods, operative diagnostic approach and surgical treatment, histological verification of the disease and further therapeutic management are described. DISCUSSION High risk population is identified, primary and secondary disease is described and clinical presentations are analyzed. Evaluation of diagnostic workup and limitations are reported. CONCLUSION In accordance with the present worldwide revival of the disease, mainly because of massive numbers of migrating population, this subject is reviewed, reminding us of a rather uncommon clinical entity.
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Affiliation(s)
- Spyridon Marinopoulos
- Breast Unit, 1st Obstetrics and Gynecology Department, Athens University Medical School, Alexandra Hospital, Athens, Greece
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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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14
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Mehta G, Mittal A, Verma S. Breast tuberculosis- clinical spectrum and management. Indian J Surg 2010; 72:433-7. [PMID: 22131650 DOI: 10.1007/s12262-010-0166-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2010] [Accepted: 05/27/2010] [Indexed: 11/28/2022] Open
Abstract
Objective of the study was to report the clinical spectrum, investigative profile and management of breast tuberculosis patients attending a tertiary care hospital. Breast tuberculosis is an uncommon form of tuberculosis. Knowledge of its varied clinical presentation and diagnostic modalities help in diagnosing this easily treatable disease. Retrospective data of 63 consecutive patients with breast tuberculosis was analyzed and information regarding demographic details, clinical presentation, cytology, histopathology and management was noted. Breast tuberculosis is essentially a disease of females (98.41%). 49.20% patients were below 30 years of age and 68.25% were from rural areas. Incidence of tubercular mastitis increases with parity (71.42% with p > 2). Commonest presentation was with painless lump (73%). Nodulocaseous tubercular disease was found in 74.60% patients whereas, 6.3% were of disseminated variety. Primary focus was detected in lungs in 11.1% patients, while 46.03% presented with loco-regional lymph nodes. FNAC was found to be a sensitive tool of diagnosis in 74.60% patients; however 25.39% cases were diagnosed with biopsy. ATT remained mainstay of treatment with surgical intervention as and when required. Breast tuberculosis despite being uncommon is not rare. Although diagnosis is not difficult but one should know where to suspect. Once confirmed treatment outcome is often rewarding.
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Affiliation(s)
- Garima Mehta
- Department of Surgery, R.N.T. Medical College, Udaipur, Rajasthan 313001 India
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15
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Abstract
Tuberculosis of the breast is an uncommon disease even in countries where the incidence of pulmonary and extrapulmonary tuberculosis is high. Clinical presentation is usually of a solitary, ill-defined, unilateral hard lump situated in the upper outer quadrant of the breast. This disease can present a diagnostic problem on radiological and microbiological investigations, and thus a high index of suspicion is needed. Incorporating a highly sensitive technique like polymerase chain reaction (PCR) may be helpful in establishing the usefulness of such technology and can aid in conforming the diagnosis early. The disease is curable with antitubercular drugs, and surgery is rarely required
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Affiliation(s)
- Salim Baharoon
- Department of Medicine, Division of Infectious Diseases, King Abdulaziz Medical City, King Fahad National Guard Hospital, Riyadh, Kingdom of Saudi Arabia.
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16
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Kao PT, Tu MY, Tang SH, Ma HK. Tuberculosis of the breast with erythema nodosum: a case report. J Med Case Rep 2010; 4:124. [PMID: 20429894 PMCID: PMC2873453 DOI: 10.1186/1752-1947-4-124] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2009] [Accepted: 04/29/2010] [Indexed: 11/22/2022] Open
Abstract
Introduction There has been an increasing number of tuberculosis cases worldwide, but tuberculosis of the breast remains rare. In rare cases this is seen with a cutaneous manifestation of erythema nodosum. Case presentation We report the case of a 33-year-old Chinese woman with tuberculosis of the left breast accompanied by erythema nodosum on the anterior aspect of both lower legs. Due to her poor clinical response to conventional therapy, and the histopathological findings of fine needle aspiration cytology, there were strong indications of tuberculosis. Her clinical diagnosis was confirmed by molecular detection of Mycobacterium tuberculosis complex by polymerase chain reaction. The diagnosis was further confirmed by a second polymerase chain reaction test of erythema nodosum which tested positive for Mycobacterium tuberculosis complex. She received anti-tuberculous therapy for 18 months, and finally underwent residual lumpectomy. During her follow-up examination after 12 months, no evidence of either residual or recurrent disease was present. Conclusion Histopathological features and a high index of clinical suspicion are necessary to confirm a diagnosis of tuberculosis of the breast. Anti-tuberculous therapy with or without simple surgical intervention is the core treatment.
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Affiliation(s)
- Pao-Tsuan Kao
- Department of Internal Medicine, Cardinal Tien Hospital, Yongho Branch, Jhongsing Street, Yongho City, Taipei County, Taiwan 234.
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Kapan M, Toksöz M, Bakır ŞD, Sak ME, Evsen MS, Bozkurt Y, Önder A. Tuberculosis of Breast. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2010. [DOI: 10.29333/ejgm/82856] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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18
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da Silva BB, Lopes-Costa PV, Pires CG, Pereira-Filho JD, dos Santos AR. Tuberculosis of the breast: analysis of 20 cases and a literature review. Trans R Soc Trop Med Hyg 2009; 103:559-63. [PMID: 19269000 DOI: 10.1016/j.trstmh.2009.02.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2008] [Revised: 02/06/2009] [Accepted: 02/11/2009] [Indexed: 11/29/2022] Open
Abstract
Tuberculosis (TB) of the breast is a very rare pathology. The clinical presentations of this disease are manifold, often mimicking carcinoma of the breast. We conducted a retrospective analysis of 20 women with TB of the breast receiving care at the mastology clinic at Getúlio Vargas Hospital, PI, Brazil, between 1994 and 2007. The clinical presentation of the disease, the diagnosis and the response to specific treatment were analyzed. Most of the patients were of reproductive age, with the disease affecting the right breast in eleven patients (55%) and the left breast in nine patients (45%). Palpable nodules were present in five patients (25%) and fistulae in 15 (75%). The mean time between onset of symptoms and diagnosis was 7.7 months (range 3-12 months). Skin testing with purified protein derivative of tuberculin was strongly reactive in all patients, six (30%) of whom were breastfeeding. Diagnosis was confirmed by histopathology and all patients were satisfactorily treated with a combination of rifampicin, isoniazid and pyrazinamide. In the present study, TB of the breast presented predominantly as breast abscesses and fistulae and responded satisfactorily to treatment with anti-TB drugs.
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Affiliation(s)
- B B da Silva
- Department of Gynecology, Hospital Getúlio Vargas, Federal University of Piauí, Teresina, PI, Brazil.
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Alzaraa A, Dalal N. Coexistence of carcinoma and tuberculosis in one breast. World J Surg Oncol 2008; 6:29. [PMID: 18318914 PMCID: PMC2268920 DOI: 10.1186/1477-7819-6-29] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2007] [Accepted: 03/04/2008] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The coexistence of breast cancer and tuberculosis is very rare. This can create a dilemma in the diagnosis and treatment as there are no pathognomonic symptoms or signs to distinguish both diseases. CASE PRESENTATION A female patient was seen in the breast clinic for a right breast lump. Clinical examination and investigation confirmed cancer and tuberculosis of the right breast. She underwent right mastectomy and axillary clearance and received chemo and radiotherapy. Unfortunately, she died of wide spread metastases. CONCLUSION The simultaneous occurrence of these two major illnesses in the breast can lead to many problems regarding diagnosis and treatment. Though rare, surgeons, pathologists and radiologists should be aware of such condition.
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Affiliation(s)
- Ahmed Alzaraa
- Department of General surgery, Tameside General Hospital, Manchester, UK
| | - Neha Dalal
- Department of Histopathology, Tameside General Hospital, Manchester, UK
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