Mastitis crónica granulomatosa tuberculosa. Diagnóstico y tratamiento en 28 casos

Abstract

ObjectivesTo explore the clinical features of tuberculous granulomatous mastitis (TGM), the diagnostic utility of complementary tests, and the results of treatment in a geographical area with a high incidence of tuberculosis. Material and methodsA descriptive, prospective study was performed from January 2010 to May 2012. The diagnosis of tuberculous mastitis was established by identification or culture of Mycobacterium tuberculosis, or by molecular studies (polymerase chain reaction) after Tru-cut biopsy. We also included those patients with granulomatous mastitis without detection of Koch bacillus but who were intense reactors (≥15mm) after inoculation of purified protein derivative. Tuberculosis treatment was administered in the first 2 months with 600mg of rifampicin, 300mg of isoniazid, 1,500mg of pyrazinamide, and 1,200mg of ethambutol. Subsequently, twice-weekly treatment with 800mg of isoniazid and 600mg of rifampicin was administered for 4 months in those patients with total resection of the lesion and for 7 months in patients who did not undergo resection. ResultsWe included 28 patients. Mammography was performed in 12 patients (42.8%). The lesions were classified as BIRADS 0 (33.3%), BIRADS III (16.7%) and BIRADS IV (50%). Breast ultrasound was performed in all patients. Purified protein derivative was performed in 27 patients (96.4%); 53.6% were intense reactors and 25% were clear reactors. TGM diagnosis was made by histopathology in all patients. Complete lumpectomy was performed prior to the start of tuberculosis treatment in 24 patients (85.8%). There were no recurrences in any of the TGM patients. ConclusionsDue to the low accuracy of imaging techniques, the definitive diagnosis of TGM should be made by histopathological study. In all patients, cure was achieved with the use of oral tuberculosis treatment together with surgery.