Tubercular mastitis - a great masquerader

Sonia Gon,Soumya Kundu,Bipasa Majumdar,Aditi Bhattacharyya

doi:10.5146/tjpath.2013.01150

Abstract

Tubercular mastitis is a rare clinical entity as mammary gland tissue, like spleen and skeletal muscle, offers resistance to the survival and multiplication of the tubercle bacillus. Tuberculosis of the breast can mimic carcinoma, whereas in young patients it can be mistaken for a pyogenic breast abscess, thus labeled a "great masquerader" in recognition of its multifaceted presentation. Breast tuberculosis commonly affects women in the reproductive age group, between 21 and 30 years, and is rare in prepubescent females and elderly women. Fine needle aspiration cytology is very useful and it is a promising technique in expert hands. In tuberculosis-endemic countries, the finding of granuloma on fine needle aspiration cytology warrants empirical treatment for tuberculosis even in the absence of positive acid-fast bacilli and without culture results. We hereby report a case of tubercular mastitis in a post-menopausal seronegative female diagnosed on fine needle aspiration cytology with a positive acid-fast bacilli and a review of the recent literature.

Highlights

Tuberculosis of the breast has been labeled a “great masquerader” in recognition of its multifaceted presentation [1]
We hereby report a case of tubercular mastitis in a postmenopausal female diagnosed on Fine needle aspiration cytology (FNAC) with a positive acid-fast bacilli (AFB) and review of the recent literature
Based on the FNAC diagnosis, the patient was put on anti tubercular therapy and the swelling greatly reduced in size after the one-month follow-up period

Summary

INTRODUCTION

Tuberculosis of the breast has been labeled a “great masquerader” in recognition of its multifaceted presentation [1]. It comprises approximately 0.025% to 0.1% of all surgically treated diseases of the breast in western countries and between 0.64% and 3.59% of all mammary conditions in India [2,3]. The finding of granuloma in FNAC warrants empirical treatment for tuberculosis even in the absence of positive acid-fast bacilli (AFB) and without culture results [5]. We hereby report a case of tubercular mastitis in a postmenopausal female diagnosed on FNAC with a positive AFB and review of the recent literature. Ziehl-Neelsen staining of the aspirate was positive for acid fast bacilli (Figure 2). Based on the FNAC diagnosis, the patient was put on anti tubercular therapy and the swelling greatly reduced in size after the one-month follow-up period

DISCUSSION

Findings

Cooper AP