Abstract
Tubercular mastitis is a rare form of extrapulmonary tuberculosis commonly seen in multiparous and lactating women in developing countries. It is a diagnostic challenge and commonly misdiagnosed as breast carcinoma. Tubercular mastitis is paucibacillary, and fine-needle aspiration cytology provides an accurate diagnosis - the presence of granulomas with Langerhans giant cells on histopathological examination warrants empirical treatment with anti-tubercular drugs. We report a case of a 31-year-old Indian female who consulted a local physician with chief complaints of a palpable, tender mass in her left breast, with pain, swelling, and purulent discharge past 15 days. The patient's past medical, surgical, medication history, and family history (concerning tuberculosis) were not significant. Initially, the patient suspected of breast malignancy based upon physical examination, mammography, and fine-needle aspiration cytology but an accurate diagnosis of tubercular mastitis made with repeated histopathological examination. Histopathologic examination of excised material showed granulomas composed of histocytes, Langerhans giant cells, and inflammatory cells. The patient underwent surgical drainage on the left breast and put on the anti-tubercular regimen for 6 months with her child also prescribed isoniazid for 6 months. The patient advised for regular follow-ups.
Highlights
Breast tuberculosis (TB), known as tubercular mastitis (TM), is a rare form of extrapulmonary tuberculosis that was first described in 1829 by English surgeon Sir Astley Cooper (Cooper, 1829)
The incidence of tubercular mastitis is 0.1% of all breast lesions in developed countries, but in developing countries where endemic is high, it reaches 3–4% (De Sousa and Patil, 2011; Gon et al, 2013). It is common in multiparous, lactating women (Dubey and Agarwal, 1968). It presents a diagnostic challenge as it closely mimics breast carcinoma, idiopathic granulomatous mastitis, and bacterial abscesses that may result in misdiagnosis
Histopathological examination of left breast mass showed breast parenchyma with epithelioid cell granulomas composed of epithelioid cells, Langerhans giant cells, central necrosis, diffuse lympho-plasmacytic chronic inflammatory infiltrates with the collection of polymorphonuclear leucocytes
Summary
Breast tuberculosis (TB), known as tubercular mastitis (TM), is a rare form of extrapulmonary tuberculosis that was first described in 1829 by English surgeon Sir Astley Cooper (Cooper, 1829). The incidence of tubercular mastitis is 0.1% of all breast lesions in developed countries, but in developing countries where endemic is high, it reaches 3–4% (De Sousa and Patil, 2011; Gon et al, 2013) It is common in multiparous, lactating women (Dubey and Agarwal, 1968). The left breast showed a painful lump with abnormal discharge. The lump was observed in the upper, anterior, and central quadrant On 26th May 2020, the patient visited NCI with severe pain and redness in the left breast, coupled with anorexia. There were no signs of icterus, pallor, bleeding, pedal oedema, clubbing, and cyanosis Her gynaecologic history was reported as G3P3A0. – Rifampicin (R) – 150 mg – Isoniazid (H) – 75 mg – Pyrazinamide (Z) – 400 mg oral
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