Breast Tuberculosis Research Articles

1647. Breast Tuberculosis: A Diagnostic Challenge

BackgroundBreast tuberculosis is a rare disease accounting for less than 0.1% in developed countries and 3-4% in high incidence regions. Its diagnosis remains challenging as it closely mimics breast cancer and abscess. We aimed to study the epidemiological, clinical and therapeutic features of breast tuberculosis.MethodsWe conducted a retrospective study including all patients hospitalized in the infectious diseases department for breast tuberculosis between 2000 and 2018.ResultsWe enrolled 17 women with a mean age of 40 ±12 years. Nine patients came from rural area (52.9%). Two patients (11.7%) had a history of tuberculosis. None of our patients had a family history of tuberculosis, nor breast cancer. The duration of symptoms varied from one month to a year. At the time of diagnosis, three patients were pregnant (17.6%) and one patient (5.8%) was lactating. The most common clinical symptoms were mastalgia (88.2%), palpable breast lump (88.2%) and fever (76.5%). The average size of the breast lump was 5 ±2 cm. Eight patients (47%) had associated signs of inflammation, 11 patients had axillary lymphadenopathy (64.7%) and four patients had nipple discharge (23.5%). The diagnosis was confirmed by histopathological proof in 14 cases (82.4%) and bacteriological proof in three cases (17.6%). The tuberculin skin test was positive in 10 cases (58.8%). The mean duration of antitubercular therapy was 10 ±1 months. Excision of the mass were indicated in 10 cases (58.8%) and a mastectomy in 2 cases (11.7%). Two cases of relapse were noted (11.7%).ConclusionBreast tuberculosis should be suspected in front of breast abscess or inflammation with poor response to antibiotic treatment, especially in patients from endemic countries.Disclosures All Authors: No reported disclosures

Mammary Tuberculosis in Male

Mammary Tuberculosis is rare, with an incidence of 4% of all breast diseases in TB endemic countries. The clinical presentation can be non-specific and may mimic malignancy of the breast. Tis is a case report of a middle-aged male patient presenting with an ulcerated lump of the breast, diagnosed as mammary tuberculosis. Breast tuberculosis is extremely rare in males. The clinical presentation is varied and a high index of clinical suspicion is extremely essential for diagnosis with confirmation by cytology and histology. Anti-tubercular treatment (ATT) is the mainstay of treatment, with surgery being required in few indicated cases

A rare case of tuberculous mastitis mimicking breast carcinoma

There have been an increasing number of tuberculosis (TB) cases worldwide, but TB of the breast remainsrare. In rare cases, this is seen with a cutaneous manifestation of erythema nodosum. We report the case ofa 33-year-old woman with TB of the left breast accompanied by erythema nodosum on the anterior aspectof both lower legs and dorsum of feet. Due to her poor clinical response to conventional therapy, and thehistopathological findings of fine-needle aspiration cytology with epithelioid granuloma with caseation,there were strong indications of TB. She received antituberculous therapy (ATT) for 6 months. Duringher follow-up examination after 6 months, no evidence of either residual or recurrent disease was present.Histopathological features and a high index of clinical suspicion are necessary to confirm a diagnosis ofTB of the breast. ATT with or without simple surgical intervention is the core treatment.

Features of breast tuberculosis determined by ultrasound imaging: report of 45 cases.

ObjectiveThis 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.MethodsWe 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.ResultsThe 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).ConclusionBTB 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.

Study of spectrum and clinical profile of benign breast disease in the rural area: is there any change

Background: Recent understanding of pathophysiology and health awareness may have impact on spectrum of benign breast disease (BBD) in rural area. We have analyzed clinical data of 88 cases of BBD for spectrum and clinical profile to compare with present studies.Methods: Clinical records of 88 cases of BBD were reviewed for demographic details, clinical presentation, management and outcome. Recent literature related to BBD in rural area was searched using various search engines. Results of our study were compared with recent studies.Results: Fibroadenoma (FA) was most common condition followed by fibrocystic disease. BBD were common in third decade 46 (52.3%). Lump was present in 87 cases. Lump was painful in 45 (52.3%), and associated with fever in 15 (17.1%) cases. Fine needle aspiration cytology and ultrasound was done in 70 and 32 patients in which diagnostic accuracy with histopathology was seen in 69.7% and 56.2% respectively. Surgical treatment included lumpectomy, lump excision, mastectomy, drainage with debridement and axillary clearance. Three patients of breast tuberculosis were treated with 9 months AKT. When compared with recent studies, over all spectrum was same expect chronic abscess presenting as lump was more in our series.Conclusions: Our study revealed benign neoplasms, inflammatory condition and tumor like lesions in 43.1%, 14.6% and 13.8% cases respectively. FA was the most common lesion. BBD were common in third decade. Except the chronic mastitis, incidence of various types of benign lesions was comparable with those found in other studies. There is not much change in overall spectrum of benign breast disease.

Primary Malignant Melanoma of the Breast in the Axillary Tail of Spence: a Rare Case Report

Malignant melanoma is an aggressive tumor of melanocytes. This is a rare occurrence in breast, accounting for less than 0.5% of the total breast tumors. A 42-year-old woman presented with complaints of a lump with ulceration of the overlying skin near the lateral part of the left breast. The differential diagnosis was made as carcinoma left breast or tubercular breast with axillary lymphadenopathy. Core needle biopsy was suggestive of malignant melanoma. She underwent wide local excision with level three axillary lymph node dissection. The final histopathological diagnosis confirmed primary malignant melanoma of breast and ipsilateral axillary lymph node involvement. Primary malignant melanoma of breast in the axillary tail of Spence is a rare entity and can present as axillary mass. It has mimics as a primary breast carcinoma or tuberculosis of breast clinically and morphologically, becomes a diagnostic dilemma to the surgeon and the pathologist.

MICROBIOLOGICALLY PROVEN CASE OF PRIMARY BREAST TUBERCULOSIS

Tuberculosis (TB) of the breast is an uncommon presentation of extrapulmonary TB, it is uncommon even in countries where the incidence of pulmonary and extrapulmonary TB is high and its diagnosis is challenging due to non-specific clinical and imaging findings and often misdiagnosed as abscess or carcinoma. It is mainly diagnosed on the basis of histopathological examination. We have reported a case of primary TB of breast diagnosed by microbiological investigations. A 19-year-old female presented with a painful lump in the breast for the past 3 months. Primary breast TB was diagnosed by sample collect by fine-needle aspiration cytology, wherein Ziehl–Neelsen stain for acid-fast bacilli and cartridge-based nucleic acid amplification test were positive. The patient received antitubercular drugs and at 4 months follow-up, the swelling had resolved and the patient was asymptomatic.

Imaging and clinical features of breast tuberculosis: a review series of 62 cases

To outline the disease burden of breast tuberculosis (TB) as a quantitative analysis amongst three tertiary hospitals in South Africa, with correlation to their clinical, demographic, and imaging features. A retrospective analysis was undertaken over an 18-month period (01/01/2017-30/06/2018) of all patients undergoing laboratory investigations for breast disease at the mammography departments of these three tertiary centres. The prevalence of breast TB was 2.5% (n=62) of 2,516 patients. The median age of presentation was 38.5 years (interquartile range [IQR] 33-45). HIV status was known in 45 patients, of whom 36 were HIV infected (80%, 95% CI: 0.65-0.90, p<0.0001). Based on the ultrasound and/or mammogram findings, the patients were classified into five categories: TB breast abscess (40.3%), inflammatory/disseminated (24.2%), isolated TB lymphadenitis (22.6%), nodular (11.3%), and sclerosing form (1.6%). Histology demonstrated necrotising granulomatous inflammation in 57 cases (92%). Acid-fast bacilli (AFB) were positive in 8.1% (n=5) of the cytology and 16.1% (n=10) of the histology specimens. Culture for Mycobacterium tuberculosis was positive in 27% (17 cases), and in 12.9% (n=8). AFB were detected histologically using polymerase chain reaction (PCR) testing. Knowledge of the varied clinical and radiological features is necessary to maintain a high degree of suspicion to prevent misdiagnoses, inappropriate management, and complications. Ultrasound-guided core biopsy rather than fine-needle aspiration (FNA) is advocated as the first-line intervention in diagnosing or excluding this disease, as it yields a better tissue sample and more often a positive diagnosis.

BREAST TUBERCULOSIS-A RARE PRESENTATION OF COMMON DISEASE WITH DIAGNOSTIC AND THERAPEUTIC CHALLENGE.

Background: Breast tuberculosis is a rare extra pulmonary tuberculosis presentation usually misdiagnosed as carcinoma, pyogenic abscess or idiopathic granulomatous mastitis. Detection of tubercular bacilli by ZN stain, culture and CBNAAT along with caseating granuloma on histopathology helps in diagnosis.&#x0D; Aims and Objectives: To study the clinico-pathological characteristic of breast tuberculosis and diagnostic accuracy of CBNAAT for early and specific diagnosis in reference to histopathological test&#x0D; Material and Methods: 38 cases of BTB between August2012 to July 2017 were studied. Culture for acid-fast bacilli, smear positivity on Z-N staining, CBNAAT, and cytological and histological examination was done for confirmation.&#x0D; Results: Prevalence of BTB in this study was found to be 3.95% .The risk factors were reproductive age (20-35), multiparity, lactation and low socioeconomic status. Unilateral lump in the upper outer and central quadrant of the breast was the commonest observation. Only 34.2% were diagnosed provisionally as BTB rest 73.68% were misdiagnosed as fibroadenoma, breast abscess and malignancy Clinically nodulo-caseous variety(55.6 %) disseminated (18.4%) and tubercular abscess (26.3%) were seen. Sensitivity of ZN staining, culture, FNAC and histopathology is 15.8%,5.8%, 74% ,100%respectively. Sensitivity, specificity, positive predictive value, and negative predictive value for the CBNAAT test were 81.818%, 93.103%, 93.10%, and 81.82% respectively.39.4% were cured completely with ATT with 60.52% with residual lesions needed surgery&#x0D; Conclusion: This study highlights the importance of early diagnosis and aggressive medical and if required surgical management to cure this disease. CBNAAT should be used as an additional test to conventional smear microscopy, culture, FNAC and histology.&#x0D; Keywords: Breast tuberculosis, CBNAAT, Extrapulmonary tuberculosis, breast lump

Pulmonary and breast tuberculosis in man: an unusual association

Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis usually involving the lung parenchyma and hilar lymph nodes. Extra-pulmonary involvement is seen in 20% of all TB cases. TB of the breast is an uncommon disease, particularly in men. Tuberculous mastitis is a rare form of extrapulmonary tuberculosis, the first case of breast TB was reported in a woman in 1829, but the first detailed description of the disease was only made by the end of the 19th Century. The first case of breast TB in a man was reported about a century later in 1927, and by 1945 there were only 21 known cases of breast TB in men. It is generally believed that the infection of the breast is usually secondary to tuberculous foci elsewhere in the body, which may or may not be clinically apparent. In this case report, we describe pulmonary and mammary tuberculosis in immunocompetent male patient.

Idiopathic granulomatous mastitis in a pregnant woman

Introduction: Idiopathic granulomatous mastitis (IGM) is a rare inflammatory breast disease of unknown etiology. It was described in 1972 by Kessler and Wolloch, who reported cases of granulomatous lobulitis with no established relationship with trauma, foreign body, or specific infection. This study aimed at reporting a case of IGM in a pregnant patient. Clinical case: A 36-year-old pregnant woman, with a gestational age of 27 weeks, was admitted with a complaint of right breast pain for 7 days. She denied comorbidities. Clinical examination showed a dense area in the junction of the right inner quadrants, associated with mild hyperemia without signs of fluctuation. Lymphadenopathy was not identified. Ultrasound revealed a non-homogeneous fluid of 4.9x1.7x5.2 cm in the right upper inner quadrant, with a consequent surgical approach and collection of fragments for analysis. Cultures with antibiogram and for fungi and the venereal disease research laboratory (VDRL) tested negative. Histopathological examination showed a chronic inflammatory process with abundant granulation tissue and isolated giant cells, suggesting granulomatous mastitis. Corticosteroid therapy was indicated after the birth, with prednisone 40 mg/day for 3 months, with complete resolution of the symptoms. Discussion: Usually, IGM affects women aged 17 to 42 years. Recent history of pregnancy is common, with identified cases ranging from 2 months to 15 years after the last delivery, rarely occurring during gestation. It manifests as a breast mass of 0.5 to 9 cm in diameter, often unilateral and on the left side. Signs of inflammation and local lymphadenopathy can also be identified. Mammography is not ideal for detecting IGM, with findings of low specificity, and false negatives are frequent in dense breasts. The most frequent ultrasound findings are irregular hypoechoic mass and tubular hypoechoic lesion. IGM can be confirmed by detecting a histological pattern of chronic granulomatous lobulitis, non-caseating granuloma with infiltration of histiocytes, few polymorphonuclear cells, and multinucleated giant cells. Ruling out syphilis, fungi, and breast tuberculosis is important. The recommended treatment is excisional biopsy, preferably a wide excision. However, surgical management has a negative cosmetic impact and is associated with up to 50% of cases of persistence and recurrence of the disease, in addition to complications such as abscesses, fistulas, and ulceration. Corticosteroids are an effective option for controlling the disease, but active surveillance can also be chosen. Considering the above, we underline the importance of early diagnosis with appropriate scientific and technical foundations to provide a better prognosis for patients.

Tuberculosis of the breast: analysis of 17 cases.

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.

Primary Tuberculous Mastitis

Background: Tuberculous mastitis is a rare entity in patients with mammary diseaseeven in countries where incidence of tuberculosis is high. In Bangladesh, TB is anendemic disease but breast tuberculosis is rarely reported. Its clinical patterns andtreatment strategies are changing day by day.&#x0D; Objective: To analyze the clinical presentations , diagnosis and treatment of tuberculousmastitis&#x0D; Methods: This is a prospective nonrandomized descriptive study to analyze clinicalpresentations, diagnosis and treatment of hundred (100) cases received care for tuberculousmastitis at the Chest Disease Hospital, Rajshahi, from July' 2012 to July' 2016.Diagnosis was made in all patients by cytological examination from suspected lesions,which revealed typical tuberculous lesions. Patient with some atypical presentationsand doubts in the diagnosis needed histopathological examination and Gene x-pert testto exclude idiopathic granulomatous mastitis and concomitant malignancy.&#x0D; Results: Most of the patients were within reproductive age. The disease affecting theright breast in fifty six patients (56%), left breast in forty three patients (43%) andbilateral in one patient (1%). Palpable lump were present in eighteen patients (18%),chronic discharging sinus with or without lump in thirty four (34%) and breast abscesswith or without discharging sinus in eighteen patients (18%),recent abscess drainagescar with lump in thirty patients(30).Medical therapy with anti-tubercular drugs ranging from 9 to 12 months with follow upmonthly was the mainstay of treatment. Surgical intervention reserved for selectedrefractory cases. Extension of anti-tubercular therapy from 9 to 12 or 18 monthsrequired in fifty-eight(58) patients on the basis of slow clinical response. Completeresolution obtained in 92 patients but residual tiny mass in eight patients confirmed byrepeated FNAC to be fibrotic.&#x0D; Conclusion: Treatment is simple but high index of suspicion is the cornerstone fordiagnosis.&#x0D; Journal of Surgical Sciences (2017) Vol. 21 (1) :19-23

Breast Abcess and Tuberculosis and its Diagnostic Challenges: A Two-Year Prospective Study in Karachi, Pakistan

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.

Breast tuberculosis in East London: A 13‐year retrospective observational study

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 highincidenceof TB. To characterize presenting features and avoidable diagnostic delayin breast TB patients. We conducted a 13-year retrospective study of breast TB patients treated at our institution including demographic, clinical, microbiology, and pathology data. Forty-seven cases were included; 44 (94%) were female, with a median age of 33years (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. A high index of suspicion for TB is required for individuals presenting with breast symptoms from countrieswhere TB is endemic. Development of standardized pathways may improve detection and management of breast TBmay reduce diagnostic delay.

Tuberculous mastitis: A review of 32 cases

BackgroundBreast 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. MethodsA retrospective study was conducted over a 10-year period. Thirty-two consecutive patients diagnosed with tuberculous mastitis were included. ResultsThere 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. ConclusionsBreast 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.

Breast Tuberculosis in Women: A Systematic Review.

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.

Primary tuberculosis of male breast: A rare case presentation

The primary tuberculosis of breast is a rare disorder which can be mistaken for pyogenic or neoplasm’s of the breast. We are reporting a case of 60 year old male who presented with a swelling in right breast. Surgeons made a diagnosis of Breast abscess,? Neoplasm and Radiologist gave a diagnosis of breast abscess.FNAC of the swelling revealed granulomatous mastitis with superadded acute inflammation. Keywords: Breast, FNAC, Abscess, Swelling, Tuberculous mastitis.

Primary tuberculosis of the breast: a diagnostic dilemma

Primary tuberculosis of the breast is a rare disease, despite the high prevalence of pulmonary and extra-pulmonary tuberculosis in disease endemic countries. The diagnosis of primary breast tuberculosis is challenging due to it’s non-specific clinical and imaging findings. Lesions of tuberculosis such as nodular mastitis, disseminated mastitis, and sclerosing lesions clinically mimic fibroadenoma, carcinoma, and fibrocystic changes, depending on the mode of presentation. We report a case of primary tuberculosis of breast, she presented with breast lump. The diagnosis was confirmed on histopathology after wide excision of the lump. The patient recovered uneventfully and was discharged on antitubercular therapy for 9 months with follow-up protocol. The primary tuberculosis of the breast presents with a diagnostic dilemma for the surgeons. A high index of suspicion for tuberculosis is needed in diseases endemic countries, especially in the Indian subcontinent.

Extrapulmonary Tuberculosis Presenting as a Suspected Case of Metastatic Breast Cancer.

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 POINTSExtrapulmonary 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.