Tuberculous Mastitis Research Articles

Nonlactational Mastitis in Western Brazilian Amazon Mastitis Cases.

Chronic mastitis varies in etiology between its lactational and nonlactational forms and can be challenging to diagnose. This study aimed to assess the epidemiological profile and diverse etiologies of nonlactational mastitis in Amazonas, Brazil, focusing on distinguishing between tuberculous mastitis (TM) and idiopathic granulomatous mastitis (IGM). This is a retrospective and prospective study that was carried out at the mastitis outpatient clinic of Fundação de Medicina Tropical Doutor Heitor Vieira Dourado from 2013 to 2021 and evaluated epidemiological data, imaging, and laboratory tests. Descriptive statistics were performed. In this retrospective and prospective analysis, 124 medical records were initially considered, with 12 excluded for various reasons. The remaining 112 cases underwent thorough evaluation through epidemiological data, imaging, and laboratory tests, by employing descriptive statistics for analysis. The pathology revealed a predominant prevalence of IGM (64.3%), followed by various forms of mastitis, including confirmed TM (4.5%), presumable TM (8.9%), and others. Our findings indicate that IGM, though a rare cause of breast masses and abscesses, accounts for a significant portion of mastitis cases. Histopathological studies were essential for diagnosis, with ultrasound being the primary imaging tool. This study is one of the largest Brazilian series on nonlactational mastitis, highlighting the condition's complexity and diverse manifestations in the Amazon region.

Characteristics of primary tuberculous mastitis in tuberculosis endemic country: A case series

Tuberculous mastitis (TM) is a rare form of tuberculosis, occurring as a primary disease when there is no evidence of tuberculosis in other locations. There are no clear clinical features of TM, especially in the absence of a previous tuberculosis infection. Due to its unclear clinical picture, diagnosis is difficult, and it is often confused with breast carcinoma or pyogenic abscesses. The aim of this study was to report our experience and discuss the characteristics and diagnostic modalities in cases of primary TM in a tuberculosis-endemic area. Method A case series study was conducted at the Arifin Achmad Regional Hospital, reporting four cases of primary tuberculous mastitis in January 2024. The patients were women aged 24-41 years. Case presentation All patients presented with complaints of breast pain for the last 2 weeks to 2 months and complained of symptoms in the form of a lump in the breast that was reddish in colour and mastalgia. One patient was diagnosed during pregnancy, and one had a history of prior breastfeeding. One patient presented with FNAB results for breast carcinoma. The other patient complained of an ulcer on her breast. Physical examination revealed axillary lymphadenopathy in all patients. Histopathological examination revealed tuberculous mastitis in all patients and 1 with tuberculous mastitis, fibrocystic changes, and Atypical Ductal Hyperplasia (ADH). Conclusion Patients with tuberculous mastitis who visited our institution had symptoms similar to those of abscesses and breast cancer. The FNAC test is the most reliable, but false-negative results can occur. Diagnosis requires teamwork between the patient’s doctor, anatomical pathologist, and radiologist. This research requires a larger scale to describe actual conditions.

Varied etiology in patients presenting with non-puerperal mastitis: an observational study

Abstract Introduction: The etiology of nonpuerperal mastitis is more diverse varying from infections to autoimmune disorders. Most of them are misdiagnosed as pyogenic mastitis and are treated with routine antibiotics. In this study the various causes of nonpuerperal mastitis which required surgical intervention were evaluated. It was observed that some of the pre-malignant and malignant conditions were also presented as nonpuerperal mastitis. Materials and methods: All non-lactating women who presented with symptoms and signs of mastitis and did not respond to single course of antibiotics (active against staphylococcus) treated in tertiary care Hospital and in private practice of primary author between June 2021 to December 2022 and in those in whom the ultrasound of breast was also suggestive of inflammatory breast disease were included in the study and rest were excluded from study. The final etiological diagnosis of these patients is given by the histopathological examination of tissue taken from the wall of abscess cavity or of breast mass. Results: Total 21 patients were included in the study of which 7 patients had nonspecific infection, 3 patients were diagnosed to have tuberculous mastitis, 3 patients with idiopathic granulomatous mastitis, 2 patients with periductal mastitis, 1 patient with fat necrosis, 3 patients with atypical ductal hyperplasia and 2 patients were diagnosed to have invasive duct cell carcinoma. Conclusion: The etiology of nonpuerperal mastitis is diverse. Not only the benign conditions but premalignant conditions like ADH, DCIS and even invasive carcinoma can present with clinical symptoms and signs of inflammatory breast disease.

Metaplastic Carcinoma Masquerading as Tuberculous Mastitis – An Interesting Case Report

Metaplastic carcinoma is a diverse subgroup of invasive breast cancer (IBC) characterised by differentiation of the neoplastic epithelium into squamous cells and/or mesenchymal-looking components, such as but not limited to spindle, chondroid and osseous cells. [1] The clinical characteristics are comparable to those of ER-negative IBC of no special type (NST), although they are more likely to present at an advanced stage. The aetiology is complicated and doesn't seem to be different from IBC-NST (especially the triple-negative subtype). [2] They account for 0.2-1 % of all IBCs. This variation in prevalence stems from the different definitions of metaplastic carcinoma used by different authors.

A Retrospective Analysis of the Clinicopathological Features of Patients with Tuberculous Mastitis: A Single Institution’s Experience

Introduction: Tuberculosis remains a global health burden, especially in low- and middle-income countries. Breast tuberculosis is a rare disease with minimal research available. This disease produces a diagnostic challenge as the clinical presentation is variable, and diagnosis often requires additional investigations. This study was undertaken to determine the efficacy of cytology and histology, together with ancillary studies, in diagnosing tuberculous mastitis. Methods: This retrospective study was conducted in a Johannesburg Hospital over 5 years. Thirty-two patients with confirmed tuberculous mastitis were included. The patients were considered positive for tuberculous mastitis if histological or cytological findings were confirmed with either a positive tuberculosis culture, Ziehl-Neelsen stain, or polymerase chain reaction examination/GeneXpert. Results: This case series comprises 3 males and 29 females with a mean age of 35.66. A breast mass was the most common presentation. Over these 5 years, more biopsies were performed on inflammatory breast lesions than fine needle aspirations. There was a higher confirmation rate for cytology diagnoses compared to histology diagnoses. Conclusion: This study supports using fine needle aspiration combined with GeneXpert as the primary diagnostic modality in diagnosing tuberculous mastitis. This test combination is advantageous in resource- and financially constrained environments as it is relatively simple to perform, cost-effective, and has a rapid turnaround time.

Mastitis Tuberkulosis Primer

Objectives : Tuberculous (TB) mastitis is an uncommon presentation of TB even in countries where the incidence of pulmonary and extrapulmonary TB is high. It accounts for < 0.1% of all breast pathologies and <2% of all cases of tuberkulosis. Case presentation : A 25-year-old female presented a palpable lump in the upper-outer quadrant left breast, measuring about 3 cm and accompanied by retraction of the adjacent skin. Conclusion : Tuberculous mastitis is a rare and results from direct infection via the breast ducts opening to the nipple or from breast skin abrasions. Breast sonography and fine needle aspiration biopsy have been used for diagnostic of tuberculous mastitis.

Metaplastic squamous cell carcinoma caricaturing as tuberculous mastitis-A vicissitude of clinical diagnostic misadventure

Tuberculous mastitis and invasive breast cancers are known to co-exist or occur in the breast independently of each other, albeit the former being less common in developed countries. Tuberculous mastitis with its clinical presentation and morphological features can caricature invasive breast carcinoma. The overlapping features of tuberculous mastitis and metaplastic squamous cell carcinoma often lead to, if no due clinical diligence and discretion is used, bewildering misinterpretation with the vicissitude of diagnostic implications of tuberculous mastitis ensuing catastrophic and perilous ramifications. A 42-year-old woman presented with exophytic growth with extensive areas of ulceration. Clinically, the lesion was diagnosed as disseminated tuberculous mastitis based on clinical and morphological features, which was surgically resected. On histological examination, the lesion was diagnosed as invasive metaplastic squamous cell carcinoma. Thecase being presented here displays the vagary involved in clinical diagnosis of tuberculous mastitis inasmuch as it often shares clinical and morphological features with a devastatingly perilous variant of invasive duct carcinoma, metaplastic squamous cell carcinoma, the inadvertent eschewing of or misapprehending of which may engender devastating prognostic implications.

Radiological response of non-specific granulomatous mastitis to anti-tuberculous treatment: A single centre study in an endemic nation

BackgroundTuberculous mastitis (TBM), is an uncommon form of extra-pulmonary tuberculosis. Clinical and radiological overlap of tuberculous mastitis with malignancy and other granulomatous conditions, along with its paucibacillary nature, make it a diagnostic challenge. In our study, we aim to assess the radiological response of microbiologically negative granulomatous mastitis cases to anti-tuberculous treatment (ATT) in an endemic country. MethodsEighty-seven cases demonstrating granulomatous lesions on breast biopsy were identified. Of these, 49 patients who were treated with ATT and had at least two serial ultrasound follow-ups were included in our study. Mammogram and ultrasound were used for initial imaging. Subsequently, ultrasound was used for serial follow-up. Mantoux skin test, acid fast staining and histological examination of tissue sample were the other investigations used. ResultsRadiologically, on ultrasound, well-circumscribed hypoechoic masses were noted in 18 patients, followed by ill-defined collections with tubular extensions in 15 cases, abscesses in 8, and a focal heterogeneity in 8 patients. Following ATT, 17 patients showed radiological resolution in 4 weeks, 18 of them at 3 months, and nine of them in 6 months. ConclusionExcellent and prompt radiological response to ATT, indicates the need for a high degree of suspicion for tuberculous mastitis (TBM), in endemic countries, even though microbiological tests may turn out negative.

Inflammatory diseases of the breast.

Inflammatory disorders of the breast are common benign breast conditions. Lactational mastitis occurs in breastfeeding women and may be associated with breast abscess in severe cases. Non-lactational inflammatory disorders are less common and include idiopathic granulomatous mastitis, periductal mastitis, and tuberculous mastitis. While these disorders have some similarities in their presentation, each disorder requires a specific treatment regimen for resolution, and correct diagnosis is crucial for appropriate treatment. In this chapter, we will review the presentation, diagnosis, and management of each of these distinct clinical entities.

A Case Series on GeneXpert Negative Tuberculous Mastitis and the Effect of Anti-tuberculous Treatment

Background: Breast tuberculosis is significant due to its rare occurrence and dilemma in prospective treatment and differentiation from neoplastic lesions. Tuberculosis of the breast usually affects women from Asia, most commonly, the Indian subcontinent and Africa. Tuberculous mastitis has a wide range of clinical presentation, radiological features, and even microbiological presentation. Materials and Method: A prospective study was conducted over 6 months. 40 female patients with varied presentations correlating to tuberculous mastitis with a lump in the breast for a particular period of time were included in the study. Results: The patients’ ages varied from 20 to 45 years. After routine investigations, the patients went in for incision and drainage or incisional biopsy or both and postoperatively their histopathological reports revealed granulomatous breast disease (tuberculous mastitis) with negative GeneXpert (CB-NAAT). Patients were started on an anti-tubercular treatment regimen and showed a progressive decrease in symptomatology. Conclusion: Granulomatous breast abscess/ tuberculous breast abscess has a varied presentation and no fixed treatment regime. Anti-tuberculous drugs in such patients proved to be efficacious in symptomatic relief with prevention of recurrence/ fistula formation.

A review of Imaging Findings of Idiopathic Granulomatous Mastitis

Background: Imaging has an established role in the diagnosis and management of idiopathic granulomatous mastitis (IGM). The main purpose of this article is to explain an imaging-based diagnostic approach for IGM and describe the imaging findings of the disease. Methods: The present article is a narrative review of the literature regarding the imaging of IGM. Results: Ultrasound and mammography are the two commonly used modalities for evaluating IGM patients. Focal asymmetry and irregular high-density mass are the most common mammographic findings. Irregular hypoechoic mass with tubular extensions is a frequent ultrasound finding. Magnetic resonance imaging (MRI) can be used as a complementary modality, but it does not usually change the disease management.. The most important differential diagnosis of IGM includes breast cancer, infectious mastitis, and tuberculous mastitis. There is currently no agreed-upon schedule for the imaging follow-up of IGM patients. Conclusion: The commonly used imaging modalities for the evaluation of IGM include ultrasound with or without mammography. There is currently no consensus on the imaging follow-up of these patients.

Granulomatous mastitis: Think tuberculosis mastitis

Tuberculous mastitis (TBM) is a rare clinical entity and can be challenging to diagnose. The diagnosis of TBM has three essential pillars: clinical examination, radiological evaluations and histopathological sampling.

Tuberculous mastitis in a low-incidence setting: should respiratory physicians be concerned?

Tuberculous mastitis in a low-incidence setting: should respiratory physicians be concerned?

Tuberculous Mastitis: A 7 year Experience in Sir Ganga Ram Hospital; Lahore.

Background: Tuberculous mastitis is a rare clinical entity and it often resembles breast malignancy and pyogenic breast abscess both radiologically and clinically. It usually affects females from the Africa and Indian sub-continent. Aim: To find out the clinical feature, diagnostic criteria and need for surgical intervention in tuberculous mastitis. Methods: Patients with clinical suspicion of breast tuberculosis were subjected to a set of investigations for confirmation and were included in the study. The main diagnostic measures were thorough history and examination. All were subjected to complete blood examination, ESR, Monteux test, ultrasound (for patients aged<40 years), mammogram (for patients aged>40 years), fine needle aspiration cytology andAFB staining. Abscesses were aspirated, lumps greater than 2cm were subjected to true cut biopsy and less than 2cm were excised and histopathology performed on the specimen. Data was recorded in a predesigned proforma and parameters like age, site, size, mode of presentation etc., were recorded along with need of surgical intervention. Results: 264 patients were included with mean age of 31.4.23 patients had bilateral disease. Primary disease was found in 162 patients and secondary in 102. Multifocal disease was found in 45. Mode of presentation was discharging sinus in 115, lump in 61, cold abscess in 60 and non- healing ulcer in 28 cases. Cytology and AFB staining had diagnostic value in 60 cases. Wall biopsy after drainage of abscess 43, true cut biopsy47 and wide local excision biopsy confirmed the diagnosis in 68 patients after the specimen were subjected to histopathology. Even after anti-tuberculous therapy, surgical intervention wasrequired for 171 patients. Conclusion: Tuberculous mastitis may masquerade malignant lesion of breast and poses diagnostic difficulties without histopathological examination. Surgical intervention may be required. Keywords: Tuberculous mastitis; discharging sinus; granulomatous mastitis.

Breast tuberculosis presenting with intractable mastitis: a case report

BackgroundBreast tuberculosis, also known as tuberculous mastitis, is an extremely rare form of tuberculosis. It accounts for <0.1% of all breast diseases and <2% of all cases of tuberculosis. It is often misdiagnosed as breast cancer, which can potentially lead to a delayed diagnosis.Case presentationA 69-year-old Japanese woman presented with a tumor-mimicking lesion in her right breast, followed by intractable mastitis with a fistula formation. The time until the correct diagnosis of tuberculosis of the breast and sternal bone was 14 months.ConclusionsAlthough rare, it is important to recognize that tuberculous mastitis can present as refractory abscesses/mastitis or mass lesions that mimic carcinomas in women of reproductive age and elderly people. Breast tuberculosis should always be considered in the differential diagnoses, particularly in patients with a history of tuberculosis and those living in areas where tuberculosis is endemic.

The utility of fine-needle aspiration cytology in differentiating granulomatous mastitis and tuberculous mastitis

Background: Tuberculous mastitis (TM) is a rare extrapulmonary presentation of tuberculosisaccounting for less than 1% of all diseases of the breast in the industrialized world. GranulomatousMastitis (GM) is an uncommon chronic inflammatory disease of the breast that almost always mimicscancer in young individuals, so it can be a diagnostic dilemma. Aims and objectives: The main aimof this study is to elucidate the utility of FNAC in differentiating granulomatous mastitis andtuberculous mastitis. Materials &amp; Methods: A retrospective observational study was conducted atthe department of pathology, Hindu Rao Hospital, Delhi. Cytology database was revealed for a periodof 4 years (2016-2019). The clinical details wherever available and cytological morphology ofindividual cases were noted and analysed. Results: In our study out of 20 cases 11 cases (55%)were found to be granulomatous mastitis and the other 9 cases (45%) were found to be tuberculousmastitis. All cases were of female patients only, with equal side distribution. In the cytologicalsmears of GM, three (27.3%) smears showed ductal epithelial cells, epithelioid cell granulomas wereseen in 11 (100%) cases and singly scattered epithelioid cells were seen in nine (81.8%) cases.Caseous necrosis was observed only in one case (9.09%) but necrotic material intermixed withdegenerated neutrophils and apoptotic bodies were seen in four cases (36.4%). Conclusion: FNACcan be an accurate method for differentiating tuberculous mastitis from granulomatous mastitis asper cytomorphological findings, along with confirmation by the demonstration of acid-fast bacilli andhence can help to decide the appropriate treatment protocols for such patients.

Primary Breast Tuberculosis Mimicking Carcinomatous Mastitis: A Case Report

The breast is a rare localization of extra-pulmonary tuberculosis, even in highly endemic countries. It is most often primitive. The clinical and radiological features are sometimes misleading. It poses diagnostic problems especially with cancer. We report a case of breast tuberculosis having clinical and radiological presentations as a breast carcinoma. Through this observation and a review of the literature, we provide an update on the epidemiological characteristics and the means of diagnosis of this lesion. It was a 52-year-old woman with inflammatory lump of the left breast, adherent to the skin. Ultrasonography and mammography revealed a homogeneous, poorly demarcated nodule of approximately 4 cm of diameter, classified ACR4. Surgical excision was performed. The histological diagnosis was breast tuberculosis. The diagnosis of tuberculous mastitis is made on bacteriological and pathological examinations. Histological examination helps for diagnostic confirmation while excluding a malignant lesion of the breast.

Primary Tuberculous Mastitis.

Primary Tuberculous Mastitis.

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.

Idiopathic Granulomatous Mastitis and its Mimics on Magnetic Resonance Imaging: A Pictorial Review of Cases from India.

Objectives:Idiopathic granulomatous mastitis (IGM) is a rare inflammatory disease of the breast, which is benign but potentially morbid. Mammographic and sonographic findings have been well characterized, but magnetic resonance imaging (MRI) findings have been less thoroughly documented. The objective of this study was to demonstrate characteristic findings for IGM and its mimics via a retrospective review.Material and Methods:Breast MRI examinations performed at Sir Ganga Ram Hospital in New Delhi, India between 2014 and 2019 were retrospectively reviewed to identify cases in which a pattern suggestive of granulomatous mastitis was seen. Cases of known malignancy were excluded. Any available breast pathology results were then obtained, and cases with presumptive or definitive diagnoses were compiled for analysis.Results:Overall, cases identified with characteristic imaging findings and confirmed diagnosis included seven cases of IGM, four cases of invasive ductal carcinoma, two cases of tuberculous mastitis, one case of non- tuberculous infectious mastitis, one case of foreign body mastitis, and one case of eosinophilc mastitis. One case of IGM with masses rather than of non-mass enhancement was also identified.Conclusion:In our review, cases with clustered ring enhancement were found to have inflammatory, idiopathic, infectious and malignant etiologies. While, these etiologies can only be reliably differentiated on pathology, familiarity with the pattern and an awareness of the differential may lead to decreased morbidity due to delays in diagnosis.