Mammary tuberculosis mimicking breast cancer: a case report

Bilateral breast tuberculosis: A case report

Key Clinical Message

Breast tuberculosis is a rare clinical condition that has the potential to imitate breast cancer or pyogenic abscess. It is crucial to consider this in patients who have resistant breast abscesses or persistent sinuses, particularly in high-risk groups or locations. The main treatment for breast tuberculosis is antitubercular treatment.

Abstract

Bilateral breast tuberculosis is a rare form of the disease that affects breasts. It is most commonly seen in young females, including nulliparous and lactating women. Diagnosis of bilateral breast tuberculosis can be challenging due to its similarity to other breast diseases, such as granulomatous mastitis and breast carcinoma. Patients from high-risk groups and/or endemic locations who present with clinically suspicious breast lumps or refractory breast abscesses should have breast TB taken into consideration in their differential diagnosis. A 24-year-old Ethiopian female presented to the surgical outpatient department with a complaint of bilateral breast pain of 1-year duration associated with a low-grade fever, not associated with chills or rigor. She also has ulceration on the lower part of both breasts. It was followed by pus discharge from the right breast 6 months later. Investigations, including fine needle aspiration cytology, were suggestive of tuberculous mastitis. Later, the patient was treated with antituberculous drugs for 6 months, and the above symptoms subsided. Individuals with breast lesions who do not respond well to antibiotics should be suspected of having breast tuberculosis, especially if they are young and reside in or were born in a nation where the disease is prevalent.

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.

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.

Diagnostic challenges of tubercular lesions of breast

INTRODUCTION:

Tuberculosis (TB) in the developing countries presents with both pulmonary and extrapulmonary manifestations. Breast TB, however, remains a rare presentation. Its importance lies in the fact that it may mimic malignancy or present as inflammatory lump/abscess.

AIMS AND OBJECTIVE:

The aim of the present study is to highlight the importance of breast TB and its diagnostic challenges.

MATERIALS AND METHODS:

It was a retrospective study conducted at a tertiary care hospital, over 2 years between 2013 and 2015 during which eight cases of breast lesions were diagnosed as of tubercular origin.

RESULTS:

Granulomas were seen in five cases while three cases revealed only few epithelioid cells, and necrosis was seen in all cases on fine-needle aspiration cytology. Histopathological evaluation was available in six out of the eight cases, while acid–fast bacilli were positive in three cases, the characteristic granulomas were seen in all the six cases evaluated.

CONCLUSION:

Significance of TB breast lies in the fact that it may masquerade as breast malignancy or pyogenic abscess. India is a developing country where TB is endemic, a high index of suspicion should be expressed in evaluating breast masses, and TB should be considered in the differential diagnosis.

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.

Tuberculosis of the breast: an uncommon presentation of an old disease

Breast tuberculosis (TB) is considered an uncommon disease with an estimated incidence of 0.1% of all breast lesions reported in developed countries. A 53-year-old Caucasian woman, with a medical history of Crohn's disease, previously treated with infliximab for 3 months suspended due to a presumptive diagnosis of TB for which antitubercular regimen was started. Five months after, a painful lump in the left breast was identified by the patient. Mammary ultrasound confirmed left breast nodules and axillary adenopathies. Histology and microbiology of both lesions confirmed breast TB. Molecular drug susceptibility testing in both samples revealed no resistance to first line anti-TB drugs and the regimen was maintained for 1 year, with clinical and radiological improvement. Mammary gland involvement usually results from lymphatic extension and differential diagnosis frequently includes breast cancer or bacterial abscess.

Breast tuberculosis cases rising in Sicily

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Mammary tuberculosis (TM) is an extremely rare condition.

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The differential diagnosis between breast cancer and breast tuberculosis is very important.

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It was possible to identify the Mycobacterium tuberculosis in between nucleic acid probes and PCR.

Introduction

Our work has been reported in line with the SCARE criteria [21].

Mammary tuberculosis (TM) is an extremely rare condition (Khanna et al., 2000 [1]). It has been estimated to be 0.1% of breast lesions examined histologically, but it reaches 3–4% in countries such as India and Africa where the disease shows a high incidence. This disease can present a diagnostic problem in radiological and microbiological investigations, and thus extreme caution is necessary.

Presentation of case

A 26 year-old Eritrean female with a personal history of HIV infection came to our Emergency Department showing generalized limphoadenopathy and weakness in addition to a huge right breast mass. Our examination revealed a tender mass measuring 12 × 10 cm that involved all right breast. Her skin was not erythematous and local temperature was normal. She was painless.

Fine needle aspiration (FNA) showed a milky and greenish shaded fluid.

Conclusions

Nowadays the differential diagnosis between breast cancer and breast tuberculosis is very important, mostly in Italy and in particular in Sicily, where the massive influx of immigrants has compelled physicians to reconsider the presence of !tuberculosis.

Breast Lump: A Rare Presentation of Tuberculosis

Tuberculosis presenting as breast lump is a rare disease. This condition usually occurs in females who are in the reproductive age group. Diagnosis is quite difficult unless prompt investigations are meticulously done. They are often mistaken for malignancy. We report a 19-year-old girl with tubercular breast abscess. The abscess was incised and drained based on fine-needle aspiration cytology and ultrasonography revealed it as pyogenic abscess. Ziehl–Neelsen stain (ZN stain) of the pus sample showed acid-fast bacilli. Now, she has been started on antitubercular treatment.

Idiopathic granulomatous mastitis: A diagnostic and therapeutic challenge

BACKGROUND

Idiopathic granulomatous mastitis is a rare benign breast disease of women of reproductive age. It usually presents as a painful mass. Since the etiology is unclear, directed diagnosis and management is lacking.

METHODS

This is a retrospective chart review of 14 patients, over twelve years (2004-2016), identified through query of pathology findings.

RESULTS

Two asymptomatic patients were diagnosed after oncologic breast resection following neoadjuvant chemotherapy. The remaining twelve patients were young (31.7 years, range 23-43 years), predominantly non-white (50% African/African-American, 36% Hispanic, 7% Asian), pregnant within the last five years (86%), with no prior granulomatous disease. Evaluation included breast imaging, microbial cultures and staining, and biopsy. Treatment included antibiotics (57%), corticosteroids (21%), methotrexate (7%), and/or surgery (71%). Imaging suggests segmental masses, possibly abscess.

CONCLUSION

Granulomatous mastitis is uncommon, and difficult to diagnose and manage. We review our experience, the literature, and propose an algorithm for diagnosis and management.

Clinical, diagnostic and therapeutic management of patients with breast tuberculosis: Analysis of 46 Cases

Breast tuberculosis is a rare form of extrapulmonary tubercular infection. Our aim is to highlight the nonspecific clinical presentations, diagnostic difficulties and therapeutic approaches of mammarian tuberculosis. Forty-six patients diagnosed with breast tuberculosis between 2005 and 2015 were reviewed retrospectively. Clinical features, all diagnostic methods, and the outcomes of treatment were analysed. All cases were female with a mean age of 36.4 years. Breast mass and pain were the most common complaints. While 34.8% of the cases had a physical examination with suspicions for malignancy, 43.5% of the patients had Breast Imaging Reporting and Data System (BI-RADS) 4 or 5 lesions suggested malignancy radiologically. Definitive diagnosis was based on histopathologic examination through core needle biopsy (n = 29), excisional biopsy (n = 12), and open biopsy (n = 5) taken from the abscess wall during drainage. Standard antiTB therapy for 6 months was given to all cases. Thirty-three patients recovered with standard 6-month therapy while extended treatment for 9-12 months was needed in 13 (28.2%) cases. Surgery was carried out in 17 cases. Two patients developed recurrence. Breast tuberculosis can be easily confused with breast cancer, suppurative abscess, and other causes of granulomatous mastitis, both clinically and radiologically. A multidisciplinary approach is required to prevent diagnostic delays and unnecessary surgical interventions. Although antiTB therapy is the mainstay treatment of breast TB, surgery is usually indicated in patients refractory to medical treatment.

Mycobacterium bovis DNA detection in colostrum as a potential indicator of vaccination effectiveness against bovine tuberculosis

Bovine tuberculosis (bTB) remains a problem on many dairy farms in Mexico, as well as a public health risk. We previously found a high frequency of Mycobacterium bovis DNA in colostrum from dairy cows using a nested PCR to detect mpb70. Since there are no reliable in vivo tests to determine the effectiveness of booster Mycobacterium bovis BCG vaccination against bTB, in this work we monitored M. bovis DNA in colostrum by using this nested PCR. In order to decrease the risk of adverse reactions in animals likely containing viable M. bovis, a single application of BCG and a subunit vaccine (EEP-1) formulated with M. bovis culture filtrate proteins (CFP) and a copolymer as the adjuvant was performed in tuberculin skin test-negative cattle (TST(-)), while TST reactor animals (TST(+)) received EEP-1 only. Booster immunization using EEP-1 was applied to both groups, 2 months after primary vaccination to whole herds and 12 months later to lactating cows. Colostrum samples were collected from 6 farms where the cows were vaccinated over a 12-month period postvaccination and, for comparison, from one control farm where the cows were not vaccinated with comparable bTB prevalence. We observed an inverse relationship between the frequency of M. bovis DNA detection and time postvaccination at the first (P < 0.001) and second (P < 0.0001) 6-month periods. Additionally, the concentration of gamma interferon (IFN-γ) was higher in mpb70 PCR-positive colostrum samples (P = 0.0003). These results suggest that M. bovis DNA frequency in colostrum could be a potentially useful biomarker for bTB vaccine efficacy on commercial dairy farms.

Breast tuberculosis: Diagnosis, management and treatment

INTRODUCTION

Mammary (breast) tuberculosis is a rare manifestation of extra-pulmonary localization of the disease which accounts for less than 0.1% of breast conditions in developed countries, but reaches 3-4% in regions where the disease presents with high incidence (India, Africa). It appears mostly in women of reproductive age, multiparous, lactating. It has been scarcely reported to infect male patients, mainly before puberty, as well as women of older age. The most common presentation is that of a tumor in the middle or upper-outer quadrant of the breast, with multifocal involvement being rarely documented. The differential diagnosis includes breast cancer and abscess formation.

PRESENTATION OF CASE

We report a case of breast tuberculosis that was treated in the Breast Unit of our hospital. Differential diagnosis, imaging methods, operative diagnostic approach and surgical treatment, histological verification of the disease and further therapeutic management are described.

DISCUSSION

High risk population is identified, primary and secondary disease is described and clinical presentations are analyzed. Evaluation of diagnostic workup and limitations are reported.

CONCLUSION

In accordance with the present worldwide revival of the disease, mainly because of massive numbers of migrating population, this subject is reviewed, reminding us of a rather uncommon clinical entity.

Mastitis: comparative etiology and epidemiology

Mastitis is broadly defined as the inflammation of the mammary gland; however, the concept of mastitis is customized to address its social and clinical impact in the case of humans and the health, welfare, and economic consequences for other mammals. There are many microbial, host, and environmental factors that influence the development of mastitis. Some are common to all mammals as well as inherent to each species. Together these factors influence the most prevalent etiological agents for each species and might determine the possibility of interspecies transmission with its consequences to public health. The present review will summarize and compare reports on mastitis etiology and its epidemiology in humans and food animal species.

Secondary tuberculosis of breast: case report

Tuberculosis of breast is a rare disease which is difficult to differentiate from carcinoma of breast. The involvement of breast can be primary or secondary to some focus in body. A case of secondary tuberculosis of right breast in a 21-year-old female from Kashmir, India, is being reported. Presentation was as a painless discharging sinus of right breast. A tubercular foci of rib was the affecting source of disease. No other evidence of tuberculosis was present in the body. Resection of involved rib segment, along with the discharging sinus, was performed. The patient had antitubercular therapy for 9 months, with no recurrence seen in followup.

Tuberculosis and malignancy

BACKGROUND

Tuberculosis (TB) and malignancy represent global threats claiming millions of lives and inflicting formidable suffering worldwide. Surprisingly, the pathophysiological and practical implications of their co-existence have received little attention.

METHODS

Therefore, we sought to review the available literature on the field and identify data regarding the association between TB and malignancy in order to highlight the neglected aspects of this association and probably derive clinically useful information. We searched PubMed up to June 2008 for case reports, case series, non-comparative and comparative studies that were written in English and reported data on the occurrence of both TB infection and a neoplastic disorder in the same patient(s). The development of mycobacterial infections in patients with immunocompromized conditions is well known and was considered outside the scope of this review.

EVIDENCE SYNTHESIS

The synthesis of the available evidence enabled us to establish three different types of association between malignancy and TB: (i) the development of cancer on the background of a previous tuberculous infection; (ii) the concurrent existence of TB and malignancy in the same patient(s) or clinical specimen(s); and (iii) the diagnostic challenges arising from the multi-faceted presentations of these two disorders.

CONCLUSION

We conclude that clinicians need to be aware of the protean manifestations of TB and cancer and maintain a high index of suspicion for simultaneous and/or misleading presentations. In addition, further research is required to determine if a tuberculous infection, being similar to other chronic infections and inflammatory conditions, may facilitate carcinogenesis.