Breast tuberculosis: a diagnosis not to be forgotten

Abstract

Objective: To study the clinical characteristics and imaging features of breast tuberculosis (TB) and to describe treatment. Material and Methods: A retrospective study including all patients hospitalized in the infectious diseases department for breast TB between 1997 and 2018. Results: Twenty-two women, with a mean age of 39±12 years, were identified. In total, 18 patients were multiparous (81.8%). Both lump and mastalgia were the presenting symptoms in 19 cases (86.3%). Ipsilateral axillary lymphadenopathy was noted in 14 cases (63.6%). The most common finding on ultrasound was a well or poorly defined mass lesion, noted in 17 cases (77.2%), followed by fistulous tracts in seven cases (31.8%). Mammography showed focal, asymmetric breast density in 17 cases (89.5%) and diffuse in two cases (10.5%). The diagnosis was confirmed based on the presence of epithelioid cell granulomas and caseous necrosis in 13 cases (59.1%). Patients received antitubercular therapy for a mean duration of 11±5 months. The disease evolution was favorable in 20 cases (91%). There were two relapsing cases (9%). Conclusion: Breast TB should be considered in the differential diagnosis of young patients presenting with palpable lump with axillary lymphadenopathy, especially in endemic regions. The diagnosis confirmation usually requires an excision biopsy providing histological or bacteriological evidence.

Breast Tuberculosis: Case report and review literature

“…Since it provides a sterile atmosphere for the survival and proliferation of bacilli, such as spleen and skeletal muscle, through the two immune modalities, innate by the macrophage that phagocytoses the bacilli and cell-mediated T4 lymphocytes through the cytokines they produce (Bouziyane et al, 2020;Haitz et al, 2019). This resistance explains the difficulty of diagnosis and the rarity that Breast Tuberculosis (BTB) presents, commonly affecting young, multiparous and lactating women (Hammami et al, 2021;Fatima & Naz, 2019). This may be due to physiological changes in the breast during the breastfeeding period, when the breast is susceptible to infections and trauma, i.e.…”

“…Breast tuberculosis represents 2% of extra-pulmonary tuberculosis, 3.5% in a case series study (Darré et al, 2017). A study that included 65 cases of breast TB reported a rate of 10.6% of lactating patients (Hammami et al, 2021). From 1995 to 2016, 28 cases of breast tuberculosis were recorded, of these 28, 26 women and 2 men with an average age of 34.2 ± 0.3 years and 63.9% were HIV positive (Sinha & Rahul, 2019).…”

“…More recent studies show that fine needle aspiration cytology (FNAC) has a good diagnostic rate, exceeding the 73% of patients actually diagnosed by this method. The other 27% required an incisional biopsy due to ulcers (Ail, 2017;Hammami et al, 2021;Kiliç et al, 2021).…”

“…The basis of treatment remains anti-tubercular therapy for a period of six months. To avoid recurrence, or when the cynical response is time-consuming, a prolonged duration of treatment has been reported, because the best medications for breast tuberculosis are: Etambutol 800 mg, Pirazinamide 1500mg, Rifampicin 450mg and Isoniazid 300mg (Hammami et al, 2021;Bouziyane et al, 2020). In addition, some clinical cases are reported that require prolongation of treatment up to 18 months, due to poor clinical response.…”

“…Therefore, clinical and radiological characteristics seen in breast TB can simulate other pathological conditions such as pyogenic breast abscess or breast neoplasms. Due to these characteristics, breast TB is often diagnosed late, which added to the low clinical suspicion and similarity with other diseases, makes the diagnosis challenging even in regions endemic for the disease (Bhat et al, 2019;Murat Kılıç et al, 2016;Hammami et al, 2021). The diagnosis of Breast Tuberculosis may include a triple evaluation by a specialized surgeon, a radiologist and a pathologist.…”