Diagnostic challenges of tubercular lesions of breast

Abstract

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.

Cystic neutrophilic granulomatous mastitis: an update

“…Histologically, TB mastitis shows necrotising or non-necrotising granulomas composed of epithelioid histiocytes, Langhans-type giant cells, eosinophils, lymphocytes and plasma cells commonly affecting ducts rather than lobules 56 58. Ziehl-Neelsen staining, culture or PCR can be used for establishing the diagnosis 59 60. Other unusual pathogens that can cause granulomatous mastitis include Bartonella henselae 61 62, atypical mycobacteria,63–65 Actinomyces ,66 Brucella ,67 fungi68 69 and parasites 70–73.…”

An unusual presentation of breast tuberculosis: A case report

“…In a recent study conducted in India, an endemic area for TB disease, eight patients with different PBT lesions were analyzed. At the physical examination, they presented lesions including firm nodules and skin erythematous induration, with clinical impression of an abscess, or fibroadenoma, or cancer, highlighting PBT diagnostic challenges 7 …”

“…At the physical examination, they presented lesions including firm nodules and skin erythematous induration, with clinical impression of an abscess, or fibroadenoma, or cancer, highlighting PBT diagnostic challenges. 7 Regarding the radiological aspect, no specific mammographic signs of mammary tuberculosis are individualized. At ultrasonography often appears as a hypoechoic/ anechoic, heterogeneous image well or poorly limited with minimal posterior reinforcement.…”

Breast Tuberculosis-a Rare Presentation of Common Disease With Diagnostic and Therapeutic Challenge.

“…Fine needle aspiration cytology (FNAC) is the most common tissue diagnostic method with 43-73% accuracy, 28% -64% sensitive (5,6,11) Histopathological diagnosis of BTB is made by demonstration of a chronic caseous necrotizing granulomas and Langhans-type giant cells with or without the demonstration of the AFB by ZN staining from specimens obtained by core biopsy, edge biopsy or biopsy from the abscess wall. (5,13) , Histopathological evaluation is 84.4% sensitive and 78.9% specific, low specificity is due of the presence of granulomas in other diseases (6,13).…”