Tubercular mastitis - a great masquerader

Abstract

Tubercular mastitis is a rare clinical entity as mammary gland tissue, like spleen and skeletal muscle, offers resistance to the survival and multiplication of the tubercle bacillus. Tuberculosis of the breast can mimic carcinoma, whereas in young patients it can be mistaken for a pyogenic breast abscess, thus labeled a "great masquerader" in recognition of its multifaceted presentation. Breast tuberculosis commonly affects women in the reproductive age group, between 21 and 30 years, and is rare in prepubescent females and elderly women. Fine needle aspiration cytology is very useful and it is a promising technique in expert hands. In tuberculosis-endemic countries, the finding of granuloma on fine needle aspiration cytology warrants empirical treatment for tuberculosis even in the absence of positive acid-fast bacilli and without culture results. We hereby report a case of tubercular mastitis in a post-menopausal seronegative female diagnosed on fine needle aspiration cytology with a positive acid-fast bacilli and a review of the recent literature.

Retrospective analysis of seven breast tuberculosis cases

“…Primary BTB is rarely reported, and the breast is the only affected area in this form of the disease. By contrast, secondary BTB is more frequently reported, and a prior history of TB is common in these cases (4,7,9). In the present study, the only organ involved was the breast, and thus all cases presented primary BTB.…”

“…BTB constitutes <1% of all diseases of the breast in developed countries. However, the incidence of the disease is higher in countries endemic for TB, such as the Indian subcontinent, where BTB may comprise up to 4.0% of breast diseases (4,7). In addition, tuberculosis constitutes 0.025-0.1% of all surgically treated diseases of the breast (8).…”

Breast tuberculosis mimicking a malignancy: A rare case report with review of literature

“…Simple mastectomy is indicated in patients with persistent and diffuse disease. Modified radical mastectomy should be reserved for patients with co-existent malignancy [13]. In our case, the lesions responded to ATT and at the end of 6 months of treatment, no residual lumps were palpable.…”

“…All the studies and case reports have highlighted the role of anti-tubercular therapy for 6 months as the the mainstay of treatment [3,8,[10][11][12][13]. The lesions show rapid resolution after the commencement of ATT and residual lesions can be excised.…”

“…Gon et al have referred to tuberculosis of the breast as a "great masquerader" in recognition of its multifaceted presentation. In addition to malignancy, breast tuberculosis can also rarely mimic fat necrosis, pyogenic abscess, idiopathic granulomatous mastitis and sarcoidosis [13]. Idiopathic granulomatous mastitis deserves special mention as the patient presents with recurrent abscess and sinus formation, which is similar to breast tuberculosis and is a diagnosis of exclusion.…”