Tuberculous mastitis: Still a diagnostic dilemma
Sunita Singh, Sonia Chhabra, Rajni Yadav, Amrita Duhan
Department of Pathology, Pt. B.D. Sharma PGIMS, Rohtak, India
Date of Web Publication 4-Mar-2011
Singh S, Chhabra S, Yadav R, Duhan A. Tuberculous mastitis: Still a diagnostic dilemma. J Global Infect Dis 2011;3:98-9
Singh S, Chhabra S, Yadav R, Duhan A. Tuberculous mastitis: Still a diagnostic dilemma. J Global Infect Dis [serial online] 2011 [cited 2020 Jan 18];3:98-9. Available from: http://www.jgid.org/text.asp?2011/3/1/98/77309
Breast tuberculosis is a rare form of tuberculosis. In developing countries, where tuberculosis is endemic, the incidence is 0.25-4.5%. [1] In western countries, the reported incidence is less than 1% of breast lesions examined histologically. However, the disease is assuming significance even in the developed countries because of the global spread of AIDS. [2] The clinical diagnosis of tuberculous mastitis is difficult because of nonspecific clinical and radiological findings. [1] The disease is often overlooked or misdiagnosed as carcinoma or pyogenic abscess. [2] We would like to share three cases of tuberculous mastitis diagnosed by fine needle aspiration cytology (FNAC) over a very short period of two months.
Case 1. A 39-year-old female presented with a 2 Χ 2 cm firm mobile lump in upper outer quadrant of right breast for six months. Clinical examination and ultrasonography suggested the diagnosis of fibroadenoma.
Case 2. A 23-year-old female presented with the complaint of lump in left breast for four months. Local examination revealed 1 Χ 0.8 cm soft, mobile swelling in upper outer quadrant of left breast which was clinically diagnosed as fibroadenoma.
Case 3. A 45-year-old female presented with tender lump in periareolar region of right breast for five months. The lump was irregular and firm to hard. Clinical examination and ultrasonography revealed an irregular mass and suggested the possible diagnosis of carcinoma.
FNA was performed in these patients. All the cases on cytology showed features of necrotizing granulomatous mastitis [Figure 1]. ZN staining was positive in two cases (case 1 and 2). HIV test was nonreactive in all the three patients. No primary site could be ascertained in the patients.
Figure 1: Necrotizing epithelioid cell granulomas in a smear prepared from FNAC breast lump. (Leishman; ×200)
Primary tuberculous mastitis is extremely uncommon. [1] The reason for low incidence of tuberculous mastitis is because mammary tissue is an inhospitable site for survival and multiplication of Tubercle bacilli as is skeletal muscle and spleen. Although cases have been reported from those aged 6 months to 73 years, yet most cases are 20-40 years old and in active sexual life. [3] It can present as a painless breast mass, generalized breast edema or localized breast abscess with or without axillary involvement. [4] Lumps are mostly misdiagnosed as fibroadenoma, fibroadenosis or malignancy. [2] Radiological imaging modalities like mammography or ultrasonography are unreliable in distinguishing it from carcinoma. [1]
The demonstration of acid fast bacilli on Ziehl Neelson stain or growth of Mycobacterium tuberculosis on culture of the FNA specimen remains the gold standard for diagnosis despite 38% yield. [4] FNAC is proving very useful in diagnosis of breast lumps with or without nodes. The presence of epithelioid cell granulomas and caseous necrosis is diagnostic. The demonstration of AFB is not a must. [1] Earlier the therapy used to be exclusively surgical resection of the infected tissue, but now anti-tuberculosis chemotherapy supplemented by limited surgery or aspiration of abscesses is considered as adequate. [3]
Although granulomatous inflammation of the breast is an uncommon entity, it should be considered in the differential diagnosis of a lump in the breast. Fine needle aspiration and cytologic analysis may provide the diagnosis.
We would like to acknowledge Dr. Rajnish Kalra, Professor and Dr. Rajeev Sen, Professor and Head for their valuable help in data collection and final reviewing of the script.
1. Kaneria MV, Sharbidre P, Burkule D, Shukla A, Somani A, Nabar ST. Bilateral breast tuberculosis: A rare entity. JIACM 2006;7:61-3.
2. Tewari M, Shukla HS. Breast tuberculosis: Diagnosis, clinical features and management. Indian J Med Res 2005;122:103-10.
3. Pal DK. Tuberculosis of breast: A retrospective review of cases. Ind J Tub 1998;45:35-7.
4. Gupta PP, Gupta KB, Yadav RK, Agarvval D. Tuberculous mastitis: A review of seven consecutive cases. Ind J Tub 2003;50:47-50.
Sunita Singh
Department of Pathology, Pt. B.D. Sharma PGIMS, Rohtak
1 Tubercular mastitis is common in Garhwal region of Uttarakhand: Clinico pathological features of 14 cases
Deepa, H. and Vijay, S. and Mishra Jai, P. and Chitra, J.
Journal of Clinical and Diagnostic Research. 2011; 5(8): 1569-1573
Singh S
Chhabra S
Yadav R
Duhan A