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Primary tuberculosis of the breast mimicking breast cancer

Abstract number: 1733_1116

Nasr B., Borzouei B., Nasserabadi A., Ahmadi M.

Background: Tuberculosis of the breast is seen quite rarely. It is mainly classified as primary and secondary forms. Primary form is rarer.

The gold standard for diagnosis of the disease is detection of the aetiologic agent, Mycobacterium tuberculosis, by using Ziehl–Neelsen staining or culture. However, smear positivity for acid-fast bacilli by Ziehl–Neelsen staining is low, and in most cases, tuberculosis of the breast can only be accurately diagnosed by histological identification of the typical necrotising granulomatous lesion.

Case report: A 49-year-old woman with complaints of breast lump and swelling of her right breast, which had appeared 40 days earlier, was admitted in our hospital. Her medical history was unremarkable. On physical examination, a hard mass (5×5 cm), which caused nipple retraction in the upper outer quadrant of the right breast, was observed. In laboratory findings she had WBC = 9,000 (neu = 38%, lym = 60%, mono = 2%), Hb = 12.7 g/dL and HCT = 38. Ultrasonography examination revealed hypoechoic mass with significant ductal dilatation, without collection and lymphadenopathy, which suggested mastitis. Mammography, which was performed in another clinical setting, suggested a malignant tumour (70×50 mm) with irregular border. Tc-99m sestamibi scan revealed abnormal large focal sestamibi uptake with T/N ratio = 1.45 which suggested malignant lesion.

The mass was excised by using surgery. After surgery, pathologic examination reported necrotising granulomatous lesion, which confirmed breast tuberculosis. The patient had no abnormal findings on computer tomography (CT) of chest but the result of a tuberculin skin test was positive. After confirmation of the diagnosis, the patient received antituberculosis therapy (rifampin, isoniazid, ethambutol, and pyrazinamide). She was currently being followed-up and the disease was showed no signs of recurrence one year after treatment.

Discussion: Breast tuberculosis is classified as primary and secondary forms. CT is useful in differentiation of primary and secondary breast tuberculosis. Pathologic confirmation is required for diagnosis. Although tuberculosis of the breast is rare, it should be considered as a possible diagnosis, particularly in countries where tuberculosis is endemic. The prognostic of breast tuberculosis is favourable.

Session Details

Date: 31/03/2007
Time: 00:00-00:00
Session name: European Society of Clinical Microbiology and Infectious Diseases
Subject:
Location: ICC, Munich, Germany
Presentation type:
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