'Not your average breast lump!'-Primary tuberculosis mimicking chronic abscess: A rare case report.

Primary breast tuberculosis is a rare disease under extrapulmonary tuberculosis category. It tends to affect females of reproductive age rather than postmenopausal women or prepubescent girls. This rare form of disease poses a challenge in diagnosing as imaging can mimic the appearance of both benign and malignant breast lesions. We describe a case of primary breast tuberculosis in a young female who presented with a persistent left breast lump. and was diagnosed with chronic left breast abscess. Histopathological examination of the lesion was consistent with granulomatous mastitis, secondary to mycobacterium tuberculosis infection. The patient was treated with a 6-month course of anti-tuberculosis drug with complete resolution of the symptoms and the left breast lesion on serial ultrasound imaging.

Diagnostic challenge: a case report of primary breast tuberculosis mimicking recurrent pyogenic breast abscess.

Introduction: Breast tuberculosis (BTB) is a rare form of extrapulmonary tuberculosis with its primary form considered even rarer. Case presentation: A 28-year-old female initially diagnosed with a breast abscess presented with chronic right breast pain and nipple discharge. Despite initial treatment, symptoms recurred, and further investigations revealed a space-occupying lesion. Fine needle aspiration confirmed recurrent breast abscess, but subsequent DNA detection of tubercular bacilli in the pus sample led to a diagnosis of primary BTB, necessitating antitubercular therapy. Clinical discussion: BTB, being rare and often misdiagnosed as an abscess, poses diagnostic challenges. However, persistent symptoms despite treatment should prompt consideration of BTB in TB endemic regions. Conclusion: Primary BTB might not have any systemic symptoms to drag the clinician towards a possible diagnosis so culturing the aspirate for acid-fast bacilli or looking for MTB DNA in the available clinical sample should always be kept in mind for better outcomes.

Is it tuberculosis mastitis or granulomatous mastitis? A thirteen-year experience at a university hospital.

BACKGROUND: Granulomatous mastitis (GM) is a rare inflammatory disease of the breast. Tuberculosis mastitis (TM), one of the causes of GM, is a rare form of extrapulmonary tuberculosis. The clinical, radiological, and histopathological findings of TM and GM are similar, and sometimes it is difficult to make a distinction between these disease states. In this study, we aimed to evaluate the clinical and radiological features, diagnostic techniques, treatment modalities and treatment outcomes of the patients with GM and TM. METHODS: The data of the patients with confirmed GM by histopathologic examination of biopsy specimens between 2007 and 2020 were retrospectively analyzed. Demographic features, main complaints, physical findings, radiological and laboratory data, treatment modalities, and treatment outcomes were recorded. RESULTS: Sixty-eight GM patients with a mean age of 35.8 (18-63) years were evaluated. The patients had a mass lesion, pain, ulceration,and abscess in their breasts. All of the cases were female. Ultrasonographic examinations were performed on 62 cases. Abscess and/or sinus tract formation was detected in 34, heterogeneous hypoechoic mass in 15, heterogeneous parenchyma or parenchymal edema in 15, axillary lymphadenopathy in 18 and cysts in 13 patients. A total of 10 patients were lost to follow-up. Twenty-six patients underwent surgery for their breast lesions or had antibiotherapy (n = 13) or corticosteroid therapy (n = 7). Eleven (16.1%) patients were diagnosed with TM. These patients were evaluated by clinical examination, chest radiography, and tuberculin skin test. Acid-fast bacilli (AFB) staining and culture were negative in all cases. The diagnosis of TM was based on histopathological evaluation results. Eight of the 11 patients achieved complete remission with antituberculosis treatment. DISCUSSION: The etiological diagnosis of GM must be based on a multidisciplinary approach. Tuberculosis mastitis should become a part of differential diagnosis of breast diseases in populations with high incidence of tuberculosis.

A rare extrapulmonary presentation of tuberculosis: Breast tuberculosis.

Key Clinical Message: Breast abscess of long duration can be tubercular origin in both developing and developed countries despite its rarity. Abstract: A 34-year-old lady presented with painful lump on her breast for 2 months, which was diagnosed with mammary tuberculosis on basis of aspiration cytology and successfully treated with antitubercular drugs. Breast abscess of long duration may be tubercular etiology in both developing and developed nations.

Breast Tuberculosis: A Case Report.

Breast tuberculosis (BTB) is a rare manifestation of tuberculosis (TB), and it is more common in countries with a high incidence of TB. We describe a case of a 36-year-old Angolan woman, who had a history of breast reduction surgery, presenting with right breast enlargement, pain, purulent discharge through multiple skin openings, fever, and abdominal pain, progressively worsening in the past year. She had already undergone several surgical drainages and six months of treatment with ciprofloxacin, with no improvement. Breast ultrasound and MRI were performed, which revealed a large fluid collection, with several small abscesses and surrounding adenopathies, complicated by multiple fistulae. The fluid was drained through needle aspiration, which was found to be sterile for bacteria, mycobacteria, and fungi. A lymph node biopsy showed necrosis without granulomas, and the biopsy culture was positive for Mycobacterium tuberculosis (Mt). This case shows how a rare manifestation can simulate bacterial breast abscesses or cancer, and hence a high index of suspicion is necessary to reach the correct diagnosis and ensure appropriate treatment delivery in these patients.

Primary Breast Tuberculosis Mastitis Manifested as Nonhealing Abscess.

Primary breast tuberculosis (TB) is a rare extrapulmonary TB mainly affecting young women of childbearing age from endemic countries. Its incidence is increasing in immunocompromised and HIV-infected people and with the emergence of drug-resistant strains of Mycobacterium tuberculosis (MTB). There are no specific clinical signs suggestive of this disease, it often presents as a hard mass or breast abscess. There is an overlap of features with other inflammatory, infectious, benign lesions, fat necrosis and malignant neoplasms of the breast. The detection of MTB remains the gold standard for diagnosis. Several other diagnostic modalities are used, with varying lack of sensitivity and specificity, and with a range of false negatives. A quarter of cases were treated solely on the basis of clinical, imaging or histological suspicion, without confirmation of the diagnosis. Therefore, we report the case of a young Vietnamese woman, presented for a nonhealing breast abscess, and diagnosed with breast TB based on the patient's ethnicity, histological findings, lack of clinical response to conventional antibiotic therapy, and a good clinical response to anti-TB treatment.

Breast tuberculosis: A forgotten diagnosis.

Breast tuberculosis is a rare entity even in endemic countries. It is often considered as a diagnostic conundrum given the non-specific clinical and imaging characteristics. Therefore, the definitive diagnosis is based on the identification of bacilli by microbiological or histopathological examination. We report the case of a 52-year-old woman, with a 2-month history of a painful lump of the left breast. The imaging features were consistent with a breast abscess. The purulent collection was aspirated and a tuberculous mammary abscess was diagnosed by molecular biology (GeneXpert). Through this observation, we discuss the clinical, radiological and biological signs by highlighting the contribution of molecular biology in the rapid management of this rare pathology.

Breast tuberculosis presenting with intractable mastitis: a case report.

BACKGROUND: Breast tuberculosis, also known as tuberculous mastitis, is an extremely rare form of tuberculosis. It accounts for <0.1% of all breast diseases and <2% of all cases of tuberculosis. It is often misdiagnosed as breast cancer, which can potentially lead to a delayed diagnosis. CASE PRESENTATION: A 69-year-old Japanese woman presented with a tumor-mimicking lesion in her right breast, followed by intractable mastitis with a fistula formation. The time until the correct diagnosis of tuberculosis of the breast and sternal bone was 14 months. CONCLUSIONS: Although rare, it is important to recognize that tuberculous mastitis can present as refractory abscesses/mastitis or mass lesions that mimic carcinomas in women of reproductive age and elderly people. Breast tuberculosis should always be considered in the differential diagnoses, particularly in patients with a history of tuberculosis and those living in areas where tuberculosis is endemic.

An unusual presentation of breast tuberculosis: A case report.

Primary breast tuberculosis is an uncommon disease, especially in nonendemic areas. Its presentation could mimic a cancer or an abscess, but this entity must be considered for differential diagnosis in women coming from endemic countries.

Primary breast tuberculosis in an HIV-infected patient.

The presentation of tuberculosis can be nonspecific and atypical in patients with human immunodeficiency virus infection, especially in the extrapulmonary forms. The incidence of breast tuberculosis is very low. We report a case of primary breast tuberculosis: a 26-year-old woman with a 5-month history of a left-sided breast lump associated with pain. Biopsy of the breast lump for histological examination suggested granulomatous inflammation, secretions tested with GeneXpert for Mycobacterium tuberculosis were positive, and no evidence of tuberculosis was found in other organs. She was treated with incision, drainage, dressing, and 6 months of anti-tuberculosis treatment; her prognosis was good.

Features of breast tuberculosis determined by ultrasound imaging: report of 45 cases.

OBJECTIVE: This study aimed to characterize the ultrasound (US) imaging features of breast tuberculosis (BTB) to clarify the process of disease progression and provide valuable clinical information. METHODS: We retrospectively reviewed 45 patients with pathologically or GeneXpert-confirmed BTB from January 2010 to December 2017. We assessed the US features of target lesions including size, shape, orientation, margin, echogenicity, calcification, posterior acoustic features, and blood-flow signal. RESULTS: The patients were classified with nodular (55.5%, 25/45), abscess (15.6%, 7/45), or sinus (28.9%, 13/45) type according to their US features. Forty lesions (88.9%, 40/45) extended in a parallel orientation and five extended in a non-parallel orientation. Calcifications were found in eight cases, including six macrocalcifications and two microcalcifications. Enlarged axillary lymph nodes were observed in three cases (6.7%, 3/45). In addition, 44 of the 45 cases (97.8%, 44/45) exhibited hypovascularity or avascularity according to color Doppler flow imaging (CDFI). CONCLUSION: BTB lesions can be classified as nodular, abscess, or sinus type according to their US imaging features. Poor blood supply detected by CDFI might be a common US feature of BTB. Characterization of its US features may facilitate the clinical diagnosis of BTB.

[Primary breast tuberculosis in a man: a case report]. / Tuberculose mammaire primitive chez un sujet de sexe masculin : à propos d'un cas.

The breast tuberculosis accounts for 0.06 to 0.1% of extra-pulmonary localizations. Frequent in women, it remains exceptional in men. We report a rare case of primary breast tuberculosis occurring in a male patient. A 33-years-old patient presented with a chronic and fistulized non-inflammatory-right breast swelling with an atrophic cutaneous ulceration. The thoracic CT was in favor of a right breast abscess with a thick wall. The patient had received non-specific antibiotics (amoxicillin-clavulanate and metronidazole) for 10 days coupled with a surgical drainage before consulting us for persisting symptoms. The culture of the pus was sterile, the GeneXpert and the search for acid-fast bacilli (AFB) both performed on the swab of the ulceration were negative. Histopathological analysis of the lesion was in favor of a granulomatous mastitis. Given the chronic and atrophic nature of the ulceration, the histological aspect of granulomatous mastitis and the persisting symptoms despite the non-specific antibiotic therapy, we made a presumptive diagnostic of breast tuberculosis. The evolution was favorable with oral anti-tuberculosis treatment.

Primary Tuberculous Mastitis: The first report from Syria.

INTRODUCTION: Primary breast tuberculosis is a rare form of extrapulmonary tuberculosis even in endemic regions. To our knowledge, this is the first report of Primary breast tuberculosis from Syria. CASE PRESENTATION: We report a case of a 37-year-old female who admitted to the surgical clinic with a 4-month history of gradually growing mass in the breast. On physical examination there were a palpable mass, painful superficial abscess in her left lateral upper quarter of breast, redness and nipple retraction and ulceration. The patient history and physical examination were clear except for uncontrolled hypothyroidism. Radiological tests including mammography, echography and laboratory investigations were performed. The patient underwent lumpectomy. Histopathologic examination showed caseating Tuberculous Mastitis and a large tuberculous abscess, with no malignancy. Patient was put on anti-tubercular chemotherapy, but recurred after three months with three masses in the same area because she did not adhere to the treatment. Lumpectomy and Anti-tuberculous therapy were repeated again with close follow-up, and the patient recovered. DISCUSSION: Primary breast tuberculosis forms about 0.025-0.1 % of all surgically treated breast diseases. Diagnosis is based on bacteriological and histological examination. We can get higher accuracy in diagnosis by biopsy such as a core needle or surgical biopsy, surgical biopsy is necessary to confirm the diagnosis of tuberculous mastitis. CONCLUSION: Tuberculous mastitis is extremely rare variant of extrapulmonary tuberculosis. However, it should be kept in the mind of physicians and pathologists while approaching a breast mass, especially in endemic area.

Breast tuberculosis.

Tuberculosis (TB) of breast is an uncommon entity even in endemic regions. Moreover, it is seldom reported. It often presents in young lactating females as a painless breast lump and confused with breast malignancy or pyogenic abscess. A high index of suspicion is required. Fine needle aspiration cytology is important to direct the patient to further tests pertaining to TB. New diagnostic modalities based on detection of nucleic acids have improved the accuracy and cut down the time to diagnosis. Anti-tubercular chemotherapy remains the standard of care. Surgical intervention is seldom required. The fact that the disease being rare, having symptom overlap with commonly prevalent breast malignancy and potentially curable, it becomes important to analyze the presentation, available investigative modalities for early goal directed treatment.

Breast tuberculosis: A case report of primary type mammary tuberculosis.

Mammary tuberculosis is exceptional in developed countries. It can mimic an abscess or a granulomatous mastitis. In subjects coming from endemic areas, it is necessary to suspect a tuberculosis infection in case of recurrent mastitis refractory to antibiotics. Positivity of Quantiferon-TB Gold assay can help to confirm the clinical suspicion.

Tuberculosis of the Breast in Togo: A Series of 28 Presumed Cases.

Our study aimed to describe the epidemiological, clinical and histological aspects of mammary tuberculosis in Togo. This is a descriptive cross-sectional study of breast tuberculosis for which the diagnosis was presumed on histological grounds in the pathology department (LAP) of the Lomé Tokoin university hospital from January 1995 to December 2016 (20 years). A total of 28 presumed cases of mammary tuberculosis were identified. There were 26 women and 2 men, with an average age of 34.2 ± 0.3 years. The clinical signs were nodule (84.1%), tumefaction (75%), abscess (63.6%) and tumefaction with cutaneous fistulization (59.1%). Breast involvement was isolated in 31.8% of cases and associated with pleuropulmonary tuberculosis in 54.5% of cases. Co-infection with HIV was found in 63.9 % of cases. Histology showed inflammatory granulomas made of Langhans giant cells, epithelioid cells and lymphocytes around the foci of caseous necrosis. Thoracic radiography was abnormal in 16 patients (57.1%).Mammary tuberculosis is not rare in our country. Clinical presentation is often misleading and is a diagnostic challenge, more particularly with breast abscess or cancer.

[Tuberculosis of the breast: four cases report at the Armies Instruction's Hospital Omar Bongo Ondimba (HIAOBO) in Libreville (Gabon)]. / Tuberculose mammaire : à propos de quatre cas à l'hôpital d'instruction des armées Omar Bongo Ondimba (HIAOBO) de Libreville (Gabon).

Mammary tuberculosis is a rare localization of extra pulmonary tuberculosis. Its frequency increases proportionally with the HIV pandemic. We report four cases of breast tuberculosis diagnosed in the general medicine department of HIAOBO including two with positive HIV serology. It is necessary to know this extra pulmonary form/feature as the differential diagnosis with breast tumors is sometimes difficult.

Primary breast tuberculosis: diagnostic and therapeutic dilemmas.

OBJECTIVE: To review the diagnostic and therapeutic challenges associated with treating isolated primary breast tuberculosis through discussion of our series of seven cases. BACKGROUND: Although breast is an uncommon site of occurrence of tuberculosis and isolated primary breast tuberculosis is an even rarer entity, its importance lies in distinguishing it from more common pathologies like abscesses or malignancy and avoiding unnecessary erroneous surgical intervention. The spectrum and presentation is wide and varied and we present our experience in managing seven such cases. MATERIALS AND METHODS: A retrospective analysis of all the cases of histopathologically proven primary breast tuberculosis in the last three years at M.S. Ramaiah Hospital (2012-2014) was done. Analysis was in terms of mode of presentation, clinical features, diagnostic modalities used for evaluation and confirmation of the diagnosis, medical treatment and surgical intervention, if any. Special emphasis was placed on dilemmas in diagnosis and difficulties encountered during treatment. All cases were followed up till cure. RESULTS: Patients most commonly presented with a breast abscess, painful breast lumps and recurrent abscesses. Other foci of tuberculosis were ruled out in all of these patients. Majority were treated exclusively with anti-tubercular therapy (although regimens varied), but those with abscesses underwent incision and drainage. All cases were treated and followed up till cure. DISCUSSION: The challenges associated with primary breast tuberculosis are multiple, including which anti-tubercular therapy regimen to use, when to surgically intervene (as the breast is a cosmetically important area) and treating atypical mycobacteria. We provide a detailed discussion of the challenges we faced and review of literature.