Fine needle aspiration cytology in breast tuberculosis: Diagnostic difficulties - study of eleven cases.

ABSTRACT

Background: Incidence of extra-pulmonary tuberculosis is on the rise. Tuberculosis of breast is rare and have multifaceted clinical presentation, often mimicking carcinoma and pyogenic breast abscess. Aim: To study morphologic variations and diagnostic difficulties of breast tuberculosis on fine needle aspiration cytology (FNAC). Methods: FNAC smears of breast tuberculosis were studied by Leishman’s Stain and categorized into four groups. Cytology smears were also studied for presence of Acid Fast Bacilli (AFB) by Ziehl Neelsen (ZN) stain. Histology of excised tissue was studied by Hematoxylin and Eosin stain ( H& E). Results: Out of 11 cases, 10 were females and 1 was male. Group1 (n=2) showed epithelioid granulomas with necrosis. Group2 (n=2) showed epithelioid granulomas without necrosis. Group3 (n=3) showed necrosis with a few scattered epithelioid histiocytes. Group4 (n=4) showed necrosis with numerous neutrophilic inflammatory cells. In four cases, caseous necrosis could be identified on cytology smears. AFB were found in five cases on FNAC smears. Histology confirmed diagnosis of tuberculosis in all cases. Conclusion: In developing countries like India, based on clinical history and other features, FNAC smears showing epithelioid granulomas with or without necrosis should be considered as breast tuberculosis as demonstration of AFB is not mandatory. Identification of caseous necrosis alone is diagnostic of breast tuberculosis in cytology smears.