TBC of the thoracic wall with fistulisation through the breast

A 53-year-old North African woman presented with a longstanding history of ulcerations of the right breast. Physical examination showed (Fig. 1 subfigure) an ulcer of 1.5 cm in the outer inferior quadrant, another smaller areolar ulcer and a discharging sinus tract in the inframammary sulcus. Apart from female genital mutilation, her past medical history was negative. Laboratory work up was essentially normal, culture of the ulcers were taken. Mammography showed infra-areolar skin retraction, associated with irregular, high density distortion of the breast tissue. Ultrasound (Fig. 1) revealed communicating sinus tracts coming from an intercostal mass with central necrosis. Mobile internal echoes were suggestive for abscess formation and a truecut biopsy was taken. An important granulomatous inflammatory pattern and fibrosis were found. Axillary lymphadenopathy was present