BACKGROUND: Coexistence of cancer and tuberculosis in axillary lymph nodes is rare. Only seven cases have been reported in the literature. CASE REPORT: We report here a case of infiltrating ductal carcinoma breast metastasizing to the axillary lymph node along with tubercular granuloma in the same lymph node without primary mammary or pulmonary tuberculosis. CONCLUSION: Primary tuberculosis coexisting with carcinoma is of rare occurrence. A possibility should always be borne in mind especially in patients from endemic areas

Abraham, Elizabeth K

K, Chandramohan

Pandey, Manoj

Rajan, Balakrishnan

English

PubMed

Manoj Pandey

Elizabeth K Abraham

Chandramohan K

Balakrishnan Rajan

Springer - Publisher Connector

Abstract Background Coexistence of cancer and tuberculosis in axillary lymph nodes is rare. Only seven cases have been reported in the literature. Case Report We report here a case of infiltrating ductal carcinoma breast metastasizing to the axillary lymph node along with tubercular granuloma in the same lymph node without primary mammary or pulmonary tuberculosis. Conclusion Primary tuberculosis coexisting with carcinoma is of rare occurrence. A possibility should always be borne in mind especially in patients from endemic areas.</p

K Chandramohan

Abraham Elizabeth K

Pandey Manoj

Rajan Balakrishnan

Directory of Open Access Journals

World Journal of Surgical Oncology

Tuberculosis and metastatic carcinoma coexistence in axillary lymph node: A case report

BioMed Central
World Journal of Surgical Oncology
ssOpen AcceCase Report
Tuberculosis and metastatic carcinoma coexistence in axillary 
lymph node: A case report
Manoj Pandey*1, Elizabeth K Abraham2, Chandramohan K1 and 
Balakrishnan Rajan3
Address: 1Department of Surgical Oncology, Regional Cancer Centre, Thiruvananthapuram, Kerala, India, 2Department of Pathology, Regional 
Cancer Centre, Thiruvananthapuram, Kerala, India and 3Department of Radiation Oncology, Regional Cancer Centre, Thiruvananthapuram, 
Kerala, India
Email: Manoj Pandey* - manojpandey@rcctvm.org; Elizabeth K Abraham - cytology@rcctvm.org; Chandramohan K - cm@vsnl.com; 
Balakrishnan Rajan - rajanrcc@techpark.net
* Corresponding author    
Breastneoplasmtuberculosistubercular lymphadinitisaxillainfiltrating ductal carcinomagiant cell granuloma
Abstract
Background: Coexistence of cancer and tuberculosis in axillary lymph nodes is rare. Only seven
cases have been reported in the literature.
Case Report: We report here a case of infiltrating ductal carcinoma breast metastasizing to the
axillary lymph node along with tubercular granuloma in the same lymph node without primary
mammary or pulmonary tuberculosis.
Conclusion: Primary tuberculosis coexisting with carcinoma is of rare occurrence. A possibility
should always be borne in mind especially in patients from endemic areas.
Background
The synchronous occurrence of tuberculosis and carcino-
ma is unusual and association of the two has baffled sur-
geons and physicians for over two centuries. Coexistence
of tuberculosis and metastatic carcinoma in axillary
lymph nodes, without pulmonary or mammary tubercu-
losis is even rare. Warthin (1899) first described the coex-
istence of tuberculosis and cancer in axillary node [1], five
other cases have been reported between 1902 and 1992
[2–4].
Case Presentation
A 52-year-old postmenopausal lady presented to the out
patient clinic at Regional Cancer Centre, Trivandrum with
a breast lump of 8 months duration. Examination re-
vealed a 3 × 2.5-cm well-defined hard mass in the upper
inner quadrant of left breast. There were no palpable
nodes in the left axilla. Contralateral breast and axilla
were normal. There were no supraclavicular nodes. Bio-
chemical parameters and chest roentgenogram were nor-
mal and metastatic work-up was negative.
Fine needle aspiration cytology revealed malignant cells.
A modified radical mastectomy was carried out. Histopa-
thology of the resected specimen revealed grade III infil-
trating ductal carcinoma. Two of the axillary lymph nodes
revealed metastatic carcinoma and granulomatous foci
(figure 1) with Langhan's giant cells (figure 2), no acid-
fast bacilli (AFB) could be demonstrated in the granulo-
ma. The tumor was negative for estrogen and
Published: 7 April 2003
World Journal of Surgical Oncology 2003, 1:3
Received: 12 January 2003
Accepted: 7 April 2003
This article is available from: http://www.wjso.com/content/1/1/3
© 2003 Pandey et al; licensee BioMed Central Ltd. This is an Open Access article: verbatim copying and redistribution of this article are permitted in all 
media for any purpose, provided this notice is preserved along with the article's original URL.Page 1 of 3
(page number not for citation purposes)
World Journal of Surgical Oncology 2003, 1 http://www.wjso.com/content/1/1/3progesterone receptors. Post operatively patient received
short course, four drug anti tubercular treatment and six
cycles of adjuvant chemotherapy with cyclophosphamide,
methotrexate and 5-flurouracil (CMF) followed by adju-
vant radiotherapy to the chest wall and supraclavicular
fossa. Patient is disease free after eight months of follow-
up.
Discussion
The association of tuberculosis and cancer has been re-
corded in most of the organs and has been described and
explained by many authors in many diverse ways. Kaplan
et al. (1974) reviewed 58,245 patients with cancer and
identified 201 cases of coexisting tuberculosis [5]. Highest
prevalence was seen in patients with Hodgkin's disease
(96/10,000 cases) followed by lung cancer (92/10,000),
lymphosarcoma (88/10,000) and reticulum cell sarcoma
(78/10,000) [5]. Among 14,742 cases of breast reviewed
by them, only 28 had coexisting tuberculosis in breast, a
prevalence of 19/10,000. No case of axillary nodal coexist-
ence was identified in their series [5].
Bayle first described the association of tuberculosis and
carcinoma in 1810. He described "cavitation cancereuse"
as one of the six types of tuberculosis, which appears to be
the first published description of coexistence of the two
[6]. The coexistence of breast cancer and tuberculosis has
been described in over 100 cases [7,8], however its coex-
istence in the axillary node is rare. Only seven cases have
been reported in the literature so far [2–4]. Majority of
these cases reported breast cancer with axillary node
showing tubercular foci, while our patient had a metastat-
ic carcinoma and tubercular granulomatous foci in the
same lymph node in the same high power field (figure 1)
with the absence of tubercular foci elsewhere. The case is
being reported for its rarity.
References
1. Warthin AS The coexistence of tuberculosis and carcinoma of
the mammary gland Am J Med Sci 1899, 118:25
Figure 1
Section of lymph node showing metastatic adenocarcinoma (C) (towards the right) and granulomatous focus composed of epi-
thelioid cells (arrow near center) (H and E × 250)Page 2 of 3
(page number not for citation purposes)
World Journal of Surgical Oncology 2003, 1 http://www.wjso.com/content/1/1/3Publish with BioMed Central   and  every 
scientist can read your work free of charge
"BioMed Central will be the most significant development for 
disseminating the results of biomedical research in our lifetime."
Sir Paul Nurse, Cancer Research UK
Your research papers will be:
available free of charge to the entire biomedical community
peer reviewed and published immediately upon acceptance
cited in PubMed and archived on PubMed Central 
yours — you keep the copyright
Submit your manuscript here:
http://www.biomedcentral.com/info/publishing_adv.asp
BioMedcentral
2. Miller RE, Solomen PF and West JP The coexistence of carcinoma
and tuberculosis of the breast and axillary lymph nodes Am J
Surg 1971, 121:338-340
3. Grege A and Kienle J Association of tuberculosis with carcino-
ma breast Radiol 1969, 93:1107-1108
4. Das DK, Mohil RS, Kashyap V, Khan IV, Mandal AK and Gulati SM
Colloid carcinoma of the breast with concomitant metasta-
sis and a tubercular lesion in the axillary lymph nodes: a case
report Acta Cytol 1992, 36:399-403
5. Kaplan MH, Armstrong D and Rosen P Tuberculosis complicating
neoplastic disease: a review of 201 cases Cancer 1974, 33:850-
858
6. Bayle GI Recherches sur la phthisie pulmonaire Gabon Paris
1810, 
7. Brammo-Cook F, O'Brian DS and Daly PA Unusual breast masses.
The sequential development of mammary tuberculosis and
Hodgkin's disease in a young woman Cancer 1988, 61:1457-1459
8. Cheng W, Alagaratnam TT, Leung CY and Chen ACL Tuberculosis
and lymphoma of the breast in a patient with
dermatomyositis Aust NZ J Surg 1993, 63:660-661
Figure 2
Section of lymph node showing tubercular granulomatous reaction composed of epithelioid cells (E) and Langhan's type of giant 
cells (L) with caseation (C) (H and E × 250)Page 3 of 3
(page number not for citation purposes)


http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=156028

Tuberculosis and metastatic carcinoma coexistence in axillary lymph node: A case report

Abstract

Similar works

Full text

Available Versions

Springer - Publisher Connector

Directory of Open Access Journals

Springer - Publisher Connector