Islam, M U

Rana, T A

Sheikh, M Y

English

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eCommons@AKUDepartment of Radiology Medical College, PakistanJune 1993Tuberculous mastitis mimicking malignancy--acase report with review of literatureM Y. SheikhT A. RanaM U. IslamFollow this and additional works at: https://ecommons.aku.edu/pakistan_fhs_mc_radiolPart of the Radiology CommonsRecommended CitationSheikh, M. Y., Rana, T. A., Islam, M. U. (1993). Tuberculous mastitis mimicking malignancy--a case report with review of literature.Journal of Pakistan Medical Association, 43(6), 122-123.Available at: https://ecommons.aku.edu/pakistan_fhs_mc_radiol/274Tuberculous Mastitis Mimicking Malignancy - A Case Reportwith Review of literaturePages with reference to book, From 122 To 123 M. Younus Sheikh, Tauqir Ahmed Rana, Muhammad Timar Islam ( Department of Radiology, The Aga Khan UniversityHospital, Karachi. ) Tuberculous mastitis is an uncommon disease even in areas where the incidence of pulmonary andextra pulmonary tuberculosis is still very high1. We present a case of tuberculosis mastitis whichpresented as a breast lump. On radiological findings, erosion of rib was also seen with pleural basedmass mimicking malignant process.Case Report A 40 year old lady with previous history of pulmonary tuberculosis presented with the recent onset ofnon-tender, 2x2 cms, freely mobile lump in the left breast. Chest radiograph showed a pleural basedlesion with  erosion of fourth rib on right side with associated soft tissue mass (Figure la).Because of the radiological finding malignancy with metastasis to the chest wall was suspected. Amammogram was done which revealed a well defined nodular density without any associated micro-calcifications, skin thickening and nipple retraction (Figure Ib).Because of the eroded rib and soft tissue mass a CT scan was performed which showed a soft tissuedensity mass in relation to the right fourth rib with underlying destruction. No other intrathoracic lesionor lymphadenopathy seen. A CT guided fine needle aspiration biopsy of the thoracic lesion was done.The smear showed acid fast bacilli and later on mycobacterium tuberculosis was cultured. Biopsy ofthe breast lump was also performed which showed epitheloid cells with granuloma formationindicating tuberculosis.Discussion Tuberculosis in both primary and disseminated form is still considered a common disease in ourcountry. Tuberculosis involving the breast - tuberculous mastitis is still an uncommon and rare entity1.Even at its peak incidence in the pre- antibiotic era, the tuberculous mastitis accounted for 2% of thebreast diseases2. In 1829, Sir Astley Cooper was the first person to describe tuberculous mastitis. Sincethen occasional reports of tuberculous mastitis have been appearing in literature mostly from areaswhere tuberculosis is still prevalent3,4. The most common presentation of tuberculous mastitis is benignbreast lump1,2,5. Other presentation includes sinus or abscess formation5. There is no general consensusregarding the pathogenesis of tuberculous mastitis. The prevailing theory being direct extension orlymphatic spread6 and appears that the route of spread is exactly opposite to the route by whichcarcinoma of breast may metastasise to lungs7. The hematogenous route remains doubtful and it seemsthat breast is resistant to tubercubus infection even in patients with debilitated disease7. Themammographic presentation usually is well defined mass suggesting fibroadenosis8. The clinicaldiagnosis of tuberculous mastitis is very difficult as it may be indistinguishable clinically fromcarcinoma9 and diagnosis rests on biopsy8. Although the diagnosis is essentially on histologicalgrounds5 but acid fast bacilli are only present in few of cases5,8. Algaratnam9 has reported histologicalappearance of acid fast bacilli in 3 and positive culture in 4 of the 16 cases. In our case the presentationwas complicated by associated pleural mass as well as a rib destruction distant to the primary breastlesion mimicking a malignant process with metastasis. The final diagnosis was made on fine needleaspiration and histopathology of rib lesion as well as breast lump.References 1. Akinola, DO., Adejuyigbe, 0., Odcsarsmi, W.O. Primary tuberculosis mastitis in a Nigerian woman.West Afr. 3. Med., 1989;8:209-12.2. Schaefer, G. Tuberculosis of the breast: a review with additional presentations of 10 cases.Am.Rcv.Tuberc., 1955;72:810-14.3. Cooper, A. Illustration of the diseases of the breast L.ondon, Longmans Rees, 1829.4. Dubey, MM., Agarwal, S. Tuberculosis of the breast J. Indian Med. Assoc., 1968;51:358-59.5. Cohen, c. Tubcrculous mastitis. S. Afr. Mcd. 3., 1977;51:611-14.6. Shams, P.K., Babel, A.I., Yadav, 5.5. Tuberculosis of the breast 3. Postgrad. Med., 1991:37:24-26.7. Domingo, C., Ruiz, 3., Roig, 3., Tcxido, A., Aguilsr, X., Morers, 3. Tuberculosis of the breast: a raremodern disease. Tubercle., 1990;71:221-23.8. McKeown, K.C., Wilkinson, A.W. Tuberculosis disease of the breast Br.3. Surg., 1952;39:420-29.9. Algaratnam, T.T., Ong. GB. Tuberculosis of the breast Br.J. Surg., 1980;67:125-26.10. Banerjee, A., Green, B., Burke, M. Tuberculous and granulomatous mastitis. Practitioner,1989;233:754-57.

Tuberculous mastitis mimicking malignancy--a case report with review of literature

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Tuberculous mastitis mimicking malignancy--a case report with review of literature

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