Primary breast actinomyces simulating malignancy: A case diagnosed by fine-needle aspiration cytology

Abstract

We report a case of primary actinomycosis of breast diagnosed by fine needle aspiration cytology (FNAC) in a postmenopausal lady who presented with a clinical impression of malignancy. Resolution of infection while conserving the breast was achieved by timely diagnosis and effective antibiotic therapy. The literature reports that primary actinomycosis of the breast is very rare after menopause, with only very few cases found after extensive search. It is imperative that this condition should be considered in the differential diagnosis of malignancy. The effectiveness of cell block sections in the final diagnosis is also highlighted.

Primary Actinomycosis of Breast – A Case Report

“…Most cases of actinomycosis of the breast have involved premenopausal women like our case (14) . The differential diagnosis should include inflammatory carcinoma, chronic suppurative mastitis, tuberculosis, syphilis, and chronic osteomyelitis of the ribs (14) . Treatment consists of the prolonged administration of penicillin and, if necessary, surgery.…”

“…Actinomycosis of breast is rare and is usually secondary to thoracopulmonary actinomycosis (14) . Primary actinomycosis of the breast starts at the nipple; most of the abscesses are retropapillary (7 ) .…”

“…Primary actinomycosis of breast is one such clinical entity of which only about 32 cases (14 ) have been reported worldwide since its first description by Ammentorp in 1893 (7) . Actinomycosis of breast is primary when portal of entry is through nipple in contrast to secondary where thoraco-pulmonary actinomycosis invades breast tissue after extending through ribs and thoracic muscles (14 ) . Such a case poses challenge to the clinicians, pathologists and microbiologists.…”

Actinomyces Species Isolated from Breast Infections

“…Actinomycosis of the breast usually presents as a chronic, recurrent abscess which in some cases can be difficult to distinguish from inflammatory carcinoma (9,15,26). Fistulas and purulent or bloody discharge from sinuses may occur, which may discharge sulfur granules (26). In advanced prolonged cases, fibrosis with architectural distortion of the breast tissue is present on mammography (15).…”

“…Disruption of the mucosal barrier is the usual precursor to infection with Actinomyces species and, in the breast, the ductal system may serve as a portal of entry. Actinomycosis of the breast usually presents as a chronic, recurrent abscess which in some cases can be difficult to distinguish from inflammatory carcinoma (9,15,26). Fistulas and purulent or bloody discharge from sinuses may occur, which may discharge sulfur granules (26).…”