Tuberculosis breast and its coexistence with carcinoma breast: A retrospective analysis at a tertiary care hospital in India

Abstract

KEYWORDSbreast carcinoma, breast tuberculosis, coexistence Tuberculosis (TB) is a major health problem and it is an important cause of mortality and morbidity in all age groups.1 Among communicable diseases, TB is the second leading cause of death worldwide. 2 TB has traditionally been regarded as a pulmonary disorder.However, nearly 17.9% of TB cases have only extrapulmonary manifestations. 3Granulomatous inflammation of the breast is an inflammatory process with multiple aetiologies. It can be caused by breast cancer, TB, granulomatous mastitis, sarcoidosis, fungal infections such as actinomycosis, and parasites such as filariasis, Wegener's granulomatosis, duct ectasia, brucellosis, and traumatic fat necrosis. 4Sir Astley Cooper in 1892 described the first case of TB of the breast. 5 TB breast can be classified as primary or secondary. Primary involvement is tuberculous infection confined only to the breast and is extremely uncommon. 6The coexistence of primary TB and breast cancer was reported only in 1897 by Pilliet and Piatot, and the TB of axillary lymph nodes was reported by Warthin in 1899. 7The synchronous occurrence of TB and carcinoma in breast is unusual and the literature includes single case reports probably due to the rarity of the disease. identified. Out of these 139 patients, four patients were male and rest 135 patients were female. One thirty five patients had carcinoma breast, three patients had isolated TB of breast, while only one patient had co-existing TB and carcinoma of ipsilateral breast.Two patients had bilateral breast carcinoma. All four male patients in this study had carcinoma breast only. Majority of the patients were in the age group of 40-60 year (77 patients), while 36 patients were younger than 40 years and 26 patients were above 60 years (Table 1).Seventy percent of the patients had clinically T2 lesion, 8.6% of patients had T1 lesion, 12.23% had T3 lesion and 7.91% patients had T4 lesion at presentation. Twenty four patients had no clinically palpable nodes while N1 nodal status was found in 79 patients at presentation and 33 patients had N2 axillary nodes. Only 1.4%patients showed metastasis at presentation. Out of four breast TB patients only one had coexisting breast carcinoma. This patient was treated with Modified radical mastectomy followed by anti-tubercular treatment and adjuvant chemotherapy. The other three were put on category II anti-tubercular therapy.

Breast Tuberculosis: Case report and review literature

“…The disseminated form is characterized by sinus formation secondary to multiple TB foci. The sclerosing form is seen when there is extensive fibrosis rather than caseation, and the entire breast hardens with a retracted nipple (Gon et al, 2013;Bhat et al, 2017).…”

“…TB has increasing clinical relevance in Western countries due to immigration, as a strong ally of lack of guidance will certainly delay diagnosis and may result in unnecessary surgeries (Gupta et al, 2017;Bhat, Gunasekaran et al, 2017).…”

“…Mammary Tuberculosis, a rare extrapulmonary form of Tuberculosis, can present in the form of an abscess or as a unilateral, painless breast mass. This condition has two primary and secondary subtypes (Bhat et al, 2017). The primary form involves a tuberculous infection located exclusively in the breast and is an extremely rare condition (Haitz et al, 2019).…”