Tuberculous mastitis

Abstract

Objective: To find out the different clinical presentations of breast tuberculosis and its treatment outcome.

Design: An observational study.

Place and duration of study: Surgical ward 3 of Jinnah Postgraduate Medical Centre, Karachi from June 2001 to November 2003.

Subjects and methods: Fifty consecutive female patients above 13 years presenting with breast lump, multiple sinuses, axillary lymphadenopathy, and cold abscess were included in the study. Medical records of the patients presented were reviewed and analyzed. Data was collected regarding the patient's name, age and marital and lactational status. Clinical Examinations and investigations were carried out by triple assessment i.e. clinical, radiological and histological / cytological evaluation.

Results: The commonest presentation was a solitary breast lump in 30 (60%) patients, breast lump with axillary lymphadenopathy in 13 (26%). Four (8%) patients presented with generalized breast swelling (edema) with ipsilateral axillary lymphadenopathy. Two (4%) presented with breast abscess and axillary lymphadenopathy and one (2%) with axillary sinus and breast lump. Upper outer quadrant was most frequently involved in 29 (58%) of patients. Thirty-two (64%) cases were secondary to tuberculosis in other sites, mostly (40%) from tuberculous axillary lymphadenitis. Forty-eight (96%) patients responded well to one year antituberculous treatment with complete disappearance of the lumps except 2 patients who had shrinkage of lump size only, underwent excision of lump.

Conclusion: Solitary lump and enlarged lymph nodes are the commonest presentation of mammary tuberculosis. Early diagnosis and treatment is necessary to prevent disfigurement of breast. Antituberculous therapy is the treatment of choice. Surgery should be reserved for unresponsive lumps.