Mammary tuberculosis -- importance of recognition and differentiation from that of a breast malignancy: report of three cases and review of the literature

Abstract

Background: While tuberculosis of the breast is an extremely uncommon entity seen in western populations, it accounts for up to 3% of all treatable breast lesions in developing countries.

Case presentations: We reviewed three female cases of mammary tuberculosis that were diagnosed and treated in Turkey during the same calendar year. All three patients presented with a painful breast mass. In all cases, fine needle aspiration was nondiagnostic for mammary tuberculosis. However, the diagnosis of mammary tuberculosis was confirmed by histopathologic evaluation at the time of open surgical biopsy. All three patients were treated with antituberculous therapy for six months. At the end of the treatment period, each patient appeared to be clinically and radiologically without evidence of residual disease.

Conclusion: The diagnosis of mammary tuberculosis rests on the appropriate clinical suspicion and the histopathologic findings of the breast lesion. Its recognition and differentiation from that of a breast malignancy is absolutely necessary. Antituberculous chemotherapy, initiated immediately upon diagnosis, forms the mainstay of treatment for mammary tuberculosis.

Figure 1

Craniocaudad mammographic views showing generalized increased radioopacity within the left breast.

Figure 2

An ill-defined, hypoechoic, heterogenous 6 cm lesion is seen in the upper-inner quadrant of the left breast on ultrasonography.

Figure 3

Mediolateral oblique mammographic views showing increased radioopacity within the upper pole of the left breast.

Figure 4

The histopathologic examination of the specimen revealed granulomas with central caseation necrosis, epitheloid histiocytes, Langhans' giant cells, and intense lymphocytic infiltration at the periphery of the granulomas (H&E, ×40).