Breast tuberculosis- clinical spectrum and management

Abstract

Objective of the study was to report the clinical spectrum, investigative profile and management of breast tuberculosis patients attending a tertiary care hospital. Breast tuberculosis is an uncommon form of tuberculosis. Knowledge of its varied clinical presentation and diagnostic modalities help in diagnosing this easily treatable disease. Retrospective data of 63 consecutive patients with breast tuberculosis was analyzed and information regarding demographic details, clinical presentation, cytology, histopathology and management was noted. Breast tuberculosis is essentially a disease of females (98.41%). 49.20% patients were below 30 years of age and 68.25% were from rural areas. Incidence of tubercular mastitis increases with parity (71.42% with p > 2). Commonest presentation was with painless lump (73%). Nodulocaseous tubercular disease was found in 74.60% patients whereas, 6.3% were of disseminated variety. Primary focus was detected in lungs in 11.1% patients, while 46.03% presented with loco-regional lymph nodes. FNAC was found to be a sensitive tool of diagnosis in 74.60% patients; however 25.39% cases were diagnosed with biopsy. ATT remained mainstay of treatment with surgical intervention as and when required. Breast tuberculosis despite being uncommon is not rare. Although diagnosis is not difficult but one should know where to suspect. Once confirmed treatment outcome is often rewarding.

Keywords: Biopsy; Breast tuberculosis; Cytology.

Fig. 1

Multiple tubercular ulcer/sinuses with breast lump involving all quadrants of breast

Fig. 2

Epitheloid granuloma with caseous necrosis and langhans type giant cells (hematoxylin and eosin stained)

Fig. 3

Tubercular abscess involving both upper quadrants

Fig. 4

Seropurulent nipple discharge

Fig. 5

Ultrasonography showing hypoechoic lesion with irregular and thickened wall