Tuberculosis of the breast: rare but still extant. Review of the literature and report of an additional case

Abstract

Tuberculosis of the breast is a rare malady that is usually manifested by a unilateral mass suggestive of carcinoma or sometimes of abscess. Mammography also suggests carcinoma in most instances. However, at operation, the discovery of necrotic tissue or abscess may lead to the suspicion of infectious or inflammatory disease rather than neoplasm. The diagnosis of tuberculosis may be established by the demonstration of acid-fast bacilli in excised tissue, by culture studies, or by guinea pig inoculation; however, the diagnosis is usually not suspected. In the past, mastectomy was the usual treatment. Today, successful treatment combines antituberculous drug therapy with the removal of infected breast tissue. The prognosis for complete cure is excellent. One case of secondary tuberculous mastitis has been reported herein. The patient, an Egyptian woman residing in the United States since 1973, was treated in Egypt for pulmonary tuberculosis at age 17. She presented in 1982 with a breast mass that mimicked carcinoma on physical examination and mammograms, but excisional biopsy and histologic examination revealed a breast abscess that contained caseous material and a solitary acid-fast bacillus. The patient was cured of her disease after appropriate operation and a course of antituberculous drugs. This has been the only documented case of mammary tuberculosis at our institution. Despite its rarity, tuberculosis of the breast should not be forgotten in this age of world travel.