Mammary tuberculosis mimicking breast cancer: a case report

We present a case of breast tuberculosis diagnosed in a 73 year old woman at our institution. The patient presented with a palpable mass of the right breast with clinical, laboratory and mammographic findings indicative of breast carcinoma. The patient underwent lumpectomy and sentinel lymph node biopsy. Frozen section of the tumor and the sentinel node revealed "granulomatous inflammation", while gross examination confirmed the diagnosis of tuberculous mastitis. The patient received anti-tuberculosis therapy for six months with no side effects or any further complications.Breast tuberculosis is an obscure disease often mistaken for carcinoma or pyogenic abscess of the breast, especially if well-defined clinical features are absent. A high index of suspicion is required because the disease can usually be treated conservatively with current antituberculous modalities while surgical intervention is reserved for rare cases only.The incidence of tuberculosis is sharply rising in developing and developed countries and rare extrapulmonary manifestations of the past can pose challenges in clinical practice. This may be due in part to the increasing number of geriatric patients, especially those with immunosuppression, as well as due to the development of drug resistant strains of Mycobacterium tuberculosis [1,2].The clinical signs of mammary tuberculosis can be insidious and nonspecific and often simulate signs of breast carcinoma. Mammary tuberculosis usually affects young, multiparous, lactating women although it may also be seen in males in 4.5% of cases [3]. The breast can be the primary site but more commonly, tuberculosis spreads to the breast through the lymphatic system from axillary, mediastinal or cervical lymph nodes, or directly from underlying structures such as the ribs. Most commonly the disease presents as a lump in the central or the upper outer quadrant of the breast while multiple lumps are less frequent. The borders of the lump are usually irregular whi