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Breast-nonmalignant

Inflammatory / infectious

Tuberculosis

 

Reviewer: Hind Nassar, M.D. in January 2009 (see Authors page)

Revised: 30 September 2012, last major update April 2010

Copyright: (c) 2002-2010, PathologyOutlines.com, Inc.

 

Definition

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Terminology

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● Also called tuberculous mastitis

 

Epidemiology

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● Rare in Western countries, but more common in India (The Internet Journal of Tropical Medicine 2005;2(2))

 

Sites

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Etiology

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Clinical features

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● May present with abscess, fistula or mass (Trans R Soc Trop Med Hyg 2009;103:559)

● Usually unilateral without pulmonary involvement (ANZ J Surg 2006;76:234, Clinics (Sao Paulo) 2009;64:607)

● Acid-fast bacilli are usually not identified

● For breast cancer patients with granulomatous axillary lymphadenitis, PCR may be required to rule out TB in endemic regions (Pathol Res Pract. 2007;203:699)

 

Prognostic factors

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Case reports

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● 30 year old woman with costochondral junction TB presenting as breast mass (Cases J 2009 Sep 9;2:7039)

● 47 year old woman with coexisting ductal carcinoma (World J Surg Oncol 2008;6:29)

● 54 year old woman with Mycobacterium abscessus, a particularly pathogenic strain (J Plast Reconstr Aesthet Surg 2010;63:e397)

● 73 year old woman with TB mimicking breast cancer (J Med Case Reports 2008;2:34)

 

Treatment

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● Antibiotics (eMedicine); excision of mass may also be necessary (J Coll Physicians Surg Pak 2009;19:158)

 

Clinical images

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†††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††

Resembles breast carcinoma††††††††††††††††††††††††††††††††††††††† Costochondral junction TB

 

 

††††††††††††††††††††††††††††††††††††††††††††††† ††††††††††††††† Figure 1 -

Partially healed fistulas after††††††††††††††††††††††††††††††††††††††††† Discoloration of overlying skin

Initiation of treatment††††††††††††††††††††††††††††††††††††††††††††††††††††††† and multiple sinuses

 ††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††

Gross description (Macroscopy)

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● Multiple sinuses or fistulas; may have focal discoloration or mass

 

Gross images

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Micro description (Histopathology)

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● Granulomas with Langhans giant cells and caseous necrosis (often)

 

Micro images

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††††††††††††††† ††††††††††††††† ††††††††††††††† †††††††††††††††

Granulomatous inflammation of major†††††††††††††††††††††††† Granulomatous inflammation

lactiferous duct with epithelial necrosis††††††††††††††††††††† and Langhans giant cells

 

 

†† †††††††††††† ††††††††††††††† †††

Granuloma with central necrosis and††††††††††††††††††††††††† Suppurative granuloma

epithelioid histiocytes†††††††††††††††††††††††††††††††††††††††††††††††††††††† and inflammatory infiltrate

 

 

††

TB and infiltrating ductal carcinoma

 

Virtual Slides

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Videos

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Cytology description

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● Foamy histiocytes, neutrophils, necrotic debris

 

Cytology images

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Positive stains

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Negative stains

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Electron microscopy descriptions

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Electron microscopy images

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Molecular / cytogenetics description

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Molecular / cytogenetics images

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Differential Diagnosis

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● (link to topic)

 

Additional references

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End of Breast-nonmalignant > Inflammatory / infectious > Tuberculosis

 

 

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