Tuberculosis of the breast. Considerations on a case]

A recently observed case of T.B. of the breast is presented and the relevant literature is examined. View are expressed concerning the aetiopathogenesis, diagnosis and treatment of this unusual form, particular attention being given to the difficulty of distinguishing it from carcinoma. Stress is laid on the importance of surgical management, this being indispensable for both correct diagnosis and for treatment.     

Tuberculosis of the female breast

The authors briefly summarize the most important characteristics of the female breast tuberculosis. They base their data on 7 histologically verified cases as well as on 2 other cases which, in view of the course of disease, were suspected to be breast tuberculosis. The various courses of disease as well as the difficulties in its differential diagnostic are described.     

Tuberculosis of the breast: medical treatment

Two patients with breast tuberculosis (BT) were discussed. In the presentation of each of the patients were a breast lump without pain and purulent discharge. There was associated axillary lymphadenopathy in one patient. Diagnoses were done by open biopsy and only antitubercular therapy was given to the patients. After two months of therapy, the breast lumps disappeared completely from both patients. Treatment was continued for 9 months. In breast tuberculosis, medical therapy can be used without further surgical intervention.     

Tuberculosis of the breast: Report of eight cases

In the 8 cases here reported (Table II), the average age was thirty-two years; youngest twenty years, oldest forty-six years. The nodular type was present in 7, the sclerosing type in one. The left breast was involved in 4, the right in 4. The upper outer quadrant alone was the seat of disease in 2, the inner lower quadrant alone in one, the outer lower quadrant alone in 2, the inner lower quadrant in one, and the outer lower and outer upper quadrants together in 2. The tuberculous mass was fixed in all 8 cases. The overlying skin was attached to the mass in 7 cases and not attached in one case. Pig-skin appearance was present in 6, including the mixed case (II) of carcinoma and tuberculosis, and not present in 2. Retraction of the nipple was present in 5 and not in 3. No case gave a history of discharge from the nipple. The breast was fixed to the chest wall in 5 cases and not so in 3 cases. A sinus was present in 4 cases and absent in 4. Axillary nodes were palpable in 7 cases. Clinical evidence of tuberculosis elsewhere in the body was present in only one case of the 8. The initial symptom was a lump in 6 cases, painful in 2 and not painful in 4 cases of the 6. An acute abscess was the initial symptom in 2 of the 8 cases. Only one case gave a positive past history of tuberculosis and possibly one other (V) who reported adenitis of neck nine years previously. Family history was negative in all cases. Only one case gave a history (VIII) of previous acute inflammation of breast. Five of the 8 cases gave a history of lactation, 6 of the 8 of pregnancy and 2 had never been pregnant. The shortest time from onset to admission to hospital was four weeks: the longest time one and onehalf years. The Wassermann reaction was positive in 3 cases, negative in 4, not recorded in one. The clinical diagnosis was tuberculosis in 2, carcinoma in 6. Tubercle bacilli were demonstrated in none. The diagnosis of tuberculosis of the breast was made by microscopic study of the tissues in all 8 cases. Six of the 8 patients were reported living and well; 1 eight years, 1 four years, 1 two years, and 3 one year each, after the operation. One patient died of shock within twenty-four hours after operation and one (II) died of metastatic cancer fifteen months after operation.     

Tuberculosis of the breast in a patient undergoing hemodialysis

A 61-year-old female patient with diabetes undergoing maintenance hemodialysis presented with fever and swelling of her right breast. She had been unresponsive to nonspecific antimicrobial therapies. Breast tuberculosis and tuberculous lymphadenitis were diagnosed by excision biopsy and tissue culture. A combination antituberculous treatment including isoniazid, rifampin, ethambutol, and pyrazinamide was started and resulted in the remission of the lesions by the end of the first month of therapy.     

Sarcoma of the breast]

Sarcoma of the breast represents only 0.2-1% of all mammary malignancies. This study reports 5 such cases, including 2 osteosarcomas, 1 fibro-, 1 lipo-, and 1 malignant fibrous sarcoma. The treatment used was mastectomy in 3 cases with excision of axillary lymph nodes. The remaining 2 patients were treated by simple mastectomy whereby 1 of these received a immediate reconstruction with a prosthesis. 1 patient demonstrated local recurrence and died. The remaining 4 patients did not develop neither metastases nor local recurrence and are still alive after an observing period between 12 months up to 17 years. Today, first-line treatment is wide local excision or simple mastectomy. Excision of the axillary lymphatics, adjuvant radiotherapy, and chemotherapy have been disappointing in the treatment of breast sarcoma.     

Tuberculosis of the breast: experience of a UK breast clinic serving an ethnically diverse population

Tuberculosis (TB) of the breast is an uncommon disease in the West but its incidence is likely to increase. Five cases of breast tuberculosis are presented. The diagnosis and management of this condition are discussed.     

Bilateral carcinoma of the breast]

Bilateral breast cancer is examined in the light of the literature data and a personal series. Lobular, asynchronous forms, either in situ or infiltrating, are usually involved. The fact that in situ changes are often found in the second neoplasia, with metastases solely in its tributary lymph nodes, suggests that such carcinoma was already present at the time of the first operation, though not clinically detectable. Since bilateral forms are commonly hormone-dependent, multiple biopsies should be routine on the contralateral breast. Preventive mastectomy associated with ovariectomy shold be performed on the slightest sign of carcinomatous or even precancerous alterations.