Tuberculosis of the breast]

The author observed 6 cases of mammary gland tuberculosis. 3 patients showed disseminated nodular form of mammary gland tuberculosis, 2--sclerotic form and 1--ulcerative form. Contrast-free mammography is an essential aid in diagnosis. Surgical intervention with postoperative specific antibacterial therapy is a radical method of treatment. Sectoral resection of the mammary gland should be carried out in young patients and amputation--in elderly ones.     

Tuberculosis of the contralateral adrenal gland: a case report

Unilateral adrenal tuberculosis is a very rare disease. A 66-year-old woman presented with epigastric discomfort and general fatigue. Abdominal CT scan revealed a homogeneous mass shadow in the right adrenal region. Findings of physical examination were normal except that the patient was obese. Hormonal data were in normal range. Adrenal scintiscanning demonstrated no RI uptake in the right adrenal gland. Right adrenalectomy was performed under the diagnosis of nonfunctioning tumor of the right adrenal gland. Histopathological examination, however, revealed typical tuberculosis with Langhans' type of giant cells and infiltrated lymphocytes. Of 322, 148 autopsies performed during the twelve years between 1970 and 1981 in Japan, 228 cases of adrenal tuberculosis were recognized. Furthermore, only 18 cases had tuberculous regions in the adrenal gland alone.     

32例乳腺结核临床分析

本文报告了我院20年来收治的32例乳腺结核。结核菌主要通过乳头或邻近的结核病灶侵入乳腺。病理上分为结节型、硬化型和弥散型。本病临床上较少见,极易误诊为乳腺其他疾病,尤其是乳腺癌。确诊主要依靠病理学检查。治疗主要采用手术治疗和抗结核治疗。     

Thoracic lymphadenopathy in Asians resident in the United Kingdom: role of mediastinoscopy in initial diagnosis.

Although the incidence of superficial glandular tuberculosis is high in Asian immigrants, a clinical diagnosis without biopsy has previously been shown to be inaccurate in 22% of cases. The role of diagnostic mediastinoscopy and biopsy in thoracic lymphadenopathy was therefore evaluated in 41 consecutive Asian patients. Tuberculosis was diagnosed by histological examination or culture (or both) of gland biopsy material in 24 (59%). A further 12 patients, however, also received antituberculous chemotherapy, with a response in 10 cases. If these are included, 34 (83%) were finally considered to have tuberculosis. The symptoms and ages of the patients with tuberculosis were similar to those typically seen in caucasians with sarcoidosis. Six had tuberculous bilateral hilar lymphadenopathy. In only four cases (10%) was a positive diagnosis other than tuberculosis established; in two (lymphoma and thymoma) mediastinoscopy confirmed preoperative suspicions, and saved only two more (with sarcoidosis and vascular anomaly) from unnecessary antituberculous treatment. Complications included severe haemorrhage (1) and chronic tuberculous sinus in the endoscopy tract (2). Mediastinoscopy is unlikely to change management in most patients, produces an appreciable amount of morbidity, and should be reserved for cases in which there is additional clinical doubt. Any future decline in the prevalence of tuberculosis in Asians may, however, require its further evaluation.     

Postmenopausal Breast Tuberculosis – Report of 4 Cases

Background

Breast tuberculosis is an uncommon disease even in countries where the incidence of tuberculosis is high.

Case Report

This is a case series concerning 4 postmenopausal breast tuberculosis cases encountered in Moulay Youssef Hospital between January 2007 and December 2010. Breast tuberculosis represents 0.25% of all hospitalized tuberculosis patients in our department. The mean age of our patients was 62.5 ± 5.8 years. Clinical findings were heterogeneous; 1 case was multifocal tuberculosis, and another case was coexistent tuberculosis and malignancy of the breast. Mammography and ultrasonography findings were suspicious for malignancy in all 4 cases. Fine needle aspiration was negative in 3 cases. The diagnosis was made in all patients by histological examination of biopsy specimens, which revealed typical tuberculous lesions. Anti-tuberculosis therapy formed the mainstay of treatment.

Conclusion

The clinical and radiological features of mammary tuberculosis can be very confusing and easily mistaken for breast cancer. Symptoms suggestive of tuberculosis warrant a biopsy to exclude possible cancer.     

肾结核的超声诊断与分型

目的：探讨肾结核超声诊断、分型及其临床价值。方法：回顾性分析资料完整的150例肾结核患者的超声声像图特点。结果：超声诊断肾结核的符合率为79．3％(119／150)，根据肾结核B超声像图特点，将肾结核分析归纳为6型，即囊肿型18例，积水型10例，积脓型6例，炎症萎缩型16例，钙化型31例，混合型38例。结论：超声检查具有价廉、无创等优点，对肾结核声像图的分型，有助于肾结核的诊断及鉴别诊断。     

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

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.     

Isolated tuberculous tenosynovitis of the flexor carpi ulnaris: a case report and review of literature

Musculoskeletal involvement is seen in only about 1.3% of all patients with tuberculosis. Very few cases of isolated tuberculous synovitis have been reported. The rarity of this condition often leads to the failure to consider tuberculosis in the differential diagnosis, resulting in delayed therapy. We present one such case of isolated tuberculous tenosynovitis of the flexor carpi ulnaris in an otherwise healthy, 17-year-old female, which healed completely on conservative treatment.     

Contemporary mediastinal tuberculosis.

Mediastinal lymphadenopathy is a prominent feature of adult tuberculosis in immigrant groups in the United Kingdom. Chest radiography of 95 tuberculous immigrants showed mediastinal gland enlargement in 29 cases, whereas none of the 42 Europeans showed this feature. An analysis has been made of the distribution of the disease in all groups together with a more detailed evaluation of mediastinal involvement in the immigrants. Pericardial effusions were seen in eight patients together with the following three unusual complications: (1) broncho-oesophageal fistula; (2) bronchial erosion; (3) superior mediastinal obstruction.     

Tuberculosis of the male urethra

Tuberculosis of the male urethra is a rare lesion, with only 21 cases reported in the literature. Two patients with tuberculosis of the urethra, who presented with multiple periurethral fistulas and a periurethral abscess, are described. In both patients there was associated genitourinary tuberculosis. Mycobacterium tuberculosis could be isolated from the urine and the exudate of the perineal ulcers. Biopsy from the perineal ulcers demonstrated tuberculous granulation tissue with tuberculous bacilli. Treatment consisted of suprapubic cystostomy and a 2-year course of antituberculous drugs, consisting of streptomycin, para-aminosalicylic acid and isoniazid. The urethral fistulas healed with this treatment. The urethral strictures were treated with repeated urethral dilations.     

Tuberculous abscess of the cerebellum. Apropos of a case

A 22-year-old Asian man developed intracranial hypertension with a 38 degrees C fever. Two months earlier, he had undergone surgery and medical treatment for tuberculous otomastoiditis and pulmonary tuberculosis. The CT scan revealed multiple tuberculous abscesses of the cerebellum. Histological, microbiological and biological proof of diagnosis was obtained. We advocate surgical treatment of intracranial tuberculous abscesses associated with antituberculosis chemotherapy for 18 months. The earlier the treatment, the better the prognosis. This pathology must be kept in mind when treating patients from countries with a high endemic rate of tuberculosis and suffering from immunodeficiency syndrome.     

Mycobacterial tuberculous tenosynovitis of the extensor tendon occurring after liver transplantation: a case report

Mycobacterial tuberculous tenosynovitis of the hand is a rare manifestation of extrapulmonary tuberculosis, while mycobacterial tuberculous tenosynovitis of the extensor tendon sheath is extremely rare. We report a case of tuberculous tenosynovitis of the extensor tendon of the finger, occurring in a man receiving immunosuppression following a liver transplantation. Symptoms improved clinically after conservative treatment with anti-tuberculous drugs.     

Chronic hypercalcemia as the presenting feature of tuberculous peritonitis in a hemodialysis patient

Hypercalcemia is a common electrolyte disturbance in chronic dialysis patients. Although most causes are easily identified, some are obscure. Tuberculosis, a granulomatous disease associated with hypercalcemia, can appear at anytime while the infection is active. Dialysis-associated tuberculosis is characterized by a higher risk than that in the general population, with a greater chance of extrapulmonary involvement and a high mortality rate. If the presentation of tuberculosis is atypical and its manifestation nonspecific, diagnosis can be delayed, leading to poor patient outcome. Herein, we report a case of tuberculous peritonitis in a hemodialysis patient. Asymptomatic hypercalcemia was noted 8 months before ascites became detectable. Nevertheless, the patient responded well to antituberculous therapy. We conclude that hypercalcemia can be an early sign of tuberculous peritonitis in the absence of other signs and symptoms. Remaining aware of the possibility of tuberculosis and testing for it, physicians can identify tuberculous infection earlier and initiate appropriate therapy in a timely manner.     

Isolated tuberculosis of the popliteal cyst

We encountered a case of tuberculosis of a popliteal cyst in a 76-year-old man. He visited our department for treatment of the left knee pain which had not responded to treatment over the previous ten months. At first examination, local rubor, swelling and tenderness on a popliteal cyst were noted. Therefore, curettage of the lesion, including resection of the cyst, was performed. Six weeks later, an abscess had formed in the subcutaneous area over the lateral aspect of the knee, which was cleaned out. The abscess recurred in the same area four months later. At the third operation, curettage of the abscess together with a knee joint synovectomy was performed. Upon pathologic examination, a tuberculous lesion of the popliteal cyst and skin were recognised. However, no tuberculous lesion was detected in the synovia of the knee joint. It is generally agreed that it is possible for a popliteal cyst to be infected from synovial tuberculosis of the knee joint. However, in our case, based on the histopathological and clinical observations, the primary tuberculous lesion appeared to have been in the popliteal cyst, which is very rare indeed. Recent developments in preventative medicine and chemotherapy have markedly reduced the incidence of tuberculous arthritis. However tuberculous arthritis is still an important disease in the differential diagnostic of persistent monoarthritis of the knee. Approximately half of the popliteal cyst communicate with the knee joint. However, it is not frequent for tuberculosis to propagate from the knee joint into the popliteal cyst.(ABSTRACT TRUNCATED AT 250 WORDS)     

Endovascular stent graft placement in the treatment of a ruptured tuberculous pseudoaneurysm of the descending thoracic aorta secondary to Pott's disease of the spine

Ruptured thoracic aortic tuberculous pseudoaneurysms as a complication of mycobacterium tuberculosis infection of the spine are rare. Conventional treatment of a ruptured tuberculous pseudoaneurysm involves surgery with graft interposition or patch repair. We report successful repair of a ruptured tuberculous pseudoaneurysm of the descending thoracic aorta by endovascular stent graft placement and provide a literature review of such entities.     

Epididymal tuberculosis: report of a case with particular color Doppler ultrasonography finding

Isolated tuberculous epididymitis is a rare entity. Because of the increase of this pathology, tuberculosis should be considered in the differential diagnosis of a scrotal swelling even in the absence of a history of previous tuberculosis. We report a case of isolated tuberculous epididymitis, diagnosed in an early stage, with color Doppler ultrasound findings.     

Tuberculous infection of the elbow joint

Tuberculosis remains a major health problem worldwide with musculoskeletal involvement reported to be infrequent. A resurgence of pulmonary tuberculosis is being evidenced, especially along with the increasing incidence of immunocompromised states and with this a concomitant rise in musculoskeletal tuberculosis. Unusual presentations of tubercular arthritis and equivocal investigations along with clinician inexperience can result in delay in diagnosis. The morbidity of delayed or untreated tubercular arthritis can be devastating, ending in painful ankylosis or a requirement for salvage procedures like excisional arthroplasty or arthrodesis. The early diagnosis of osteoarticular tuberculosis can be difficult. Presentation of the disease can mimic other conditions like neoplasia, non-tubercular infections and inflammatory arthropathy. Reports of tuberculous infection of the elbow are few. We report a case of a primary tuberculous infection of the elbow joint that presented as an isolated abscess in the cubital fossa, without pulmonary or systemic involvement. To prevent considerable morbidity, a diagnosis of tuberculosis should be included in the repertoire of diagnostic possibilities when confronted with unusual musculoskeletal manifestations.     

单纯性附睾结核的诊治分析

目的:提高对单纯性附睾结核的诊治水平。方法:在35例附睾结核患者中通过尿路影像学检查无肾结核及尿抗酸杆菌检测阴性者,定义为单纯性附睾结核20例进行回顾性分析,均行强化抗结核治疗,即异烟肼(INH)、利福平(RFP)、链霉素(SM)或乙胺丁醇(EB)联合用药,2周后行病灶切除术,术中均行附睾结核病灶清除,术后继续常规抗结核治疗6～9个月。结果:随访6个月～5年,16例无异常情况,3例分别于术后3、3.5、5年出现泌尿系结核感染,1例于术后3.5年出现对侧附睾结核。结论:单纯性附睾结核可能为唯一或早期泌尿生殖系结核首发的表现,及时手术治疗,预后较好。     

Inflammatory pseudotumour of the spleen associated with splenic tuberculosis

Inflammatory pseudotumor (IPT) of the spleen is an uncommon entity with an uncertain aetiology. Inflammatory pseudotumors present diagnostic difficulties because the clinical and radiological findings tend to suggest a malignancy. The symptoms include weight loss, fever, and abdominal pain. Most cases of splenic IPT present solitary relatively large well circumscribed masses on imaging. The diagnosis in the majority of the cases is made after histopathologic study of splenectomy specimens. The IPTs that occur in the spleen and liver are typically associated with Epstein-Barr virus. Thirty-seven percent of all new cases of active tuberculosis infection are extrapulmonary tuberculosis and tuberculous lymphadenitis the most commonly occurring form of extrapulmonary tuberculosis. We report the case of an inflammatory pseudotumor of the spleen associated with splenic tuberculous lymphadenitis in a 50-year-old female patient who was preoperatively diagnosed with a malignant spleen tumour based on her history of breast of carcinoma.     

The calcium-sensing receptor regulates PTHrP production and calcium transport in the lactating mammary gland

Lactating mammals must supply large amounts of calcium to the mammary gland where it is transported across mammary epithelial cells and into milk. This demand for calcium is associated with transient loss of bone mass, triggered, in part, by the secretion of parathyroid hormone-related protein (PTHrP) from the mammary gland into the circulation. The calcium-sensing receptor (CaR) is a G-protein-coupled receptor that signals in response to extracellular calcium ions. It is responsible for coordinating calcium homeostasis by regulating parathyroid hormone secretion in the parathyroid glands and by regulating calcium handling in the renal tubules. Previous studies had shown that the CaR is expressed on mammary epithelial cells during lactation, and it had been suggested that CaR signaling in the mammary gland helps to coordinate its production of PTHrP and calcium transport into milk. In this study, we examined mammary gland PTHrP production and calcium transport in CaR^+/− mice, a genetic model of CaR insufficiency. We found that haploinsufficiency for the CaR resulted in increased PTHrP production both in vivo and in vitro. In contrast, CaR haploinsufficiency impaired calcium transport into milk in vivo and transepithelial calcium transport by mammary epithelial cells in vitro. These data provide genetic confirmation that the CaR regulates PTHrP production and calcium transport in the lactating mammary gland. This allows the mammary gland to become a calcium-sensing organ and to participate in systemic calcium homeostasis during lactation.