A rare and interesting case of primary mammary tuberculosis mimicking breast carcinoma

Introduction

Mammary tuberculosis (MT) is an extremely rare form of extrapulmonary tuberculosis (TB), which is uncommon even in countries where TB is considered to be endemic. It can occur in primary and secondary forms, clinically and radiologically, both of which can mimic breast carcinoma or persistent breast abscess.

Case presentation

A 35-year-old multigravida presented with a history of swelling in the right breast and axilla that had begun six months earlier, to be followed three months later by a yellowish dirty discharge, and five months later by blackish discolouration of the overlying skin. Ultrasonography (USG) showed cutaneous oedema and lymphatic dilatation in the right breast with a lump measuring 6 cm × 7 cm, as well as three significantly enlarged pectoral lymph nodes in the right axilla.

Discussion

The most common type of MT is the nodular pattern which may be mistaken for carcinoma or fibroadenoma. MT may present as multiple heterogeneous, hypoechoic masses with irregular margins, or on USG as thickwalled cystic lesions with septa and sinus tracts. It can only be accurately diagnosed by histological identification of typical necrotising granulomas in the tissue sections. Conservative surgery (local excision of the mass) if needed, followed by antitubercular therapy is the standard treatment protocol.

Conclusion

An atypical rare entity, primary MT may mimic adenoma or carcinoma and may often be misdiagnosed without formal histopathology due to its intriguing clinical and radiological features.