October - LRS Institute of Tuberculosis & Respiratory Diseases

CASE REPORTS
TUBERCULOSIS OF THE BREAST
S.H. KULKARNI,* H.R. TATA,** ANP M. JAIRAMAIAH***
Summary : Mammary gland is an unusual site for tuberculosis and it appears to have peculiar
resistance to tubercular infection. Eighty biopsy proved cases of tuberculosis of the breast are reported.
Most of the cases were in 21-30 years age-group. 91.25% patients presented with a lump and 32.5%
patients presented with lump and sinus both. Both the breasts were involved in one case. Six cases had
associated pulmonary tuberculosis. Eleven patients were lactating. Associated malignancy was found
in two cases. Excision followed by chemotherapy was the treatment given.
Introduction
Sir Astley Cooper in 1829 had described this
entity as a “Scrofulous swelling in the bosom
of young women”. Since then, several cases
have been reported. In the present study, 80
cases of breast tuberculosis seen during the
last 16 years, i.e., 1963 to 1979, are reviewed.
Patients and Methods
The cases included have been taken up from
the patients attending the surgical department of
the Wanless Hospital, Miraj. Some cases are
also included whose histopathology was reported
from the Pathology Department of the hospital,
though the cases were treated elsewhere.
Seventy eight patients were females and two
were males. The majority of the patients were
under the age of 40 years (63 out of 80). Largest
number of cases was in the age group 21-30
years. Youngest patient was 15 years and oldest
70 years old. Two patients were pregnant and
11 were lactating. The mode of presentation was
a lump in 73 patients and both lump and discharging
sinus in 26 patients. The lump was
painful in 20 patients. The axillary lymph
nodes were enlarged on the side of breast lesion
in 16 patients. Six patients had associated
pulmonary tuberculosis and one had cervical
lymphadenitis. In the remaining 57 cases no
other tuberculous focus could be detected
anywhere in the body.
In all the patients the diagnosis was made
by biopsy of the lesion with histological examination.
Diagnostic criteria included the presence
of granulomatous inflammatory infiltration or
the presence of tubercles with central cassation.
Acid fast bacilli were seen in only 5 cases.
These patients were treated by excision of
the mass or wedge excision of the abscess cavity
and overlying sinuses, followed by antituberculous
chemotherapy for 18 months.
Discussion
Most of the cases occur below the age of
40 years. In the present series, 63 patients out of
80 were below 49 years. In the series of Dharkar
et al (1968) most of the cases were in the age
group 18-25 years. Thirteen out of the 14 cases
reported by Dubey and Agarwal (1968) were
between 20 and 40 years in age.
Involvement of the breast tissue by a tuberculous
disease is not common. It may be due
to mammary tissue itself being unsuitable
for multiplication and survival of tubercle
bacilli. Raw (1924) observed only 7 cases in
10,000 necropsies in a T.B. Sanatorium.
Nagashima (1925) did not find a single case of
breast involvement in 34 autopsies on the patients
with miliary tuberculosis.
There is a controversy regarding the possible
route of entry of bacilli in the breast. The
bacilli may reach the breast tissue via blood
stream., lungs or from contiguous structures
(Nagashima, 1925; Hall, 1936; Raven, 1949).
According to McKeown and Wilkinson (1952)
infection travels from the lungs to the breast
tissue via tracheobronchial lymph nodes. In
the present series 6 patients had pulmonary
and 17 patients had nodal involvement. In the
remaining 57 cases no other tuberculous focus
could be detected anywhere in the body.
McKeown and Wilkinson (1952) classified
tuberculosis of the breast in following subgroups
on the basis of clinico-pathological cor
relation.
(i) Acute miliary tuberculous mastitis in
* Reader in Surgery
** Associate Professor of Surgery
*** Associate Professor of Pathology
Wanless Hospital, Miraj Medical College, Miraj-416 410.
Ind. J. Tab., Vol. XXIX, No. 4