OBJECTIVE: To review the diagnostic and therapeutic challenges
associated with treating isolated primary breast tuberculosis through
discussion of our series of seven cases.
BACKGROUND: Although breast is an uncommon site of occurrence
of tuberculosis and isolated primary breast tuberculosis is an even rarer
entity, its importance lies in distinguishing it from more common
pathologies like abscesses or malignancy and avoiding unnecessary erroneous
surgical intervention. The spectrum and presentation is wide and varied and
we present our experience in managing seven such cases.
MATERIALS AND METHODS: A retrospective analysis of all the
cases of histopathologically proven primary breast tuberculosis in the last
three years at M.S. Ramaiah Hospital (2012-2014) was done. Analysis was in
terms of mode of presentation, clinical features, diagnostic modalities used
for evaluation and confirmation of the diagnosis, medical treatment and
surgical intervention, if any. Special emphasis was placed on dilemmas in
diagnosis and difficulties encountered during treatment. All cases were
followed up till cure.
RESULTS: Patients most commonly presented with a breast
abscess, painful breast lumps and recurrent abscesses. Other foci of
tuberculosis were ruled out in all of these patients. Majority were treated
exclusively with anti-tubercular therapy (although regimens varied), but
those with abscesses underwent incision and drainage. All cases were treated
and followed up till cure.
DISCUSSION: The challenges associated with primary breast
tuberculosis are multiple, including which anti-tubercular therapy regimen
to use, when to surgically intervene (as the breast is a cosmetically
important area) and treating atypical mycobacteria. We provide a detailed
discussion of the challenges we faced and review of literature.
