Tuberculosis of the breast masquerading as carcinoma: A study of 100 patients

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Abstract
One hundred patients with tuberculous mastitis were referred to the Tata Memorial Hospital, a cancer center, with a clinical diagnosis of malignancy. This study identifies the possible causes of misdiagnosis and reviews the management of these patients. A lump in the breast with or without ulceration was the commonest presentation, the others being diffuse nodularity and multiple sinuses. Concomitant axillary lymph nodes were found in one‐third of the patients. Tuberculosis lesions such as nodular mastitis, disseminated mastitis, and sclerosing lesions clinically mimicked a fibroadenoma, carcinoma, and fibrocystic mastitis depending on the mode of presentation. A young, multiparous, lactating woman with a lesion should arouse the suspicion of tuberculous mastitis, although pretherapcutic pathologic confirmation of a benign disease is mandatory. Mammography, fine‐needle aspiration cytology, and excision biopsy for this purpose are successful in 14%, 12%, and 60% of cases, respectively. Acid‐fast bacilli were identified in 12% patients. All patients received antituberculous chemotherapy, and 14% patients required simple mastectomy, due to either lack of response to chemotherapy (10%) or large painful, ulcerative lesions involving the entire breast (4%). Axillary dissection was performed in only 8% patients with large ulcerated axillary nodes. All patients, followed for a minimum of 2 years, were free of disease after therapy.