A 42 year old woman presents with a slowly enlarging lump in her left breast of 2 months duration. There is no associated pain or nipple discharge. She recalls a history of trauma to the affected area several months ago. Her medical history is unremarkable, while there is no family history of malignancy. She is nulliparous, and attained menarche at the age of 12. Her menstrual cycles are regular.
Mammography shows an irregular hyperdense mass approximately 2 cm in diameter in the upper outer quadrant of the breast. Four axillary lymph nodes approximately 0.5 cm in size each are noted.
Fine needle aspiration cytology shows several necrotizing epithelioid cell granulomas. Ziehl-Neelsen stains demonstrate the presence of acid-fast bacilli.
The chest x-ray shows an area of cavitation in the right upper lung. The left lung appears unaffected. The hila appear normal.
CA 15-3, CA-125, CA 19-9, alpha-fetoprotein (AFP) and carcinoembryonic antigen (CEA) levels are all normal.