Tuberculosis, Breast

Surprised

Step 1: View clinicals

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.


Step 2: Order all relevant investigations

Mammography

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.

FNAC

Fine needle aspiration cytology shows several necrotizing epithelioid cell granulomas. Ziehl-Neelsen stains demonstrate the presence of acid-fast bacilli.

Chest X-Ray

The chest x-ray shows an area of cavitation in the right upper lung. The left lung appears unaffected. The hila appear normal.

Tumor markers

CA 15-3, CA-125, CA 19-9, alpha-fetoprotein (AFP) and carcinoembryonic antigen (CEA) levels are all normal.


Step 3: Select appropriate management

Mastectomy
IV Antibiotics
Methotrexate
Antituberculous therapy


Score: ★★☆