Tuberculosis of the breast

Tuberculosis of the breast is rare in western countries (Haagensen, 1971; Raw, 1924), and is unusual even in countries where other forms of tuberculosis are common (Mukerjee et al., 1974). It usually presents as a mass or abscess in the breast and clinically may be mistaken for a carcinoma. Indeed carcinoma and tuberculosis may co-exist in the same breast (Miller et al., 1971; Grausman and Goldman, 1945). We wish to present a case in which the diagnosis of tuberculosis of the breast was made radiologically prior to surgery. A 60-year-old Caucasian woman presented with a painless mass in her left breast. On examination there was a very firm, non-tender, 9 cm diameter mass in the upper outer quadrant of the breast. There was no axillary lymphadenopathy. A routine pre-operative chest radiograph demonstrated consolidation in both upper lobes, more marked on the left, and enlarged left hilar lymph nodes (Fig. 1). Mammography (Figs. 2a and b) demonstrated marked skin thickening laterally and thickened, distorted trabeculae with loss of normal architecture throughout the breast. Surgical exploration of the mass produced pus containing tubercle bacilli. Subsequent sputum specimens were also positive for tubercle bacilli. There have been very few reports of the use of mammography in the diagnosis of tuberculosis of the breast. Features previously noted have been nonspecific dense mass lesions of variable size and shape but with no skin thickening (Gottschalk et al., 1976), and dense oval areas with irregular contours suggesting malignancy (Tabar et al., 1976).