Cytolomorphological Spectrum of Tubercular Mastitis in a Tertiary Hospital in North India - Abstract
Introduction: Although tuberculosis (TB) is common in endemic areas, isolated tubercular mastitis of the breast is very rare. Its incidence in India has been described as ranging from 0.1 to 3%
Aims and objectives: To study the cytomorphological spectrum of breast tuberculosis and review the literature
Materials and Methods: This is a retrospective study done over past 6 years of patients who presented with a breast lump, and were referred for Fine needle aspiration (FNA) at Cytopathology Laboratory, Maulana Azad Medical College. FNAC smears were reviewed for cytomorphological spectrum.
Results: Hundred and seventy cases (170) were included in the study of which 159 were female and 11 male patients. 88% of female patients were in the reproductive age group. Either breast was affected in equal proportions. All patients presented with a palpable lump along with an associated nipple discharge in 12 cases. FNAC yielded purulent, whitish and hemorrhagic aspirate in 68%, 21% and 11% cases respectively. Cytology smears were studied in detail and were grouped as I to IV- I: epithelioid cell granulomas (ECG) only (30%), II: caseous necrosis only (16.5%), III: both granulomas and caseous necrosis (14.7%) IV: acute inflammation (38.8%). Acid fast bacilli were demonstrated in 46 cases. Histopathological correlation was observed in 18 cases.
Conclusion: TB breast is rare but not so uncommon in India. It poses diagnostic difficulty both clinicoradiologically and on cytology more so in the elderly women. The diagnosis can be established with accuracy on cytology alone with the help of special stains. Epithelioid cell granulomas may not always be present, hence a holistic approach should be adopted to arrive at the correct diagnosis, whenever suspecting possibility of tuberculosis in a breast lump.