Primary breast tuberculosis

A 67-year-old Mediterranean single lady presented with a right breast lump that had been gradually increasing in size for four months. On palpation, the mass measured 3 x 5 cm in size and felt solid and irregular in nature. No redness or change in skin color was noted. A draining sinus from the medial aspect of the ipsilateral axilla was noted. This was associated with purulent discharge and a palpable 2 cm axillary lymph node. The patient reported no fever, cough or sputum production. Her chest Xray was normal. Ultrasound of the breasts showed a large hypoechoic solid nodule with slightly irregular contour in the right breast (A) raising the suspicion of a phylloides tumor or fibroadenoma. Multiple axillary lymph nodes were also noted, one of which was associated with a sinus tract. Mammography revealed a suspicious irregular mass in the right breast (B). Magnetic resonance imaging (MRI) of the breasts showed a macro-lobulated cyst with a necrotic component and a thick peripheral rim (C). There was extension to the pectoralis major muscle with linear extension to the lymph nodes, some of which were necrotic. Core needle biopsy of the cystic mass ruled out malignancy but showed abundance of inflammatory cells. The patient was taken to the operating room for excision of the right breast mass. An incision over the mass was extended to the axilla whereby the mass was totally excised down to the pectoral muscles together with the axillary sinus which was communicating with both lymph nodes. The frozen section was negative for malignancy.