International Journal of Clinical Case Reports 2017, Vol.7, No.19, 86-90
88
2 Discussions
Breast tuberculosis is a very rare form of tuberculosis. Its frequency varies from 0.06% to 0.1% of tuberculosis
(Khanna et al., 2002; Agoda-Koussema et al., 2014). The rarity of this clinical form could be explained by the fact
that breast tissue does not seem to be very conducive to the survival and multiplication of tubercle bacilli
(Marinopoulos et al., 2012).
It essentially affects the young woman (Boukadoum et al., 2012). Pregnancy, lactation and multiparity are risk
factors (Hawilo et al., 2012), which are explained by the effect of galactophoric ectasia during lactation.
Routes of infection are diverse (Khanna et al., 2002): the lymphatic route or axillary lymphadenopathy is often
found; hematogenous pathway, in the context of a miliary tuberculosis; propagation by contiguity from a
neighborhood focus; The ductal: dilation of the galactophoric ducts in women during pregnancy or lactation
increases the sensitivity of these ducts to infection with bacilli; The direct way: exceptional, it is the penetration of
the bacillus of Koch in the breast following a cutaneous abrasion or galactophoric.
Classically, there are two types of breast tuberculosis: secondary with involvement of other organs and primary or
tuberculosis appears strictly localized in the breast, the latter is the most common (Marinopoulos et al., 2012;
Gulpinar et al., 2013).
Concerning our patient the attack was primitive.
The attack is often unilateral and sits mainly at the level of the upper quadrant of the breast bilateral would be
observed in only 3% of cases.
Clinically, mammary tuberculosis is characterized by the absence of specific clinical signs (Hawilo et al., 2012),
whether in the form of a nodular mass or an inflammatory mass mimicking breast cancer. General signs of
tuberculous impregnation (asthenia, anorexia, weight loss and vesperal fever) are classically present, but may be
absent or incomplete.
However, there are clinical criteria that can lead to tuberculosis (Khanna et al., 2002): the existence of recurrent
abscess rebelling to antibiotics; the existence of fistulized axillary lymphadenopathy, mammary fistula with nipple
discharge and the existence of a breast fistula with intermittent flow rhythmized by the menstrual cycle.
On the radiological level, there are no specific mammographic signs of mammary tuberculosis (Morsad et al.,
2000; Filippou et al., 2003), mammography may show irregular heterogeneous opacities, poorly limited
sometimes with calcifications rather orienting towards a malignant etiology. On ultrasound, mammary
tuberculosis often appears as a hypoechoic, heterogeneous image well or poorly limited with minimal posterior
reinforcement (Filippou et al., 2003). On MRI, the aspects are not specific because they are found in carcinomas
and abscesses. However the MRI makes it possible to make the assessment of locoregional extension.
The intra dermal reaction to tuberculin is usually positive in the endemic area. This test is insensitive, and may
give false negatives, not excluding the diagnosis of tuberculosis (Daali et al., 2001).
The diagnosis of certainty is histological examination (Mirsaeidi et al., 2007) with the detection of epitheloid and
giant cell granuloma with caseous necrosis.
The diagnosis of certainty can be as bacteriological and is based on the identification of Mycobacterium
tuberculosis in the biopsy or in the secretions of breast fistula. However, the tubercle bacillus is not found only in
25% of cases (Makanjuola et al., 1996). In addition, culture it takes four to six weeks.
The main differential diagnosis to be feared in breast tuberculosis is breast cancer. Other pathologies are to be
discussed, such as breast abscess, fibroadenoma, sarcoidosis and granulomatous mastitis.
