A case of breast tuberculosis suspected cancer by imaging findings

Background : Tuberculosis (TB) of the breast is very rare, as the breast tissue is known to be relatively resistant to tubercular infection. Herein, we report a case of breast TB that was initially suspected as a case of breast carcinoma based on the imaging findings.Case : A women aged in her 70 s presented with a lump in her right breast. Ultrasonography showed several nodular lesions in both breasts. The largest lesion was an intracystic papilloma-like lesion, measuring 11×11mm in size, located in the B area of the right breast. It was judged as being mammography category 3 and magnetic resonance imaging category 5, suggestive of carcinoma. Fine-needle aspiration cytology (FNAC) showed granulomatous cells (epithelioid cells, multinucleated giant cells, fine granular necrosis), although, because of the presence also of some atypical spindle cells, we could not make a definitive diagnosis. Excisional biopsy was performed, and histological examination confirmed the features of TB. Retrospective immunohistochemical analysis and immunocytochemical analysis for CD68 suggested the possibility of the spindle cells being of histiocytic origin.Conclusion : TB of the breast is a rare benign disease, but the imaging findings can mimic those of breast carcinoma. Therefore, FNAC would be indicated for obtaining the diagnosis in these patients. Pathologists examining breast FNAC specimens should bear in mind the possibility, even though rare, of breast TB.