Tuberculosis of the breast - A cytomorphologic study

OBJECTIVE: Extrapulmonary tuberculosis occurring in the breast is rare desp ite the fact that 1-2 billion people worldwide suffer from tuberculosis. Th e aim of this study was to examine the cytomorphology of breast tuberculosi s (breast TB) and to review the literature. STUDY DESIGN: Old records from the Cytopathology Laboratory, All India Inst itute of Medical Sciences, were reviewed pont January 1980 to December 1998 . Cases of breast TB where a cy cytologic diagnosis was rendered or a histo logic diagnosis with prior fine needle aspiration cytology (FNAC) was avail able were selected. These slides were reviewed for determining the cytologi c findings. RESULTS: One hundred sixty cases of breast TB were included in the study. S ix males and 154 females with a clinical suspicion of carcinoma had undergo ne FNA that was reported as TB. The majority of the patients (111) were in the reproductive age group, 21-40 years. qi the 160 cases, 118 (73.75%) had cytomorphology diagnostic of tuberculosis-epithelioid cell granulomas with caseous necrosis. Eleven of the remaining 42 cases were positive far acid- fast bacilli (AFB) on Ziehl-Neelsen (ZN) staining, while 31 cases were conf irmed to be tuberculosis on histology. ZN staining was done in 44 cases, an d AFB were demonstrated in only 38.6% of cases. CONCLUSION: Up to 73% of breast TB can be confidently diagnosed when both e pithelioid cell granulomas and necrosis are present. Also, the possibility that a woman in the reproductive age group who presents with a palpable lum p in the breast may have tuberculosis must be kept ill mind, especially as the incidence of breast TB may increase in the future with the global sprea d of AIDS.