Case report: breast cancer associated with contralateral tuberculosis of axillary lymph nodes
© Baslaim et al.; licensee BioMed Central Ltd. 2013
Received: 21 October 2012
Accepted: 16 February 2013
Published: 25 February 2013
Breast cancer coexisting with tuberculous axillary lymph nodes is rare.
We report a 69 years old Yemeni patient with a left breast invasive ductal carcinoma associated with contralateral tuberculous axillary lymph nodes containing microcalcifications mimicking malignancy. The patient had to be investigated for the possibility of bilateral breast cancer since she had no history of previous exposure to tuberculosis.
Tuberculosis involving lymph nodes can create a diagnostic dilemma in the presence of a malignant process. The presence of calcifications in lymph nodes should raise the possibility of tuberculosis even in the absence of contact history with tuberculosis.
KeywordsBreast cancer Tuberculosis Axillary lymph nodes
18F-fluorodeoxyglucose positron emission tomography
Fine needle aspiration
Invasive ductal carcinoma
Magnetic resonance imaging
The synchronous occurrence of carcinoma and tuberculosis is unusual. The earliest known report of such a case is that of Pilliet and Piatot in 1897 . After that and in 1899, Warthin reported the first case of coexisting tuberculosis and cancer in axillary lymph nodes . Tuberculosis can produce masses and nodes that can imitate or complicate staging of the neoplastic disease .
We report a case of breast cancer with contralateral tuberculous axillary lymph nodes that created a diagnostic dilemma and raised the possibility of a bilateral breast cancer.
A 69-year-old Yemeni woman presented to the breast clinic with a left breast painless mass increasing gradually in size over a few months. Lately she had noticed that the left nipple started to ulcerate and retract. Eight years ago, she had had colonic carcinoma, which was managed with left hemi-colectomy followed by chemotherapy and radiotherapy. She was from a high socioeconomic class, living in Saudi Arabia for more than 20 years and did not recall contact with patients with tuberculosis. Examination of the left breast showed a retracted ulcerated nipple; the skin was thickened making with the underlying mass an irregular large palpable area measuring 15 × 12 cm in maximum dimensions and there were no palpable axillary lymph nodes. Right breast examination was unremarkable but there was a rounded firm mobile 2-cm lymph node high up in the right axilla.
The coexistence of tuberculosis and malignancy has been reported in the literature mainly with Hodgkin's lymphoma, sarcoma, leukemia, or lung cancer. It is least prevalent in patients with carcinoma of the colon, bladder, uterus, breast, prostate, and kidney .
Most of the reported cases of breast cancer with concomitant tuberculous axillary lymph nodes were of ipsilateral involvement [4–9]. Our patient created a diagnostic dilemma clinically and radiologically, since a malignant right axillary lymph node was suspected with no evidence of a primary lesion in the breast; hence a bilateral breast cancer was suspected. Moreover, breast MRI did not exclude malignant right axillary lymph nodes. Yang et al. reported a case of tuberculous axillary lymph node that was misinterpreted by 18F- fluorodeoxyglucose positron emission tomography (FDG-PET) as a malignant metastatic disease from a possibly occult breast cancer .
Extensive surgery such as axillary dissection can be avoided by clinically suspecting granulomatous disease with assessment of intraoperative frozen sections.
In cancer patients, a tuberculous lymph node should be suspected whenever an enlarged lymph node shows calcifications on radiography, even without history of exposure to tuberculosis.
Written informed consent was obtained from the patient for publication of this report and any accompanying images.
- Miller RE, Salomon PF, West JP: The coexistence of carcinoma and tuberculosis of the breast and axillary lymph nodes. Am J Surg 1971, 121:338–340.PubMedView Article
- Warthin AS: The coexistence of tuberculosis and carcinoma of the mammary gland. Am J Med Sci 1899, 118:25.View Article
- Kaplan MH, Armstrong D, Rosen P: Tuberculosis complicating neoplastic disease: a review of 201 cases. Cancer 1974, 33:850–858.PubMedView Article
- Robinson AJ, Horne CA, Weaver A: Coexistence of axillary tuberculous lymphadenitis with lymph node metastases from a breast carcinoma. Clin Oncol (R Coll Radiol) 2001, 13:144.
- Fujii T, Kimura M, Yanagita Y, Koida T, Kuwano H: Tuberculosis of axillary lymph nodes with primary breast cancer. Breast Cancer 2003, 10:175–178.PubMedView Article
- Pandey M, Abraham EK, Chandramohan K, Rajan B: Tuberculosis and metastatic carcinoma coexistence in axillary lymph node: a case report. World J Surg Oncol 2003, 1:3.PubMedView Article
- Tulasi NR, Raju PC, Damodaran V, Radhika TS: A spectrum of coexistent tuberculosis and carcinoma in the breast and axillary lymph nodes: report of five cases. Breast 2006, 15:437–439.PubMedView Article
- Khurram M, Tariq M, Shahid P: Breast cancer with associated granulomatous axillary lymphadenitis: a diagnostic and clinical dilemma in regions with high prevalence of tuberculosis. Pathol Res Pract 2007, 203:699–704.PubMedView Article
- Salemis NS, Razou A: Coexistence of breast cancer metastases and tuberculosis in axillary lymph nodes—a rare association and review of the literature. Southeast Asian J Trop Med Public Health 2010, 41:608–613.PubMed
- Yang CM, Hsu CH, Hsieh CM, Chen MY: 18 F- FDG PET in a clinical unsuspected axillary tuberculous lymphadenitis mimicking malignancy. Ann Nucl Med Sci 2003, 16:107–110.
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