CASES 856-857: TB MASTITIS, Dr PHAN THANH HẢI, Dr NẠI THỊ HƯƠNG THOANG, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 Two cases of breast abscess failed in prolonged treatment, but at last were cured successfully in TB management.

CASE 01: A 28 year-old woman  with left swollen breast abscesses without pain nor fever. Drainage and antibiotic treatment were not response for 6 months.

Ultrasound detected some necrotic cystic masses, hypoechoic  non vascularized in the left breast and some inflamed axillary lymph nodes.

Tthe TB PCR result of pus was negative.

But FNAC result was positive with Langhans cells.

CASE 02: A 33 year-old with breast abscess.

FNAC in the first time resulted breast abscess.

And tuberculous mastitis in the second time.

TB mastitis is still complex in diagnostic sometimes has to  setting up a trial treatment.

DISCUSSION on the DIAGNOSIS of BREAST TUBERCULOSIS  CASES at MEDIC:

1/ Besides the clinical situations, the diagnosis of TB breast based primarily on ultrasound (90%, therefore mainly), mammography, biopsy (most breast tuberculosis is only accurately diagnosed by histology with granulomatous lesions, caseous necrosis, Langhans macrophage cell) and Ziehl–Neelsen acid-fast bacilli staining (low positive rate).

Other imaging modalities  used  to determine the extent of the disease  for orientational and differential (rather than diagnostic) notations. However, mammography keeps difficult to differentiate the malignancy mass from the breast tuberculosis.

2/ The most common form of TB breast is the extended form. Sclerosing and carcinomatosis associated with breast tuberculosis have never been encountered.

Figure 3 types of breast tuberculosis: extended, nodular and fibrotic (Figure by Dr. Nguyen Duy Thu, Breast tuberculosis and Imaging Diagnosis) .

3/ With Shear Wave Elastography ultrasound: Use elastography to diagnose differentially in ultrasound imaging for breast tuberculosis (and breast cancer). Breast tuberculosis has very hard code at the periphery, elasticity E= >120kPa (red), while the central area is softer, heterogeneous, with  elasticity E= 60kPa (green or no signal). In soft tissue cancer with necrotic areas, the opposite result means: the color map tends to be red (hard) and spreads evently from the outside to the mass center. The elastogram mapping helps to selecting of the biopsy site to avoid a pseudonegative result.

REFERENCES:

https://www.ultrasoundmedicvn.com/2024/10/case-786-accessory-breast-tuberculosis.html

https://www.ultrasoundmedicvn.com/2025/03/case-818-breast-tb-node-dr-phan-thanh.html

https://www.nguyenthienhung.com/2012/01/lao-vu.html