A 37-year-old patient applied to our center. He said that the area of the left mammary gland was red, swollen, painful, and felt like a knot. This happened a few months ago, when he received outpatient anti-inflammatory treatment on the advice of a doctor, but to no avail.
The patient was then referred to an oncologist-mammologist for a fine-needle biopsy of the patient's left mammary gland. Based on the results of histological analysis, the patient was diagnosed with "left breast tuberculosis" and sent to our center. In the Extrapulmonary TB Department of our center, the patient underwent a full inpatient examination and special treatment was recommended. After a two-month course of treatment, the patient's symptoms completely disappeared, and the mammary gland returned to normal without cosmetic defects. Such examples are common enough.
According to statistics, TB accounts for 0,1 to 4 percent of TB patients worldwide, with 1000 in 1 TB cases in Western Europe and 100 in 4 in India and East Asia. corresponds to.
Nowadays, tuberculosis of the mammary gland is becoming a topical problem. Its relevance is that the disease is in many ways reminiscent of breast cancer in appearance and course. For this reason, most patients see an oncologist. Some patients do not even see an oncologist because of their carcinophobia (fear of cancer). As a result, the disease progresses to more complex forms, many serious defects appear, and the patient develops severe depression. So how can this be prevented?
In general, what is the disease of breast tuberculosis? In fact, everyone should know about the origin, course, symptoms, diagnosis, treatment and prevention of this disease.
Origin and specificity of the characters
coke-stick
Breast tuberculosis is a specific inflammatory disease of the mammary gland caused by Mycobacterium tuberculosis (Cox's bacillus), which is divided into primary and secondary types. Primary tuberculosis most often occurs during lactation (when milk comes from the breast), when pathogens enter the milk ducts and cause specific inflammation. In the secondary type, the pathogen enters the glandular tissue through the blood and lymphatic system from organs previously infected with tuberculosis (lungs, thoracic cavity, etc.), and forms foci of inflammation.
In addition, the sclerosing form of breast tuberculosis is more common in older women, with almost no signs of inflammation or pus. The abscess type is divided into two. In the first type, there are signs of active inflammation, the process is manifested by the formation of a leaky skin on the skin, which leads to purulent discharge from the wound. The second type is called a "cold abscess" because it does not bother the patient for a long time and is only in the form of a nodular lesion.
Although tuberculosis is not a common breast disease, it should never be ignored, especially in immunocompromised patients.
Movable nodules, purulent wounds
Symptoms of mammary gland tuberculosis include painless, uneven growths or stiffness in the mammary gland, skin changes (wrinkles, tightness of the nipples), and enlarged local lymph nodes. Occasionally there is a painful swelling and redness in the chest, which in medical parlance is called "tuberculosis mastitis." Patients complain of occasional fever, profuse sweating, and fatigue.
Outbreaks appear to be exacerbated during pregnancy and in patients with small, mobile nodules or large, painful tumors that may adhere to the chest. In the most common type of mammary gland tuberculosis, multiple foci of inflammation are found in the glandular tissue. In this case, the glandular tissue and skin are significantly hardened. Occasionally, ulcers appear on the skin of the chest and purulent discharge from the wound. In patients, the axillary, lumbar, and upper extremities, and the cervical lymph nodes may become enlarged, and in some cases, the nodules may coalesce into large stones.
Diagnostic complications
mammography
Given the different manifestations of mammary gland tuberculosis, the diagnosis is somewhat complicated. Because it is often reminiscent of breast cancer, breast cancer is suspected in oncology facilities and can be clearly diagnosed during surgery or after a biopsy.
The main method in diagnosing breast damage is to take a biopsy from the affected area. The obtained tissue is examined by microbiological and histological methods. Microbiological examination is based on the detection of tuberculosis in the affected material and the assessment of its susceptibility to anti-tuberculosis drugs. It should be noted that the absence of TB rods in the obtained tissue does not mean that the TB process is completely ruled out. Detection of specific tuberculosis granulomas or giant Pirogov-Langhans cells in the test tissue confirms that the tuberculosis process is progressing.
X-ray mammography is now widely used in the diagnosis of breast diseases (including breast tuberculosis). Mammography can detect the following:
- In the nodular type of breast tuberculosis there is a product with unclear boundaries, high density, large size (it is difficult to distinguish it from breast cancer);
- X-ray image of the most common type of breast tuberculosis is reminiscent of a tumor-infiltrated form of breast cancer;
- In sclerosing type of mammary tuberculosis, fibrous changes in the gland can be observed.
Ultrasound examination helps to determine the nature of the damaged tissue (nodules, cavities, etc.), the path of the wound in the types of fractures, the location of the biopsy by puncture.
The final diagnosis can be made only by morphological and microbiological examination.
Due to the complexity of the diagnosis of breast tuberculosis, in suspicious cases, when other methods do not help, a partial resection of the affected area is performed to determine whether the process is tuberculosis or cancer, and the resulting tissue is subjected to rapid histological examination.
In ulcerative forms of mammary tuberculosis, the secretion of the wound is microbiologically examined, and if the causative agent of tuberculosis is detected, drug treatments are prescribed depending on the type of drug susceptibility. In such cases, surgery is performed as an adjunct only when the medication is not fully effective.
The treatment is beneficial
mammary gland-tuberculosis-treatment
Anti-tuberculosis drugs are widely used in the treatment of mammary tuberculosis. In the early stages of the disease, medication alone may be sufficient for complete, uncomplicated recovery.
Surgery is used when the disease progresses and irreversible changes in breast tissue occur. In surgery, the mammary gland is removed from the damaged tissue.
After the main course of treatment, all patients are under the supervision of the TB dispensary in their place of residence. They must receive supportive care to prevent recurrence.
Our special recommendation is that women should periodically feel the mammary glands on the tip of the hand and consult a doctor if they notice any changes. If a breastfeeding woman has tuberculosis, it is forbidden to breastfeed with a damaged breast to prevent the disease from spreading to the baby.
If breast tuberculosis is detected in time and the necessary treatment is carried out diligently, patients will recover and return to a full-fledged family life.
Zarifa MOʼMINOVA,
Republican Specialized Tuberculosis and Pulmonology
mammologist of the Scientific-Practical Medical Center.
