Tuberculosis is a specific process that can affect organs other than the lungs. So, with tuberculosis, the mammary gland can be affected. The gland tissue has a relative resistance to mycobacteria, so breast tuberculosis is an infrequent occurrence. Tuberculosis of the mammary glands can also be observed in men.
Main forms of breast tuberculosis
There are several clinical forms of breast tuberculosis:
- Tumor-like - often there is a nodular lesion with the formation of a caseous node with deformation of the breast. Skin ulcers and local inflammatory reactions are observed. On palpation, dense painful nodules are found.
- Abscessing tuberculosis - the formation of a single conglomerate when the nodules merge. With suppuration, an abscess appears. According to the clinic, this form is similar to mastitis.
- Disseminated form of tuberculosis - characterized by the presence of multiple foci with caseosis. The mammary gland is very compacted.
- Sclerosing form of tuberculosis - more often observed in women of advanced age. At the same time, fibrous changes predominate. On palpation, dense nodes are found that are soldered to the skin.
Breast tuberculosis can be either primary or secondary.
Causes of the first signs of breast tuberculosis
If the process is primary, most likely its development is associated with intraductal infection during lactation. Tuberculosis symptoms may occur when Mycobacterium tuberculosis enters the milk ducts while feeding an infected child.
The secondary process develops with hematogenous or lymphogenous spread of infection from the main focus (lymph node, root of the lung, pleura). Often tuberculosis of the mammary gland is combined with genital tuberculosis, tuberculosis of the bones, intestines, and lungs.
Predisposing factors are chest trauma, lactation, long-term therapy with glucocorticosteroids and immunosuppressive drugs, endocrine disorders (diabetes mellitus).
Clinical symptoms of breast tuberculosis
Symptoms of breast tuberculosis are local and general. Local changes in the mammary gland consist in the presence of a focus in it, which can have a different size. The mammary gland becomes hypertrophied from the presence of a conglomerate, which is often soldered to the chest.
The skin of the mammary gland is hyperemic, edematous, there may be a positive symptom of fluctuation in the focus. The tuberculous process in the mammary gland first grows intensively, stretching the tissues of the gland and causing pain. Then the focus melts in the process of caseous decay, and opens with the formation of fistulas.
Regional lymphadenitis develops. The nodes are enlarged, soldered to each other and painful on palpation.
In general, there are such symptoms of tuberculosis as fever, drowsiness, general weakness, weight loss, loss of appetite and increased sweating.
Diagnosis and treatment of breast tuberculosis
The detection of breast tuberculosis is difficult due to the polymorphism of the clinical course and high oncological alertness. If breast tuberculosis is suspected, differential diagnosis is carried out with fibroadenoma, breast cancer, abscessing mastitis and actinomycosis of the mammary gland.
A carefully collected history will reveal possible contact with a carrier of tuberculosis.
Of the additional research methods for the treatment of breast tuberculosis, ultrasound, CT, MRI, mammography are used, which reveal focal opacities. They have an inhomogeneous character and uneven contours, which are called "tongues of flame." This is a characteristic feature of breast tuberculosis.
To clarify the diagnosis and form of the course, before treating tuberculosis of the mammary glands, a biopsy and further cytological examination of the punctate of the mammary gland are performed. When a purulent secret is isolated, a microbiological study is carried out. With tuberculosis of the breast, specific tuberculous granulomas and Pirogov-Langhans giant cells are found in the material.
There is a positive reaction during tuberculin diagnostics.
Treatment of tuberculosis of the mammary glands consists in the removal of single caseous nodes from the breast and the appointment of specific anti-tuberculosis chemotherapy.
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