Srinivas Rajagopala1, Ritesh Agarwal. 1. Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India. visitsrinivasan@gmail.com
Abstract
BACKGROUND: Tuberculous mastitis is usually reported in multiparous postpartum women and is an unusual cause of gynecomastia in adolescent men. METHODS: We describe an illustrative case and review all cases of tubercular mastitis reported in men in the English literature. RESULTS: Our search yielded 24 cases of male tubercular mastitis. Most presented with an isolated breast lump. Constitutional symptoms were rare (21.4%), and associated tuberculosis foci, mostly inactive, were seen in 43.8%. Breast parenchymal involvement, chest wall masses, pectoral muscle abscesses, cold abscesses tracking through the chest wall, and empyema necessitatis presented as breast lumps. Fine-needle aspiration cytology was the most common diagnostic modality, and acid-fast bacilli were demonstrable in a minority (33%). A combination of granulomatous mastitis, necrosis, and clinical response to antitubercular therapy was the most common mode of establishing the diagnosis. Most patients responded to antitubercular therapy alone. CONCLUSION: Tubercular mastitis is a rare cause of breast masses in men, and a high index of suspicion can prevent diagnostic delays. Most patients respond to antitubercular therapy alone.
BACKGROUND:Tuberculous mastitis is usually reported in multiparous postpartum women and is an unusual cause of gynecomastia in adolescent men. METHODS: We describe an illustrative case and review all cases of tubercular mastitis reported in men in the English literature. RESULTS: Our search yielded 24 cases of male tubercular mastitis. Most presented with an isolated breast lump. Constitutional symptoms were rare (21.4%), and associated tuberculosis foci, mostly inactive, were seen in 43.8%. Breast parenchymal involvement, chest wall masses, pectoral muscle abscesses, cold abscesses tracking through the chest wall, and empyema necessitatis presented as breast lumps. Fine-needle aspiration cytology was the most common diagnostic modality, and acid-fast bacilli were demonstrable in a minority (33%). A combination of granulomatous mastitis, necrosis, and clinical response to antitubercular therapy was the most common mode of establishing the diagnosis. Most patients responded to antitubercular therapy alone. CONCLUSION:Tubercular mastitis is a rare cause of breast masses in men, and a high index of suspicion can prevent diagnostic delays. Most patients respond to antitubercular therapy alone.