Anatomo-Clinical Case: Coexistence of Tuberculosis with Axillary Lymph Node Metastasis in Breast Carcinoma (Case Report)

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DOI: 10.4236/ojpathology.2018.84015    1,047 Downloads   2,339 Views  Citations

ABSTRACT

Introduction: The coexistence of tuberculosis with axillary lymph node metastasis in breast carcinoma is uncommon. Observation: We report a case of a patient aged 59 years presenting a painless nodule in the right breast for one year. The scan and mammography revealed a long-axis node of 3 × 2 × 1 cm in the upper outer quadrant of the right breast ranked stage IV by the American College of Radiology (ACR), associated with a set of axillary lymph nodes and the largest one measuring 15 × 15 × 20 millimeters (mm). The breast biopsy helped diagnose a Scarff Bloom Richardson (SBR) grade II non-specific invasive carcinoma, modified by Ellis and Elston. A right mastectomy associated with a lymph node dissection was performed. We noticed a not well defined and whitish 5 mm tumor mass associated with 16 lymph nodes removed. The histological examination confirmed the diagnosis of SBR grade II non-specific invasive carcinoma with invasion of 7 lymph nodes (N+ = 7/16). In 3 metastatic lymph nodes, there were epithelioid and gigantocellular granulomas with full central necrosis. The Ziehl Neelsen staining had highlighted acid-fast bacilli. The tumor was oestrogen and progesteron receptor, without an overexpression of the oncoprotein human epidermal growth factor receptor 2 (HER2), which corresponds to a 0 score and the Ki 67 proliferation index assessed at 10%. The patient was given an anti-tuberculosis treatment combining Rifampicin (H), Isoniazid (I), Pyrazinamid (Z), Ethambutol (E) over 2 months and secondly a combination of Rifampicin and Isoniazid over 4 months (2RHZE/4 RH). The anti-tumor chemotherapy used a protocol combining 3 FAC60+ 3 Docetaxel (F = Fluorouracil®; A = Adriblastin®, C = Cyclophosphamid). Conclusion: This coexistence is uncommon, of incidental discovery and necessitates a multidisciplinary care.

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Ouédraogo, A. , Bambara, H. , Ido, F. , Ramdé, W. , Sawadogo, R. , Savadogo, I. , Ouattara, S. , Barry, H. , Sanou-Lamien, A. and Lompo, O. (2018) Anatomo-Clinical Case: Coexistence of Tuberculosis with Axillary Lymph Node Metastasis in Breast Carcinoma. Open Journal of Pathology, 8, 132-138. doi: 10.4236/ojpathology.2018.84015.

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