Revista de enfermedades tropicales y salud pública

Abstracto

Tuberculosis of the Female Breast and Reproductive Organs: A Diagnostic Dilemma

Modupeola O Samaila, Adebiyi G adesiyun, Turaki T Mohammed, Sunday A Adewuyi and Bello Usman1

Background: Tuberculosis is prevalent in developing countries and extra-pulmonary involvement is now a frequent manifestation. However, involvement of the breast and reproductive organs in females is a cause of diagnostic confusion due to the non- specific nature of presenting symptoms which may simulate malignant disease processes.

Materials and methods: All females with histological confirmation of tuberculosis involving the breast and reproductive organs were analyzed over a 16 year period. Tissue biopsies were fixed in formalin, processed in paraffin and stained with haematoxylin & eosin and Ziehl Neelsen stain to identify the acid fast bacilli of mycobacterium tuberculosis.

Results: 28 females are presented and their ages ranged from 14 to 52 years with a mean age of 29.3. Presenting symptoms were varied and included abdominal/pelvic pain, abdominal swelling, post coital bleeding, vaginal bleeding and discharge, amenorrhoea and infertility while four females presented with breast mass and pain. Duration of symptoms was from one month to 5 years. Clinical diagnosis included dermoid cyst, tubo-ovarian abscess, leaking ectopic gestation, malignant ovarian tumour, fibroadenoma and breast cancer. Eighteen of the females had laparotomy, four had endometrial curettage, another four had excision biopsy/lumpectomy and two had cervical punch biopsy. Only the four females with breast lesions had fine needle aspiration biopsy prior to tissue biopsy. Also, one female was HIV positive and on anti-retroviral drugs. Microscopy of tissue biopsies from the breast, ovary, fallopian tubes, endometrium and cervix revealed granulomata, multinucleated langhan type giant cells and extensive caesation.

Conclusion: Tuberculosis may mimic malignant lesions of the breast, ovary and cervix due to the absence of specific diagnostic symptoms and should be a differential diagnosis in breast and gynaecological diseases in reproductive age females. In resource limited setting, early diagnosis by fine needle aspiration technique and tissue histology may reduce attendant morbidity, irreversible sterility and also prevent unnecessary surgery in patients.