Doenças Micobacterianas
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Tuberculosis in 7 Breast Cancer Cases: Diagnostic and Therapeutic Challenges

Muna M Baslaim, Masoud A Al-Ghamdi, Taha S Al-Numani, Abdullah S Ashour and Shefaa A Al-Amoudi

Objective: To review the challenges in treating patients with breast cancer and history of or co-existing tuberculosis [TB].

Method: A review of the data base of the breast unit at King Fahd General Hospital performed from 1998 till end of July, 2012. Records of all breast cancer patients seen in that period [221 patients] were reviewed for clinical, radiologic, pathologic data and disease outcome.

Results: In the study period, there were 7 cases with concurrent or past history of tuberculosis. Two cases had concurrent tuberculosis of axillary lymph nodes, one had contralateral calcified tuberculous axillary lymph nodes that were radiologically suspicious for malignancy and the other one had ipsi-lateral tuberculous axillary lymph nodes discovered during axillary dissection. Both were reluctant to receive the lengthy anti-tuberculous treatment for an asymptomatic disease. Three cases had past history of pulmonary tuberculosis, 2 of them presented with multiple lung nodules that were radiologically indistinguishable [whether tuberculous or metastatic nodules] and eventually they died of lung metastases. They had no radiologic evidence of skeletal or other metastatic sites. One case had past history of treated synovial [knee] and cerebral tuberculosis presented with lung metastases. She also had a thigh lesion that was suspicious for tuberculosis but proved histologically to be metastatic in nature. The last case had a past history of treated ovarian tuberculosis; she had multiple calcified pelvic nodules on computerized tomography. The last 2 cases received chemotherapy with no evidence of reactivation of tuberculosis.

Conclusion: The presence of tuberculosis with breast cancer cause clinical and radiologic diagnostic difficulties and requires extra invasive diagnostic procedures for differentiation. Fear of tuberculosis reactivation with chemotherapy may force clinicians to prescribe prophylactic anti tuberculous treatment unnecessarily. A well planned management with psycho-social support is mandatory to maximize patient compliance.