Indian Journal of Cancer
Home  ICS  Feedback Subscribe Top cited articles Login 
Users Online :4114
Small font sizeDefault font sizeIncrease font size
Navigate here
  Next article
  Previous article 
  Table of Contents
Resource links
   Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
   Article in PDF (85 KB)
   Citation Manager
   Access Statistics
   Reader Comments
   Email Alert *
   Add to My List *
* Registration required (free)  

  In this article
   Article Figures

 Article Access Statistics
    PDF Downloaded276    
    Comments [Add]    
    Cited by others 5    

Recommend this journal


Year : 2008  |  Volume : 45  |  Issue : 4  |  Page : 182-184

Ipsilateral axillary tubercular lymphadenopathy, contralateral osseous tuberculosis in a case of ductal carcinoma of breast

Department of Surgery, Jawaharlal Nehru Medical College, Sawangi (Meghe), Wardha-442 004, Maharashtra, India

Correspondence Address:
B N Wani
Department of Surgery, Jawaharlal Nehru Medical College, Sawangi (Meghe), Wardha-442 004, Maharashtra
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0019-509X.44671

Rights and Permissions

How to cite this article:
Wani B N, Jajoo S N. Ipsilateral axillary tubercular lymphadenopathy, contralateral osseous tuberculosis in a case of ductal carcinoma of breast. Indian J Cancer 2008;45:182-4

How to cite this URL:
Wani B N, Jajoo S N. Ipsilateral axillary tubercular lymphadenopathy, contralateral osseous tuberculosis in a case of ductal carcinoma of breast. Indian J Cancer [serial online] 2008 [cited 2022 Dec 3];45:182-4. Available from:

Dear Sir,

The coexistence of breast cancer and tuberculosis has been described in over 100 cases [1],[2],[3],[4],[5],[6] however its coexistence in the axillary node is rare. [1],[4],[5],[6] We present a case of, 43-year-old housewife presented with complaint of diffuse swelling over right distal forearm associated with dull pain of 4 months duration, for which she received conservative management but without relief. Around a month later she developed pathological fracture in the forearm after following trivial trauma. [Figure 1] Following FNAC report that suggested the lesion to be of chronic granulomatous lesion she was started on antibiotic therapy and at the same time underwent fixation of the fracture by interlocking nail.

Her all hematological and biochemical tests were normal. To rule out tuberculosis versus malignancy, the bone scan with 20 ml of tracer was performed and it showed hot spots involving right radius, the findings consistent with post-operative status and rest all bones showed physiological distribution of tracer. Serum IgG, IgM, IgA levels for Mycobacterium Tuberculosis were found to be within normal limits. For HIV, IgM antigen was reactive and IgG non-reactive but status confirmed negative by Western Blot technique, but window period could not be but ruled out. Mammography, X-ray chest, USG abdomen were found to be normal. After consultation with second orthopedic surgeon, she underwent removal of right radial nail with excision of growth with fibular graft. Grossly cut section of specimen showing hemorrhagic cavity with friable bone. Histopathological examination of the excised tissue showed numerous granulomas, epitheloid cells, Langhan's giant cells at places and caseation necrosis, the findings consistent with tuberculosis.

However she further noticed solitary, non-tender, firm lump situated in the lower medial quadrant of the left breast, which measured 2 x1.5 cm, having restricted mobility adherent to skin and also 5 th costal cartilage. Right axilla revealed enlarged lymph nodes in the anterior, central and apical groups, four in number, largest measuring 1x1.5cm. They were firm, non-tender, discrete and mobile. The right breast, right axilla and supraclavicular fossa were normal. Other systems revealed no abnormalities. A clinical diagnosis of carcinoma of left breast with TNM (tumor, node and metastasis) stage T1N1M0 was made. FNAC from lump in left breast suggestive of Ductal carcinoma, so underwent for left modified radical mastectomy with axillary dissection of 18 nodes. Histopathology of breast lump [Figure 2A] showed grossly scirrhous irregular lump, fibrofatty mass, gritty grey white tumor mass; microscopically invasive duct cell carcinoma with diffuse infiltration of tumor in fibromuscular and fatty tissue. Modified Richardson bloom score 5; suggestive of Invasive ductal carcinoma with well differentiated grade I, with clear margins. There was no evidence of tubercular foci in the breast specimen. Borders of lump, skin, apical tissue free from malignancy and all 18 axillary lymph nodes dissected out of which all negative for metastasis; but 6 positive for tuberculosis [Figure 2B].

In the postoperative period, the patient was started on chemotherapy with CMF (Cyclophosphamide, Methotrexate, 5-Fluorouracil) regimen while awaiting the status of estrogen/progesterone receptors that turned out to be negative. Following this the Methotrexate was changed to Adriamycin for a total of 6 cycles along with anti tubercular chemotherapy (Rifampicin-450mg, Isoniazide 300 mg, Pyrazinamide 1000 mg, Ethambutol-800 mg and Pyridoxine 40 mg for initial three months to followed by Rifampicin and Isoniazide for nine months). Follow-up is going on.

In our case the involvement of the contra lateral lymph nodes can be explained by the facts that hematogenous spread from an obvious [5],[6] or sub clinical focus can lead to the systemic spread and involvement of the other organs. [4] A possibility of tuberculosis should always be borne in mind especially in patients from endemic areas. [2] The simultaneous occurrence of carcinoma and tuberculosis can lead to many problems regarding diagnosis and treatment. [3]

  References Top

1.Graeme-Cook F, O'Briain DS, Daly PA. Unusual breast masses: The sequential development of mammary tuberculosis and Hodgkin's disease in a young woman. Cancer 1988;61:1457-9.   Back to cited text no. 1  [PUBMED]  
2.Pandey M, Abraham EK, K C, Rajan B. Tuberculosis and metastatic carcinoma coexistence in axillary lymph node: A case report. World J Surg Oncol 2003;1:3.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]
3.Alzaraa A, Dalal N. Coexistence of carcinoma and tuberculosis in one breast. World J Surg Oncol 2008;6:29.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]
4.Avninder SP, Saxena S. Infiltrating ductal carcinoma of the breast, metastatic to axillary lymph nodes harboring primary tuberculous lymphadenitis. Pathol Oncol Res 2006;12:188-9.  Back to cited text no. 4  [PUBMED]  [FULLTEXT]
5.Gupta PP, Gupta KB, Yadav RK, Agarwal D. Tuberculous mastitis: A review of seven consecutive cases. Indian J Tuberculosis 2003;50:47-50.  Back to cited text no. 5    
6.Gilbert AI, McGough EC, Farrell JJ. Tuberculosis of the breast. Am J Surg 1962;103:424-7.  Back to cited text no. 6  [PUBMED]  


  [Figure 1], [Figure 2A], [Figure 2B]

This article has been cited by
1 Fine needle aspiration cytology of supraclavicular lymph nodes: Our experience over a three-year period
Mitra, S. and Ray, S. and Mitra, P.K.
Journal of Cytology. 2011; 28(3): 108-110
2 Tuberculosis of breast: unusual manifestation of tuberculosis
Uday Yanamandra, Nishant Pathak, Nardeep Naithani, Naveen Grover, Velu Nair
Journal of Infection and Chemotherapy. 2011;
[VIEW] | [DOI]
3 Coexistence of breast cancer and tuberculosis in axillary lymph nodes: a case report and literature review
Sami Akbulut, Nilgun Sogutcu, Yusuf Yagmur
Breast Cancer Research and Treatment. 2011;
[VIEW] | [DOI]
4 Differential diagnosis of lung nodules: Breast cancer metastases and lung tuberculosis
Endri, M. and Cartei, G. and Zustovich, F. and Serino, F.S. and Fassina, A.
Infezioni in Medicina. 2010; 18(1): 39-42
5 Coexistence of breast cancer metastases and tuberculosis in axillary lymph nodes - a rare association and review of the literature
Salemis, N.S. and Razou, A.
Southeast Asian Journal of Tropical Medicine and Public Health. 2010; 41(3): 608-613


Print this article  Email this article
Previous article Next article


  Site Map | What's new | Copyright and Disclaimer | Privacy Notice
  Online since 1st April '07
  2007 - Indian Journal of Cancer | Published by Wolters Kluwer - Medknow