“A sheep in a wolf’s clothing”. Case report of tubercular axillary lymph nodes mimicking metastasis in a case of breast carcinoma with brief review of literature
“Appearances can be deceptive” – the saying holds true in our case where sinister appearing enlarged axillary lymph nodes draining breast carcinoma were surprisingly found to be tubercular. A 60-year-old nulliparous female presented with complaints of a right breast lump with no comorbidities. Examination and evaluation revealed a retro areolar non – metastatic breast of clinical stage (cT2N1M0). Surprisingly, the operative specimen revealed all isolated lymph nodes to be free of tumor but with features of granulomatous lymphadenitis raising a suspicion of tuberculosis which was confirmed by further tests. On the basis of Multi-disciplinary Board (MDB) discussions and literature research the patient was started on anti-tuberculous treatment (Category-1) with adjuvant chemotherapy planned after the intensive phase. Problems of diagnosis and management arise when breast carcinoma and tuberculosis coexist in unique scenarios. Hence it would be worthwhile for the reading surgeon to keep an eagle eye on the lookout for such cases as wrong treatment strategies in such scenarios could prove disastrous. Major lacunae do exist in many aspects of managing such cases with larger studies being the way forward helping formation of standard guidelines to approach such complex encounters. We portray this case with a brief summary of similar published scarce literature and discussion on the various aspects of management of such coexistences based on the available literature evidence.
Established protocols of evaluation and management exist already in the various aspects of managing common disorders like breast carcinoma and tuberculosis but management aspects become complex when the disorders co-exist as naturally no fixed protocols exist in approaching these cases considering extreme rarity. This article describes this rare and unique case scenario with a summary of published scarce literature thus far with thought provoking new insights on the subject.
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