The association between cancer and non tuberculous mycobacterium is extremely rare, very few cases are reported in the literature. We report a case of infiltrating ductal cell carcinoma of the breast, metastatic to axillary lymph nodes harbouring non tuberculous mycobacterium.
Case report: A 50-year-old female presented with lump in the right breast. Fine-needle aspiration cytology from breast and axillary lymph node revealed infiltrating ductal cell carcinoma with metastasis in axillary node respectively. The patient underwent neoadjuvant chemotherapy followed by modified radical mastectomy with axillary lymph node dissection. Histopathology of the resected specimen revealed grade 2 infiltrating ductal carcinoma in the breast and granulomatous foci with langhans giant cells in the axillary lymph node with no acid fast bacilli(AFB) demonstrated in the granuloma. The tumor was positive for estrogen and progesterone receptors. Mycobacterial culture revealed non tubercular mycobacteria(mycobacterium avium ). Postoperatively patient received six cycles of chemotherapy. Simultaneously she was also started on regimen containing clarithromycin with ethambutol and rifabutin therapy, Patient is responding well.
Discussion: NTM infection more commonly affects lungs, lymph nodes, skin, soft tissue and bone. These environmental mycobacteria cause disease in individuals who offer some opportunity due to altered local or systemic immunity. Mycobacterium avium is the most prevalent NTM species worldwide . The coexistence between NTM and breast cancer has not been well recognized.Primary or isolated axillary lymph node involvement in carcinoma patients without clinical evidence of any other organ is extremely unusual.The possible explanation of tuberculosis limited to lymph nodes could be either a retrograde spread from the mediastinal nodes, or hematogenous spread from a subclinical focus. Treatment regimen includes clarithromycin,ethambutol ,rifabutin, streptomycin, rifampicin,amikacin, and pyridoxine. The treatment duration was one year after culture conversion. The unique pathological combination of tubercular infection and breast cancer existing in the same patient was first described in 1899 by Warthin and later by other authors. Majority of these cases reported breast cancer with axillary node showing tubercular foci, while our patient had a metastatic carcinoma with non tubercular granulomatous foci in the same lymph node . The case is being reported for its rare entity.
Conclusion: The present case is coincidental but noteworthy example illustrating that such a possibility of coexistence of cancer with NTM should always be kept in mind, especially in TB endemic regions. This case highlights the usefulness of mycobacterial culture, so that the diagnosis and treatment of NTM is not delayed.
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