It often occurs secondary to pulmonary subcutaneous nodules, intestinal tuberculosis, or mesenteric lymph node tuberculosis, spreading to the breast via the bloodstream. Clinically, it is relatively rare.

bubble_chart Etiology

Most are secondary to hematogenous dissemination from pulmonary or mesenteric lymph node subcutaneous nodes, or result from retrograde lymphatic spread or direct extension from adjacent subcutaneous node lesions (such as ribs, sternum, pleural membrane, or axillary lymph node subcutaneous nodes).

bubble_chart Clinical Manifestations

Common in women aged 20 to 40, the disease progresses slowly. In the initial stage, there are one or several nodules in the breast, with no pain or tenderness, and unclear boundaries with surrounding tissues. Skin adhesion is often present, and the ipsilateral axillary lymph nodes may be enlarged. Clinically, there is no fever. The abscess softens to form a cold abscess, which may perforate the skin to form a fistula or sinus, discharging thin pus with caseous debris. In a few patients, the mass undergoes fibrosis and becomes hardened, altering the breast's shape and causing inward invasion of the nipple, making it difficult to distinguish from breast cancer.

bubble_chart Diagnosis

1. It mostly occurs in women aged 20 to 40, with a slow disease progression.

2. Initial stage [first stage]: Limited to one area of the breast, presenting as a single or several nodular lumps, painless, with unclear boundaries and possible adhesion to the skin. The lump may liquefy to form a cold abscess, which can rupture to form one or several sinuses or ulcers, with thin secretions containing caseous material. The ulcer edges show undermining, and acid-fast bacilli may occasionally be found in stained smear examinations of the secretions.

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4. May be accompanied by low-grade fever, night sweating, and an elevated erythrocyte sedimentation rate.

bubble_chart Treatment Measures

1. Increase nutrition and pay attention to rest.

2. Systemic anti-subcutaneous node therapy.

3. For localized lesions, lesion resection can be performed; for extensive lesions, simple mastectomy can be performed, and if the ipsilateral lymph nodes are swollen, they can be removed together.

4. Patients with primary lesions still need to continue anti-subcutaneous node therapy after surgery. {|103|}