Stage IIA ER-positive breast cancer with axillary tuberculosis: no metabolically active disease after treatment

What happened, in summary

This 63-year-old woman came for evaluation after feeling a lump in her right breast for 20 days. The lump was not painful and was not associated with nipple discharge or nipple inversion. She had diabetes and hypertension treated with medication, but no personal or family history of cancer or tuberculosis. On examination, doctors felt a firm mass in the upper outer right breast and firm lymph nodes in the right armpit. Mammography showed a suspicious density, and ultrasound found a 3.8 × 2.5 cm irregular hypoechoic breast lesion with multiple enlarged axillary lymph nodes, the largest measuring 1.02 cm. Core needle biopsy showed invasive carcinoma, not otherwise specified, grade II. Tumor testing showed ER 78% positive, PR-negative, HER2/neu-negative disease with Ki-67 of 21%, consistent with a Luminal A subtype. Pre-surgical imaging showed metabolic activity in the breast lesion and axillary nodes but no systemic metastases. She underwent right modified radical mastectomy with axillary dissection. The breast specimen confirmed invasive carcinoma, with clear resection margins and no tumor in the nipple-areola complex. The axillary nodes did not contain metastatic breast cancer; instead, they showed caseating granulomatous inflammation, and acid-fast bacilli testing confirmed ipsilateral axillary tuberculosis. Her cancer was staged pT2N0, Stage IIA. Treatment included 6 cycles of anthracycline-based adjuvant chemotherapy followed by letrozole because the tumor was ER-positive. She also completed 6 months of standard anti-tuberculosis therapy. As of April 2025, follow-up PET-CT showed reduced soft-tissue thickening and no metabolically active disease, and the axillary tuberculosis had resolved.