Right breast invasive carcinoma and contralateral left axillary abscess representing a rare dual pathology

Right breast invasive carcinoma and contralateral left axillary abscess representing a rare dual pathology | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Right breast invasive carcinoma and contralateral left axillary abscess representing a rare dual pathology Addagarla Srilakshminagasaikrishnapraneeth, Ashok Ranjan, kirthi Sathyakumar This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8770602/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract A 53-year-old woman arrived with bilateral breast enlargements and a left axillary mass. The MRI indicated a concerning lesion in the right breast and a collection in the left axilla. FNAC verified aggressive cancer of the right breast and a tuberculous abscess in the left axilla, with CBNAAT identifying Mycobacterium tuberculosis DNA. The patient commenced anti-tubercular medication and underwent surgical removal of the right breast lesion, confirming Grade 3 invasive carcinoma of no special type (NST). This case underscores the necessity of matching imaging with histopathology to distinguish cancer from infectious diseases, hence assuring precise diagnosis and therapy. Breast carcinoma axillary abscess Bilateral breast lump BI-RADS 4c Invasive carcinoma NST Figures Figure 1 Figure 2 Figure 3 Background Breast cancer generally manifests as a unilateral mass accompanied by ipsilateral axillary involvement. Bilateral lesions or contralateral axillary enlargements are uncommon and may resemble metastatic illness. Precise diagnosis by imaging, fine-needle aspiration cytology (FNAC), and molecular assays is crucial for distinguishing cancer from infection [ 1 , 2 , 3 ]. This case report provides an uncommon instance of invasive cancer in the right breast accompanied with a contralateral tuberculous axillary abscess, highlighting the importance of meticulous clinic radiological and pathological linkage. This case is notably unique due to the simultaneous presence of two disparate diseases with conflicting etiologies—an invasive carcinoma in the right breast and a contralateral tuberculous axillary abscess—closely resembling advanced metastatic illness. This appearance presents a considerable diagnostic and staging challenge and is hardly documented in the literature. Case Presentation A 53-year-old female presented with swelling in both breasts for the past three months, associated with swelling in the left axilla. The swellings were insidious in onset, gradually progressive, and not associated with pain, nipple discharge, fever, cough, or weight loss. There was no history of tuberculosis, chronic kidney disease, epilepsy, diabetes, or hypertension. Past history was significant only for sterilization surgery in 2003. Family history was non-contributory. On examination, the patient was afebrile and hemodynamically stable. Local examination revealed a hard, irregular lump with ill-defined margins of size ~ 1 x 1 cm in the upper inner quadrant of the right breast, with restricted mobility. The left breast was diffusely nodular on palpation with an ill-defined lump in the upper outer quadrant. In the left axilla, a 2 × 2 cm fluctuant, tender swelling with overlying erythema was palpable, clinically suggestive of an abscess. Investigations USG bilateral breast was done elsewhere and was suspicious for malignancy, the images were however unavailable. Since the clinical findings were also suspicious, MRI of both breasts with contrast was done for detailed assessment. MRI revealed a small T1/T2 iso-hypointense, taller than wider lesion with spiculated, irregular margins showing diffusion restriction in the right breast. The lesion measured approximately 6.8 × 7.1 × 9.3 mm. (CC x TR x AP). On post contrast images, intense enhancement was seen with a Type II kinetic time intensity curve, concerning for malignancy ( Fig. 1 ) . It was classified as BI-RADS 4c. No significant right axillary lymph nodes were noted. In the left axilla, MRI revealed a large relatively well defined T1 hypointense T2 isointense diffusion restricting lesion/collection measuring 4.1 × 7.9 × 3.9 cm. The lesion showed peripheral enhancement with central non-enhancing hypointense areas – consistent with necrotic areas. The collection was seen extending into the adjacent pectoralis major muscle with associated muscle edema, and was abutting the pectolaris minor muscle with associated muscle edema. Two small similar peripherally enhancing areas measuring ~ 3.8 x 4.6 x 1.8 cm (CC x TR x AP) and ~ 3.8 x 3.2 x 2.1 cm (CC x TR x AP) were seen abutting each other, in the subcutaneous plane of left axilla, just inferior to the above-mentioned collection (Fig. 2 ). Multiple additional necrotic nodules and lymph nodes were identified in the axilla, retro pectoral region and left upper outer quadrant, the largest measuring 1.8 × 1.2 cm. Diffuse edema extended from the left axilla into the upper outer and upper inner quadrants of the left breast, with thickened Cooper’s ligaments and left axillary skin thickening. Figure 3 depicts the screening USG images of bilateral breast lesions. FNAC from the left axillary swelling yielded pus. Smears showed neutrophils, lymphocytes, inflammatory debris, and necrotic material. No malignant cells were seen. Ziehl–Neelsen stain for acid-fast bacilli was negative. The findings were consistent with an abscess. Cartridge based nuclei acid amplification test (CBNAAT) was done from the sample aspirated, which showed Mycobacterium tuberculosis (MTB) complex DNA, with no rifampicin resistance. The patient was advised to start on anti-tubercular therapy (ATT) as per national guidelines (2- month HRZE, followed by 4-month HR). The patient was counselled regarding drug adherence, side effects and the need for regular follow-up. Ultrasound-guided FNAC from the right breast lump revealed malignant epithelial cells arranged in clusters and singly, showing pleomorphism, irregular nuclear contours, and high nuclear-cytoplasmic ratio, suggestive of invasive carcinoma. Wide local excision of the right breast lump was subsequently performed. Histopathology confirmed invasive carcinoma of breast, no special type (NST), Grade 3 (Nottingham Histologic Score), with lymphovascular invasion. Tumor margins were free, although the deep margin was close. Plan for adjuvant chemotherapy was made, after assessing the patient in 2–4 weeks following initiation of anti-tubercular therapy. Discussion Breast carcinoma is the most common malignancy among women and typically presents as a unilateral lump with ipsilateral axillary lymphadenopathy. Bilateral breast lumps or axillary findings are less common and may suggest dual primaries, metastatic disease, or coexisting benign conditions [ 1 ]. The present case is unusual because the patient had a malignant lesion in the right breast, while the left axillary swelling turned out to be an abscess but not metastatic disease. MRI plays an important role in characterizing breast lesions, particularly when ultrasound findings are unavailable or unclear. MRI has high sensitivity for detecting suspicious features on ultrasound requiring further evaluation [ 2 ]. The MRI features of the right breast lesion - spiculated margins, diffusion restriction and Type 2 perfusion curve were in favour of malignancy. Histopathology confirmed invasive carcinoma NST, Grade 3, supporting our imaging findings. However, contralateral axillary swelling in such cases generally raises possibility of metastatic nodal disease, which would upstage the disease [ 3 ]. However, FNAC demonstrated an abscess rather than malignancy and CBNAAT confirmed Mycobacterium tuberculosis, confirming the diagnosis of tuberculous abscess, which guided the initiation of antitubercular therapy. Treatment decisions (both locoregional and systemic therapy) in breast cancers are guided by accurate staging, nodal status and overall disease burden. International guidelines suggest combining clinical assessment, imaging and pathology to ensure appropriate diagnosis and avoid upstaging [ 4 ]. Misdiagnosing abscess as a metastatic disease, in our case, would have led to incorrect staging and initiating aggressive therapy. Dual/multiple pathologies of the breast or axilla are rare but have been described in literature, such as coexistence of fibroadenoma with invasive carcinoma, phyllodes tumor with carcinoma, carcinoma within hamartoma, or even synchronous lesions but histologically distinct tumors in different quadrants of the same breast. These conditions often challenge clinicians as imaging may suggest a single dominant diagnosis, while a second pathology is only revealed on histology. Our case fits into this broader spectrum of dual pathology. Unlike previously reported cases of benign and malignant lesions within the same breast [ 5 , 6 ], our patient had invasive carcinoma in the right breast and a contralateral axillary abscess mimicking metastatic disease. Such a presentation is exceptional and, to our knowledge, rarely documented. MRI was important in this case because clinical examination showed abnormalities in both breasts and ultrasound alone was insufficient for adequate assessment, given the inflammatory skin changes and multiple sites involved. MRI helps in problem-solving situations by characterizing small lesions, assessing pattern of enhancement and identifying features suggestive of malignancy [ 7 ]. Imaging alone, however, cannot confirm if a swelling is cancerous or infectious. FNAC, therefore, is essential as it can show whether a lesion is malignant or benign or infective and prevents infections masking as neoplastic processes [ 8 ]. This importance is further highlighted in our patient, where FNAC confirmed neoplasm in right breast and tubercular abscess in left axilla, helping avoid misdiagnosis and treatment. Conclusion This case reports a rare case of bilateral breast and axillary lumps where the right breast lesion was invasive carcinoma and the contralateral left axillary swelling was an abscess. This unusual presentation emphasizes the need for careful clinicoradiological and pathological correlation to ensure correct diagnosis and overtreatment. Declarations Acknowledgements The authors would like to thank SRM Medical College Hospital and Research Centre, Faculty of Medicine and Health Sciences, SRMIST, Kattankulathur , for their cordial support of this study. They also express their sincere gratitude to Dr. Vishnupriya Subramaniyan, PhD, Research Writer, SRM Medical College Hospital and Research Centre, SRMIST , for her valuable assistance in the preparation of this case report. Data Availability No new datasets were produced or examined for this case report. Data sharing is not relevant to this subject. Author Contribution Addagarla Srilakshminagasaikrishnapraneeth : Contributed to data collection, patient assessment, and literature review. Ashok Ranjan : Assisted in imaging analysis, interpretation of radiological findings, and manuscript drafting. Kirthi Sathyakumar : Conceptualized the study, supervised the clinical and radiological evaluation, reviewed and critically revised the manuscript Financial Disclosure The authors gratefully acknowledge the financial support provided by SRM Medical College Hospital and Research Centre, Faculty of Medicine and Health Sciences, SRMIST, Kattankulathur, for defraying the publication costs of this article Data availability The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request. Conflict of Interest The authors declare that they have no conflicts of interest related to this manuscript. Ethics Statement This study was conducted in accordance with the ethical principles of the Declaration of Helsinki and relevant institutional ethical guidelines.This study received assessment and approval from the Institutional Ethics Committee of SRM Medical College Hospital and Research Centre. A wavier for ethical approval was granted since this was a report with no intervention. Consent to Participate The patient provided written informed consent for inclusion in this case report. The patient was apprised of the report's objective, the utilisation of anonymised clinical data and photographs, and consented to participate voluntarily. Consent to publish Written informed consent for publication was obtained from all participants, explicitly authorizing the use of their anonymized clinical data and images in this manuscript. Competing interests The authors declare no competing interests. References Narod SA. Bilateral breast cancers. Nat Rev Clin Oncol. 2014;11(3):157–66. https://doi.org/10.1038/nrclinonc.2014.3 . Spick C, Baltzer PAT. Diagnostic utility of second-look US for breast lesions identified at MR imaging: a systematic review and meta-analysis. Radiology. 2014;273(2):401–9. https://doi.org/10.1148/radiol.14140011 . Moossdorff M, Vugts G, Maaskant-Braat AJG, Strobbe LJA, Voogd AC, Smidt ML. Contralateral axillary lymph node metastases in breast cancer: a systematic review. Eur J Surg Oncol. 2015;41(10):1297–304. https://doi.org/10.1016/j.ejso.2015.07.019 . Cardoso F, Kyriakides S, Ohno S, et al. Early breast cancer: ESMO Clinical Practice Guidelines. Ann Oncol. 2019;30(8):1194–220. https://doi.org/10.1093/annonc/mdz173 . Tchaou M, Sano D, Mouchi A, et al. Breast abscessed cancer in nonlactating women. Case Rep Surg. 2017;2017:1216320. https://doi.org/10.1155/2017/1216320 . Faghani R, Rahimi A, Zare F, et al. Poorly differentiated breast carcinoma with cystic necrotizing mass: a case report. J Med Case Rep. 2024;18:138. https://doi.org/10.1186/s13256-024-04138-3 . Waks AG, Winer EP. Breast cancer treatment: a review. JAMA. 2019;321(3):288–300. https://doi.org/10.1001/jama.2018.19323 . Sharma SK, Mohan A, Sharma A. Challenges in the diagnosis and treatment of miliary tuberculosis. Indian J Med Res. 2012;135(5):703–30. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 02 Mar, 2026 Reviews received at journal 01 Mar, 2026 Reviews received at journal 17 Feb, 2026 Reviewers agreed at journal 17 Feb, 2026 Reviewers agreed at journal 17 Feb, 2026 Reviewers invited by journal 17 Feb, 2026 Editor invited by journal 15 Feb, 2026 Editor assigned by journal 14 Feb, 2026 Submission checks completed at journal 13 Feb, 2026 First submitted to journal 13 Feb, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8770602","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":592742218,"identity":"5bc7c3d2-4fcf-4181-86ca-069fee40cb07","order_by":0,"name":"Addagarla Srilakshminagasaikrishnapraneeth","email":"","orcid":"","institution":"SRM Institute of Science and Technology (SRMIST),","correspondingAuthor":false,"prefix":"","firstName":"Addagarla","middleName":"","lastName":"Srilakshminagasaikrishnapraneeth","suffix":""},{"id":592742220,"identity":"a9e3321a-23a4-407f-a10e-565e44c2ba61","order_by":1,"name":"Ashok Ranjan","email":"","orcid":"","institution":"SRM Institute of Science and Technology (SRMIST),","correspondingAuthor":false,"prefix":"","firstName":"Ashok","middleName":"","lastName":"Ranjan","suffix":""},{"id":592742222,"identity":"90543bee-4ff2-4ed6-914e-c1d680938f37","order_by":2,"name":"kirthi Sathyakumar","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6UlEQVRIie3OsYrCMBzH8V8I9JbUuUVoXyHFtQ+TIuhU6BP0Ch1cfADFwVcI+AKVgA6Wu9X1cHAWlwo3XKpuSnNuDvlCAn/IJ/wBm+0N8yhAwRG0Q4X7XRkIKTUZ3B6L/xC0BEiK6yhgeK/zJ+7xkGX5eLnYJetLg6C3F0RlHaRPP6JyxlUqv1KpmMDA3wuoWQcJqENKxqtUMlcqvVgiW8LMJB+HU1euG4FPI+nfCBWoXVnpxQQ3Eb90yIJxFUlNFBt50bz+KTqJ973Bmf3moV5sdWriOOxth+rcRR6+0IcULwCbzWazPesPARtKraTfAJMAAAAASUVORK5CYII=","orcid":"","institution":"SRM Institute of Science and Technology (SRMIST),","correspondingAuthor":true,"prefix":"","firstName":"kirthi","middleName":"","lastName":"Sathyakumar","suffix":""}],"badges":[],"createdAt":"2026-02-03 03:53:33","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8770602/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8770602/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":103167226,"identity":"983db479-69e0-416b-b526-41c330ac23b3","added_by":"auto","created_at":"2026-02-22 12:45:19","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":578912,"visible":true,"origin":"","legend":"\u003cp\u003eCE-MRI of Breast - Axial images show a small focal lesion with irregular, spiculated margins in the upper inner quadrant of right breast (yellow arrow). The lesion appears hypointense in T2w image \u003cstrong\u003e(a)\u003c/strong\u003e. Hyperintense in STIR image \u003cstrong\u003e(b).\u003c/strong\u003e Diffusion-weighted image shows restricted diffusion \u003cstrong\u003e(c)\u003c/strong\u003e. Post-contrast T1w fat-suppressed images show avid enhancement, and type II kinetic enhancement curve (\u003cstrong\u003ed and e).\u003c/strong\u003e Corresponding ADC map demonstrates low ADC signal intensity, confirming true diffusion restriction \u003cstrong\u003e(f).\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8770602/v1/9ea7e509f4f165ccb0875d79.jpeg"},{"id":103167224,"identity":"bd9aaf06-2b67-4cd0-abd5-03e37abd3b73","added_by":"auto","created_at":"2026-02-22 12:45:19","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":584871,"visible":true,"origin":"","legend":"\u003cp\u003eMultisequence breast MRI demonstrating necrotic lesions in the left axilla. \u003cstrong\u003eAxial T2w\u003c/strong\u003eshows a well-defined and thick walled hyperintense lesion in the left axilla \u003cstrong\u003e(a).\u003c/strong\u003e Showing marked diffusion restriction with corresponding low ADC values \u003cstrong\u003e(b and c)\u003c/strong\u003e. \u003cstrong\u003ePost-contrast axial T1w\u003c/strong\u003e image reveals peripheral rim enhancement with non-enhancing central area \u003cstrong\u003e(d)\u003c/strong\u003e. \u003cstrong\u003eCoronal STIR\u003c/strong\u003eimage shows multiple hyperintense lesions with surrounding edema \u003cstrong\u003e(e)\u003c/strong\u003e. Two small similar peripherally enhancing lesions on T1w post contrast image, just inferior to the above-mentioned collection \u003cstrong\u003e(f).\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8770602/v1/21447f65154c89bc2fcf78e4.jpeg"},{"id":103167225,"identity":"d30dce52-f681-4f7e-9735-c222d408d0a1","added_by":"auto","created_at":"2026-02-22 12:45:19","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":309312,"visible":true,"origin":"","legend":"\u003cp\u003eUltrasound examination of right breast shows an irregular, taller than wide, markedly hypoechoic lesion in upper inner quadrant \u003cstrong\u003e(a).\u003c/strong\u003e Ultrasound examination of left axilla shows two large ill-defined anechoic collections with thick internal echoes \u003cstrong\u003e(b and c).\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8770602/v1/145eddb69f8539d1320034d6.jpeg"},{"id":103167246,"identity":"18af1a64-142f-48fd-b44f-87025ddd0c49","added_by":"auto","created_at":"2026-02-22 12:45:24","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2018222,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8770602/v1/45bba8c5-9b54-4214-9d84-2ef3abe5b965.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Right breast invasive carcinoma and contralateral left axillary abscess representing a rare dual pathology","fulltext":[{"header":"Background","content":"\u003cp\u003eBreast cancer generally manifests as a unilateral mass accompanied by ipsilateral axillary involvement. Bilateral lesions or contralateral axillary enlargements are uncommon and may resemble metastatic illness. Precise diagnosis by imaging, fine-needle aspiration cytology (FNAC), and molecular assays is crucial for distinguishing cancer from infection [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. This case report provides an uncommon instance of invasive cancer in the right breast accompanied with a contralateral tuberculous axillary abscess, highlighting the importance of meticulous clinic radiological and pathological linkage.\u003c/p\u003e \u003cp\u003eThis case is notably unique due to the simultaneous presence of two disparate diseases with conflicting etiologies\u0026mdash;an invasive carcinoma in the right breast and a contralateral tuberculous axillary abscess\u0026mdash;closely resembling advanced metastatic illness. This appearance presents a considerable diagnostic and staging challenge and is hardly documented in the literature.\u003c/p\u003e"},{"header":"Case Presentation","content":"\u003cp\u003eA 53-year-old female presented with swelling in both breasts for the past three months, associated with swelling in the left axilla. The swellings were insidious in onset, gradually progressive, and not associated with pain, nipple discharge, fever, cough, or weight loss. There was no history of tuberculosis, chronic kidney disease, epilepsy, diabetes, or hypertension. Past history was significant only for sterilization surgery in 2003. Family history was non-contributory.\u003c/p\u003e \u003cp\u003eOn examination, the patient was afebrile and hemodynamically stable. Local examination revealed a hard, irregular lump with ill-defined margins of size\u0026thinsp;~\u0026thinsp;1 x 1 cm in the upper inner quadrant of the right breast, with restricted mobility. The left breast was diffusely nodular on palpation with an ill-defined lump in the upper outer quadrant. In the left axilla, a 2 \u0026times; 2 cm fluctuant, tender swelling with overlying erythema was palpable, clinically suggestive of an abscess.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eInvestigations\u003c/h2\u003e \u003cp\u003eUSG bilateral breast was done elsewhere and was suspicious for malignancy, the images were however unavailable. Since the clinical findings were also suspicious, MRI of both breasts with contrast was done for detailed assessment. MRI revealed a small T1/T2 iso-hypointense, taller than wider lesion with spiculated, irregular margins showing diffusion restriction in the right breast. The lesion measured approximately 6.8 \u0026times; 7.1 \u0026times; 9.3 mm. (CC x TR x AP). On post contrast images, intense enhancement was seen with a Type II kinetic time intensity curve, concerning for malignancy \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e. It was classified as BI-RADS 4c. No significant right axillary lymph nodes were noted. In the left axilla, MRI revealed a large relatively well defined T1 hypointense T2 isointense diffusion restricting lesion/collection measuring 4.1 \u0026times; 7.9 \u0026times; 3.9 cm. The lesion showed peripheral enhancement with central non-enhancing hypointense areas \u0026ndash; consistent with necrotic areas. The collection was seen extending into the adjacent pectoralis major muscle with associated muscle edema, and was abutting the pectolaris minor muscle with associated muscle edema. Two small similar peripherally enhancing areas measuring\u0026thinsp;~\u0026thinsp;3.8 x 4.6 x 1.8 cm (CC x TR x AP) and ~\u0026thinsp;3.8 x 3.2 x 2.1 cm (CC x TR x AP) were seen abutting each other, in the subcutaneous plane of left axilla, just inferior to the above-mentioned collection (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Multiple additional necrotic nodules and lymph nodes were identified in the axilla, retro pectoral region and left upper outer quadrant, the largest measuring 1.8 \u0026times; 1.2 cm. Diffuse edema extended from the left axilla into the upper outer and upper inner quadrants of the left breast, with thickened Cooper\u0026rsquo;s ligaments and left axillary skin thickening. Figure\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e depicts the screening USG images of bilateral breast lesions.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFNAC from the left axillary swelling yielded pus. Smears showed neutrophils, lymphocytes, inflammatory debris, and necrotic material. No malignant cells were seen. Ziehl\u0026ndash;Neelsen stain for acid-fast bacilli was negative. The findings were consistent with an abscess. Cartridge based nuclei acid amplification test (CBNAAT) was done from the sample aspirated, which showed \u003cem\u003eMycobacterium tuberculosis\u003c/em\u003e (MTB) complex DNA, with no rifampicin resistance. The patient was advised to start on anti-tubercular therapy (ATT) as per national guidelines (2- month HRZE, followed by 4-month HR). The patient was counselled regarding drug adherence, side effects and the need for regular follow-up.\u003c/p\u003e \u003cp\u003eUltrasound-guided FNAC from the right breast lump revealed malignant epithelial cells arranged in clusters and singly, showing pleomorphism, irregular nuclear contours, and high nuclear-cytoplasmic ratio, suggestive of invasive carcinoma. Wide local excision of the right breast lump was subsequently performed. Histopathology confirmed invasive carcinoma of breast, no special type (NST), Grade 3 (Nottingham Histologic Score), with lymphovascular invasion. Tumor margins were free, although the deep margin was close. Plan for adjuvant chemotherapy was made, after assessing the patient in 2\u0026ndash;4 weeks following initiation of anti-tubercular therapy.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eBreast carcinoma is the most common malignancy among women and typically presents as a unilateral lump with ipsilateral axillary lymphadenopathy. Bilateral breast lumps or axillary findings are less common and may suggest dual primaries, metastatic disease, or coexisting benign conditions [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The present case is unusual because the patient had a malignant lesion in the right breast, while the left axillary swelling turned out to be an abscess but not metastatic disease.\u003c/p\u003e \u003cp\u003eMRI plays an important role in characterizing breast lesions, particularly when ultrasound findings are unavailable or unclear. MRI has high sensitivity for detecting suspicious features on ultrasound requiring further evaluation [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The MRI features of the right breast lesion - spiculated margins, diffusion restriction and Type 2 perfusion curve were in favour of malignancy. Histopathology confirmed invasive carcinoma NST, Grade 3, supporting our imaging findings. However, contralateral axillary swelling in such cases generally raises possibility of metastatic nodal disease, which would upstage the disease [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. However, FNAC demonstrated an abscess rather than malignancy and CBNAAT confirmed Mycobacterium tuberculosis, confirming the diagnosis of tuberculous abscess, which guided the initiation of antitubercular therapy.\u003c/p\u003e \u003cp\u003eTreatment decisions (both locoregional and systemic therapy) in breast cancers are guided by accurate staging, nodal status and overall disease burden. International guidelines suggest combining clinical assessment, imaging and pathology to ensure appropriate diagnosis and avoid upstaging [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Misdiagnosing abscess as a metastatic disease, in our case, would have led to incorrect staging and initiating aggressive therapy.\u003c/p\u003e \u003cp\u003eDual/multiple pathologies of the breast or axilla are rare but have been described in literature, such as coexistence of fibroadenoma with invasive carcinoma, phyllodes tumor with carcinoma, carcinoma within hamartoma, or even synchronous lesions but histologically distinct tumors in different quadrants of the same breast. These conditions often challenge clinicians as imaging may suggest a single dominant diagnosis, while a second pathology is only revealed on histology. Our case fits into this broader spectrum of dual pathology. Unlike previously reported cases of benign and malignant lesions within the same breast [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], our patient had invasive carcinoma in the right breast and a contralateral axillary abscess mimicking metastatic disease. Such a presentation is exceptional and, to our knowledge, rarely documented.\u003c/p\u003e \u003cp\u003eMRI was important in this case because clinical examination showed abnormalities in both breasts and ultrasound alone was insufficient for adequate assessment, given the inflammatory skin changes and multiple sites involved. MRI helps in problem-solving situations by characterizing small lesions, assessing pattern of enhancement and identifying features suggestive of malignancy [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Imaging alone, however, cannot confirm if a swelling is cancerous or infectious. FNAC, therefore, is essential as it can show whether a lesion is malignant or benign or infective and prevents infections masking as neoplastic processes [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. This importance is further highlighted in our patient, where FNAC confirmed neoplasm in right breast and tubercular abscess in left axilla, helping avoid misdiagnosis and treatment.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis case reports a rare case of bilateral breast and axillary lumps where the right breast lesion was invasive carcinoma and the contralateral left axillary swelling was an abscess. This unusual presentation emphasizes the need for careful clinicoradiological and pathological correlation to ensure correct diagnosis and overtreatment.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank \u003cstrong\u003eSRM Medical College Hospital and Research Centre, Faculty of Medicine and Health Sciences, SRMIST, Kattankulathur\u003c/strong\u003e\u003cstrong\u003e,\u003c/strong\u003e for their cordial support of this study. They also express their sincere gratitude to \u003cstrong\u003eDr. Vishnupriya Subramaniyan, PhD, Research Writer, SRM Medical College Hospital and Research Centre, SRMIST\u003c/strong\u003e\u003cstrong\u003e,\u003c/strong\u003e for her valuable assistance in the preparation of this case report.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo new datasets were produced or examined for this case report. Data sharing is not relevant to this subject.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAddagarla Srilakshminagasaikrishnapraneeth\u003c/strong\u003e: Contributed to data collection, patient assessment, and literature review. \u003cstrong\u003eAshok Ranjan\u003c/strong\u003e: Assisted in imaging analysis, interpretation of radiological findings, and manuscript drafting. \u003cstrong\u003eKirthi Sathyakumar\u003c/strong\u003e: Conceptualized the study, supervised the clinical and radiological evaluation, reviewed and critically revised the manuscript\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFinancial Disclosure\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors gratefully acknowledge the financial support provided by SRM Medical College Hospital and Research Centre, Faculty of Medicine and Health Sciences, SRMIST, Kattankulathur, for defraying the publication costs of this article\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have \u003cstrong\u003eno conflicts of interest\u003c/strong\u003e related to this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics\u0026nbsp;Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted in accordance with the ethical principles of the Declaration of Helsinki and relevant institutional ethical guidelines.This study received assessment and approval from the Institutional Ethics Committee of SRM Medical College Hospital and Research Centre. A wavier for ethical approval was granted since this was a report with no intervention.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent\u0026nbsp;to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe patient provided written informed consent for inclusion in this case report. The patient was apprised of the report\u0026apos;s objective, the utilisation of anonymised clinical data and photographs, and consented to participate voluntarily.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to publish\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent for publication was obtained from all participants, explicitly authorizing the use of their anonymized clinical data and images in this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eNarod SA. Bilateral breast cancers. Nat Rev Clin Oncol. 2014;11(3):157\u0026ndash;66. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1038/nrclinonc.2014.3\u003c/span\u003e\u003cspan address=\"10.1038/nrclinonc.2014.3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSpick C, Baltzer PAT. Diagnostic utility of second-look US for breast lesions identified at MR imaging: a systematic review and meta-analysis. Radiology. 2014;273(2):401\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1148/radiol.14140011\u003c/span\u003e\u003cspan address=\"10.1148/radiol.14140011\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMoossdorff M, Vugts G, Maaskant-Braat AJG, Strobbe LJA, Voogd AC, Smidt ML. Contralateral axillary lymph node metastases in breast cancer: a systematic review. Eur J Surg Oncol. 2015;41(10):1297\u0026ndash;304. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.ejso.2015.07.019\u003c/span\u003e\u003cspan address=\"10.1016/j.ejso.2015.07.019\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCardoso F, Kyriakides S, Ohno S, et al. Early breast cancer: ESMO Clinical Practice Guidelines. Ann Oncol. 2019;30(8):1194\u0026ndash;220. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1093/annonc/mdz173\u003c/span\u003e\u003cspan address=\"10.1093/annonc/mdz173\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTchaou M, Sano D, Mouchi A, et al. Breast abscessed cancer in nonlactating women. Case Rep Surg. 2017;2017:1216320. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1155/2017/1216320\u003c/span\u003e\u003cspan address=\"10.1155/2017/1216320\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFaghani R, Rahimi A, Zare F, et al. Poorly differentiated breast carcinoma with cystic necrotizing mass: a case report. J Med Case Rep. 2024;18:138. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s13256-024-04138-3\u003c/span\u003e\u003cspan address=\"10.1186/s13256-024-04138-3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWaks AG, Winer EP. Breast cancer treatment: a review. JAMA. 2019;321(3):288\u0026ndash;300. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1001/jama.2018.19323\u003c/span\u003e\u003cspan address=\"10.1001/jama.2018.19323\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSharma SK, Mohan A, Sharma A. Challenges in the diagnosis and treatment of miliary tuberculosis. Indian J Med Res. 2012;135(5):703\u0026ndash;30.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"discover-oncology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"dion","sideBox":"Learn more about [Discover Oncology](https://www.springer.com/12672)","snPcode":"","submissionUrl":"","title":"Discover Oncology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Breast carcinoma, axillary abscess, Bilateral breast lump, BI-RADS 4c, Invasive carcinoma NST","lastPublishedDoi":"10.21203/rs.3.rs-8770602/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8770602/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eA 53-year-old woman arrived with bilateral breast enlargements and a left axillary mass. The MRI indicated a concerning lesion in the right breast and a collection in the left axilla. FNAC verified aggressive cancer of the right breast and a tuberculous abscess in the left axilla, with CBNAAT identifying \u003cem\u003eMycobacterium tuberculosis\u003c/em\u003e DNA. The patient commenced anti-tubercular medication and underwent surgical removal of the right breast lesion, confirming Grade 3 invasive carcinoma of no special type (NST). This case underscores the necessity of matching imaging with histopathology to distinguish cancer from infectious diseases, hence assuring precise diagnosis and therapy.\u003c/p\u003e","manuscriptTitle":"Right breast invasive carcinoma and contralateral left axillary abscess representing a rare dual pathology","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-22 12:45:13","doi":"10.21203/rs.3.rs-8770602/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-02T22:19:24+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-01T18:02:23+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-17T12:39:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"141407173572331985808572546539982989239","date":"2026-02-17T11:55:03+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"138838019608062137069422129835226573580","date":"2026-02-17T11:02:25+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-17T09:09:46+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-02-16T04:51:54+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-14T05:37:53+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-13T09:23:22+00:00","index":"","fulltext":""},{"type":"submitted","content":"Discover Oncology","date":"2026-02-13T09:15:11+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"discover-oncology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"dion","sideBox":"Learn more about [Discover Oncology](https://www.springer.com/12672)","snPcode":"","submissionUrl":"","title":"Discover Oncology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4bb73b2f-e811-488a-86ee-e41be8055c42","owner":[],"postedDate":"February 22nd, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-17T23:53:29+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-22 12:45:13","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8770602","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8770602","identity":"rs-8770602","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}