Bilateral primary lymphoma of the breast: A case report initially diagnosed by FNAC

Abstract

Primary lymphoma of the breast (PLB) is a rare disease, representing 0.04-0.5% of all malignant breast neoplasms. We present a patient with bilateral breast involvement by a high-grade diffuse large B-cell lymphoma, which was diagnosed initially by fine-needle aspiration cytology (FNAC). Mammography revealed a diffuse increase in density of the right breast and a large solitary mass on the left breast, suggestive of an inflammatory carcinoma. The patient underwent FNAC and the diagnosis of a non-Hodgkin's lymphoma (NHL) was suggested. Physical examination revealed palpable bilateral axillary lymph nodes but no evidence of concurrent widespread disease. The patient underwent complete staging evaluation. The only positive findings were an elevated lactate dehydrogenase (LDH) and evidence of axillary lymphadenopathy on CT. Excisional biopsy was performed on the left breast. The morphological and immunohistochemical analysis confirmed the diagnosis of a high-grade diffuse large B-cell lymphoma with an immunophenotype suggestive of a germinal center cell origin.

Primary breast non‐Hodgkin's lymphoma: A large single center study of initial characteristics, natural history, and prognostic factors

“…In our series and in these reports, almost all cases had a B-cell non-Hodgkin's lymphoma, which was high-grade in about 80% of cases (range: 50-100%), and particularly of DLBCLs. However, very few series have evaluated the bcl-2 expression [23] and the germinal center B-cell expression profile in PBL [23,24]. We found 71% of Bcl-2-positive tumor samples when more than 30% of the tumor cells were positive.…”

Magnetic resonance imaging of primary breast lymphoma

“…In a recent study performed at Stanford University and encompassing 10,125 lymphoma patients admitted from 1981 to 2005, only 51 cases had lymphoma involving the breast [17]. As a consequence, there are few data concerning the radiological features of breast lymphoma, which mainly arise from mammographic and ultrasonographic examinations [2,3,6,7,9,18,19], which led to the conclusion that PBNHL does not show specific radiological features [2,3]. In fact, many different mammographic features of breast lymphomas have been described: Liberman et al described one or more than one primitivo della mammella, con o senza diffusione ai linfonodi regionali, in assenza di linfoma pre-esistente o simultaneo in altre sedi [2,4].…”

“…Di conseguenza, esistono in letteratura pochi dati riguardanti le caratteristiche radiologiche del linfoma mammario. La maggior parte di tali lavori ha valutato solo esami mammografici e ecografici [2,3,6,7,9,18,19], e sostanzialmente tutti concordano sul fatto che i linfomi primitivi della mammella non hanno aspetti radiologici specifici [2,3]. Per quanto riguarda gli aspetti mammografici, i risultati descritti non sono omogenei: alcuni autori hanno descritto una o più lesioni ben circoscritte senza microcalcificazioni e con reazione desmoplastica [2]; con densità parenchimale diffusamente aumentata, anche associata ad ispessimento cutaneo [2,5]; altri [20].…”

Non-Hodgkin’s Lymphoma of the Breast: Report of Five Cases and Review of the Literature

“…Commonly involved extranodal sites include the stomach, tonsils, lungs, adenoids, skin, small intestine, and testis. 1,3,8,11,12 Lymphoma involving the breast is very rare. The rarity of the breast lymphoma may be related to the relatively small amount of lymphoid tissue present in the breast as compared to the gut or lung in which primary lymphomas are much more frequent.…”

“…These tumors can appear in teenagers or patients in their 90's, but the peak age incidence is during the six decade. 3,[8][9][10] Extranodal NHL accounts for 10-48% of all NHL cases. Commonly involved extranodal sites include the stomach, tonsils, lungs, adenoids, skin, small intestine, and testis.…”