Breast Mass and Lytic Bone Lesions: A Rare Presentation of Non-Hodgkin’s Lymphoma Arising in the Breast

Abstract

Background. Primary breast lymphoma is a rare malignancy representing less than 1% of all tumors presenting in the breast. Case Presentation. A 55-year-old woman presented with altered mental status due to severe hypercalcemia and was found to have a large breast mass with lytic bone lesions in the calvarium of the skull. Biopsy of the mass revealed diffuse large B-cell lymphoma. Staging workup did not reveal any visceral organ or distant lymph node involvement. The patient's bone marrow biopsy was positive for involvement with lymphoma. Interestingly, the patient also had a non quantifiable IgA kappa monoclonal protein in the serum. Conclusion. Here, we describe a common presentation in medical oncology, that is, a patient presenting as a clinically advanced breast tumor with hypercalcemia from lytic bone lesions. However, diagnostic workup led to the diagnosis of another common malignancy in an uncommon location, namely, diffuse large B-cell lymphoma arising in the breast.

Lytic Bone Metastasis in a Case with Primary Breast Lymphoma

“…Patients suffer from acute, rapidly worsening pain which doesn't relieve with rest. Pathological fractures in this area results in impaired mobility, dysfunction and decreased quality of life [14].…”

Hypercalcemia (C), renal dysfunction (R), anemia (A), and lytic bone lesion (B) (CRAB) as presenting features in non myelomatous malignancies: A case report and review of the literature

“…CRAB like initial presentation mimicking active myeloma is uncommonly reported in the literature. [3][4][5][6][7][8][9][10][11][12][13][14][15][16] In this manuscript we describe a middle-aged female subject who presented with clinicoradiological and biochemical features secondary to metastatic breast cancer mimicking CRAB positive myeloma and present a comprehensive review of all such CRAB positive nonmyelomatous malignancies reported in the literature.…”

“…There were twenty-two cases of CRAB positive nonmyelomatous malignancies (M:F = 1:1) the details of which are briefly summarized in Table 1. [3][4][5][6][7][8][9][10][11][12][13][14][15][16] The median age at presentation was 58. G reversal was described in a case reported by Roy et al in a case of primary osseous Burkitt lymphoma.…”

“…G reversal was described in a case reported by Roy et al in a case of primary osseous Burkitt lymphoma. [3][4][5]11,16 The hypercalcemia was severe (≥14 mg/dl) in fourteen (66.6%), moderate (12-13.9 mg/dl) in five (23.8%); and mild (10.5-11.9 mg/dl) in remainder three (13.6%) cases. 17 Data pertaining to serum ALP was not available or the same was not done in 17/22 (77.2%) cases; and in remainder four cases (where available), it was found to be elevated (237 [case 2], 219 [case 7], 177 [case 10], 263 U/L [case 11]).…”