Hematologic Malignancies of the Breast: A Contemporary Series Investigating Incidence, Presentation, Accuracy of Diagnosis on Core Needle Biopsy, and Hormone Receptor Expression

Abstract

Background: Distinguishing breast hematologic malignancies in core needle biopsies from other entities can be challenging. Misclassification as a breast carcinoma could result in inappropriate treatment. The aim of this study was to characterize the types, incidence, and helpful diagnostic features of hematologic malignancies of the breast. Design: All hematologic malignancies of the breast diagnosed at our institution from 2004 to 2017 were identified. Clinical notes, imaging, and slides were reviewed. Immunohistochemical analysis of estrogen receptor α (ERα), estrogen receptor β (ERβ), and androgen receptor (AR) was performed when tissue was available. Results: In all, 43 hematologic malignancies from biopsies of 37 women and 6 men were identified. Core needle biopsies (35 or 81%) were more common than excisions (8 or 19%). For 14 patients (40%), the core biopsy was the first diagnosis of a hematologic malignancy. Diagnoses included 37 lymphomas (7 primary), 4 leukemias, and 2 myelomas. There was 1 misdiagnosis of carcinoma. Low positivity for hormone receptors was observed in a minority of lymphomas. A definitive diagnosis of hematologic malignancy was made in 31 (89%) of the core needle biopsies. Only 3 patients undergoing core biopsy required excision for diagnosis. Conclusions: Most of the hematologic malignancies of the breast are currently diagnosed on core needle biopsy and 40% of patients do not have a prior history. To avoid errors, pathologists need to be aware of diagnostic features and morphologic mimics. A hematologic malignancy should be considered if tumor cells are discohesive, carcinoma in situ is absent, and hormone expression is low or absent.

Primary breast lymphoma initially diagnosed as invasive ductal carcinoma: A case report

“…Guilbert et al reported a similar proposal. 8 Yoneyama et al reported a similar case, and they highlighted several characteristics, including conspicuous apoptosis, marked nuclear rays due to crushing, and polymorphism in tumor cells, that distinguish breast cancer from PBL. 5 Lin et al also identified several characteristics as findings suspicious of lymphoma, such as lack of in situ lesions, frequent individual karyorrhectic cells, lymphoepithelial lesions, and cellular discohesiveness.…”

Hematolymphoid Neoplasms of Breast – A Case Series with Review of Lymphoid Cell Rich Lesions of Breast

“…This pattern can also be noted in chronic lymphocytic lymphoma. According to Guilbert et al, [8] diabetic mastopathy shows periductular and perivascular infiltrate with sparing of intervening stroma which is dense collagenous. In contrast, intervening stroma is involved with lymphocytic infiltrate in chronic lymphocytic lymphoma.…”

“…However complete absence of cohesion, lack carcinoma in situ component along with absent receptor expression should alert pathologist for some other entity. [8] Likewise lobular carcinoma with its typical Indian file pattern of infiltration is a close mimic for lymphoma. However, lobular carcinoma in general express strong ER positivity in 95% of cases [9] and its absence in a suspected case of lobular carcinoma should be taken as a lead for further evaluation.…”

Metastatic cyclin D1 positive lobular breast carcinoma as a potential lymphoma mimicker

“…Lobular carcinoma of the breast infiltrates can present as single cells and the tumor cells could mimic lymphocytes [1]. Cyclin‐D1, a well‐known oncogene, is overexpressed in approximately half of breast cancers [2–4].…”

“…A 60-year-old female presented with fatigue and pinpoint bruising on her legs and abdomen. Labs were consistent with severe pancytopenia and bone marrow aspiration and biopsy were performed to investigate the cause; however, flow cytometry studies could not be done due Lobular carcinoma of the breast infiltrates can present as single cells and the tumor cells could mimic lymphocytes [1]. Cyclin-D1, a well-known oncogene, is overexpressed in approximately half of breast cancers [2][3][4].…”