F-18 FDG PET/MRI findings of primary breast lymphoma in two cases: FDG PET/MRI findings of primary breast lymphoma

Primary Isolated Breast Lymphoma Presenting as Primary Breast Cancer with 18F-FDG PET/CT

A 40-year-old woman with a palpable mass lesion in her right breast suggested as breast cancer was admitted to ¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) unit for the metabolic characterization of the lesion and for the staging of the disease. The patient had no fever and no evidence of weight loss or night sweats. ¹⁸F-FDG PET/CT revealed an isolated solid mass lesion with increased ¹⁸F-FDG uptake in the upper outer quadrant of the right breast and increased ¹⁸F-FDG uptake in the lymph nodes of the right axilla suspected as primary breast cancer and its local lymph node metastasis. There was no other pathological ¹⁸F-FDG uptake in the whole body. Excisional biopsy histopathology revealed diffuse large B-cell non-Hodgkin lymphoma.

Primary Breast Diffuse Large B-Cell Lymphoma in a 42-Year-Old Female: A Case Report and Review of Literature

Primary breast diffuse large B-cell lymphoma (PB-DLBCL) is a rare localized extranodal lymphoma. It is mainly diagnosed by pathological examination due to the lack of specific clinical and imaging manifestations. Whole-body positron emission tomography-computed tomography (PET-CT) is widely used in determining clinical staging and guiding clinical treatment. As part of comprehensive treatment, targeted therapy with rituximab, intrathecal methotrexate injection and consolidation radiotherapy remain controversial in treating PB-DLBCL, but the comprehensive treatment based on full-course of chemotherapy is still widely used as the first-line treatment. Comprehensive treatment often leads to a sharp decline in the immunity of elderly patients with malignancy. In this situation, surgery may be a good chance to improve their life quality without serious complications. We present a rare case of PB-DLBCL during the coronavirus disease 2019 (COVID-19) pandemic. The patient underwent chest CT scan to screen COVID-19 and a mass of left breast was accidentally found. Because of the city lockdown policy in Wuhan, she did not seek medical help until noticing that the mass was gradually enlarged. Both ultrasonography and mammography indicated that the lesion was breast cancer. However, ultrasound-guided core needle biopsy revealed diffuse large B-cell lymphoma of breast and PET-CT scan showed that the lesion was a primary hypermetabolic tumor of left breast. The patient subsequently received comprehensive treatment based on six cycles of rituximab-cyclophosphamide, hydroxydaunomycin, oncovin, prednisone (R-CHOP) chemotherapy.