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Feng K, Zhao S, Shang Q, Qiao G, Liu J, Yang C, Wei Y, Li Y, Ren F, Xuan L, Wang X, Wang X. The prognostic value of IPI in patients with primary breast lymphoma, a multicenter retrospective study. Cancer Cell Int 2022; 22:357. [PMID: 36376836 PMCID: PMC9664603 DOI: 10.1186/s12935-022-02772-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 10/30/2022] [Indexed: 11/16/2022] Open
Abstract
Background Due to the rarity of PBL and the lack of large-scale studies, the prognostic value of IPI in PBL was controversial. Especially in the rituximab era, the ability of IPI to stratify prognosis in patients receiving immunochemotherapy was severely reduced. Then revised IPI (R-IPI) and National Comprehensive Cancer Network IPI (NCCN-IPI) were introduced. The present study aimed to evaluate the prognostic value of IPI and the other IPIs in patients with PBL in a Chinese population. Methods We performed a multicenter retrospective study of 71 patients with PBL from 3 institutions in China. The Kaplan–Meier method and log-rank tests were used for the survival analysis. Cox regression analysis was performed to evaluate the prognostic factors. Subgroup analysis was performed to assess the prognostic significance of IPI scores, R-IPI scores, and NCCN-IPI scores. Results The median follow-up was 4.7 years (0.7–21.8 years). The 5-year progression-free survival (PFS) and overall survival (OS) rates were 90.2% and 96.3%. In the multivariate analysis, only IPI scores and radiotherapy were significantly associated with OS and PFS (P < 0.05). Applying the R-IPI in our patient cohort indicates a significant difference in PFS between the two groups of R-IPI (P = 0.034) but not for OS (P = 0.072). And the NCCN-IPI was prognostic for OS (P = 0.025) but not for PFS (P = 0.066). Subgroup analyses of IPI showed that survival analysis of IPI scores for the PFS and OS of patients using rituximab were not significantly different (P > 0.05). Conclusions Our study confirms the prognostic value of IPI in patients with PBL, but the predictive value of IPI proved to be relatively low with the addition of the rituximab. The R-IPI and NCCN-IPI can accurately assess the high and low-risk groups of PBL patients but were insufficient to evaluate the intermediate risk group. Supplementary Information The online version contains supplementary material available at 10.1186/s12935-022-02772-y.
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2
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Ouriagli SN. Unexpected Rare Association of Secondary Breast, Thyroid, and Ovarian Lymphomas in a Female Patient with Burkitt Lymphoma: PET-CT Findings. World J Nucl Med 2022; 21:80-82. [PMID: 35502275 PMCID: PMC9056131 DOI: 10.1055/s-0042-1746172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
We report the case of a 15-year-old female, followed for Burkitt lymphoma with initial ovarian presentation. Positron emission tomography-computed tomography (PET-CT) with 18 F-fluorodeoxyglucose ( 18 F-FDG) performed to evaluate initial extension assessment showed an unexpected association with secondary breast, thyroid, and ovarian lymphomas. To our knowledge, this association is very rare, unusual, and these extranodal presentations have been reported in literature as a separate case report. Authors highlight performance of PET-CT with 18 F-FDG to determinate the secondary origin of this multiglandular involvement, to establish a lesional map of the whole body, and to contribute to the therapeutic decision.
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Duckworth LA, Cotta CV, Rowe JJ, Downs-Kelly E, Komforti MK. Amyloid in the breast: retrospective review with clinicopathological and radiological correlation of 32 cases from a single institution. Histopathology 2021; 79:57-66. [PMID: 33404113 DOI: 10.1111/his.14329] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 12/13/2020] [Accepted: 01/04/2021] [Indexed: 12/01/2022]
Abstract
AIMS Mammary amyloid is an uncommon and easily overlooked pathological diagnosis with ambivalent presentation. Herein, we delineate the clinicopathological and radiographic characteristics of mammary amyloid. METHODS AND RESULTS The Department of Pathology database was searched from 1993 to 2019 for keywords 'breast' and 'amyloid', yielding 32 cases from 23 patients, including consultation cases. All patients were female, age range = 52-81 (mean = 67.4 years). The left breast was involved more than the right (43 versus 33%, respectively); bilateral amyloid involvement was also present (24%). Amyloid was most often associated with a benign histopathological diagnosis (57%), lymphoma in 39% [all B cell lymphomas; five of nine were mucosa-associated lymphoid tissue (MALT) lymphoma] and rarely with a concurrent epithelial malignancy (invasive lobular carcinoma, 4%). Of the 14 patients with available clinical history, amyloid presented as a mass clinically or radiographically (six patients, 43%), as microcalcifications (five patients, 36%), and only occasionally as an asymmetry (14%) or fibroglandular density (7%). Microscopic examination detected microcalcifications in an additional nine cases (total 14 patients; 44% of the cohort). Interestingly, one patient had concurrent epithelial and haematological malignancy and amyloid within an axillary lymph node. Co-morbidities included autoimmune diseases and multiple myeloma. CONCLUSION The majority of mammary amyloid cases are associated with benign histopathological findings, while imaging most frequently noted microcalcifications or mass lesions. To avoid overlooking amyloid as simply fat necrosis or fibroelastotic stromal change, a low threshold for performing ancillary stains should be considered in elderly women with benign core needle findings performed for mass lesions or microcalcifications.
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Affiliation(s)
| | - Claudiu V Cotta
- Department of Pathology, Cleveland Clinic, Cleveland, OH, USA
| | - J Jordi Rowe
- Department of Pathology, Cleveland Clinic, Cleveland, OH, USA
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4
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Takahashi H, Sakai R, Sakuma T, Matsumura A, Miyashita K, Ishii Y, Nakajima Y, Numata A, Hattori Y, Miyazaki T, Hashimoto C, Koharazawa H, Takemura S, Taguchi J, Fujimaki K, Fujita H, Nakajima H. Comparison of Clinical Features Between Primary and Secondary Breast Diffuse Large B Cell Lymphoma: A Yokohama Cooperative Study Group for Hematology Multicenter Retrospective Study. Indian J Hematol Blood Transfus 2021; 37:60-66. [PMID: 33707836 DOI: 10.1007/s12288-020-01307-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 06/11/2020] [Indexed: 11/25/2022] Open
Abstract
We performed a retrospective analysis of DLBCL with breast involvement to compare the prognosis of primary breast lymphoma (PBL) to secondary breast lymphoma (SBL; especially in limited stage cases). We retrospectively reviewed records of 25 diffuse large B-cell lymphoma (DLBCL) patients with breast involvement who received chemotherapy between January 2000 and August 2012. We compared clinical features and prognosis among patients with PBL (n = 11), limited stage SBL (LSBL; n = 6), and advanced stage SBL (ASBL, n = 8). The PBL group had significantly lesser patients with breast tumours (BTs) > 5 cm than the SBL group (P = 0.02). After a median follow-up of 71.3 months, we observed significantly better 5-year overall survival (OS) in the PBL group (90.0%) than in the LSBL (33.3%, P = 0.01) group, but not for progression-free survival (PFS). Patients with BT > 5 cm had worse OS (P = 0.01) and PFS (P = 0.04) than those with BT ≤ 5 cm. PBL had a better prognosis than SBL among limited stage DLBCL.
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Affiliation(s)
- Hiroyuki Takahashi
- Department of Hematology and Medical Oncology, Kanagawa Cancer Center, 2-3-2, Nakao, Asahi-ward, Yokohama, 241-8515 Kanagawa Japan
| | - Rika Sakai
- Department of Hematology and Medical Oncology, Kanagawa Cancer Center, 2-3-2, Nakao, Asahi-ward, Yokohama, 241-8515 Kanagawa Japan
| | - Takayuki Sakuma
- Department of Hematology and Medical Oncology, Kanagawa Cancer Center, 2-3-2, Nakao, Asahi-ward, Yokohama, 241-8515 Kanagawa Japan
| | - Ayako Matsumura
- Department of Hematology and Medical Oncology, Kanagawa Cancer Center, 2-3-2, Nakao, Asahi-ward, Yokohama, 241-8515 Kanagawa Japan
| | - Kazuho Miyashita
- Department of Hematology, Yokohama City University Medical Center, Yokohama, Kanagawa Japan
| | - Yoshimi Ishii
- Department of Hematology, Yokohama City University Medical Center, Yokohama, Kanagawa Japan
| | - Yuki Nakajima
- Department of Hematology, Yokohama City University Medical Center, Yokohama, Kanagawa Japan
| | - Ayumi Numata
- Department of Hematology, Yokohama City University Medical Center, Yokohama, Kanagawa Japan
| | - Yukako Hattori
- Department of Hematology/Oncology, Yamato Municipal Hospital, Yamato, Kanagawa Japan
| | - Takuya Miyazaki
- Department of Hematology and Clinical Immunology, Yokohama City University School of Medicine, Yokohama, Kanagawa Japan
| | - Chizuko Hashimoto
- Department of Hematology/Oncology, Yamato Municipal Hospital, Yamato, Kanagawa Japan
| | | | - Sachiya Takemura
- Department of Internal Medicine, Yokohama Ekisakai Hospital, Yokohama, Kanagawa Japan
| | - Jun Taguchi
- Department of Hematology, Shizuoka Red Cross Hospital, Shizuoka, Japan
| | | | - Hiroyuki Fujita
- Department of Hematology, Saiseikai Yokohama Nanbu Hospital, Yokohama, Kanagawa Japan
| | - Hideaki Nakajima
- Department of Hematology and Clinical Immunology, Yokohama City University School of Medicine, Yokohama, Kanagawa Japan
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Su W, Niu X, Ji H, Xu Y, Zhong L, Wang S, Tang D, Zhou X, Zhang Q, Zhou J. A novel classification based on B-cell receptor signal gene expression correlates with prognosis in primary breast diffuse large B-cell lymphoma. J Cancer 2020; 11:2431-2441. [PMID: 32201514 PMCID: PMC7066002 DOI: 10.7150/jca.39083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 01/03/2020] [Indexed: 12/13/2022] Open
Abstract
Primary breast diffuse large B-cell lymphoma (PB-DLBCL), the most common histologic subtype of lymphoid malignancy in the breast, is a clinically and genetically heterogeneous disease that has insufficient systematic studies on the pathological and molecular features, optimal treatment scheme, as well as the prognostic factors. The aim of our study was to identify biomarkers and distinct subtypes of PB-DLBCLs and then evaluate the prognosis of this rare malignant lymphoma. We carried out hierarchical clustering analysis to evaluate protein expressions of potential biomarkers detected by immunohistochemistry staining of samples from 68 PB-DLBCL patients. The gene expression data from TCGA database was obtained to validate the identified clusters. We identified three robust clusters based on the B-cell receptor (BCR) signaling pathway, including two recognized NF-κB-dependent and PI3K-dependent clusters, and a distinct subset of PB-DLBCL with NF-κB-independent anti-apoptotic overexpression plus PI3K signaling, which exhibited an evolving definition and distinctive characters of a cluster group. Furthermore, survival analysis results showed an inferior outcome in NF-κB-dependent cluster patients and favorable survival in the PI3K-dependent cluster patients, suggesting an important predictive value of the three clusters. Our study provided a new perspective for understanding clinical complexity of PB-DLBCLs, and gave evidence for finding targeted biomarkers and strategies.
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Affiliation(s)
- Wenjia Su
- Department of Hematology, First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin 150081, Heilongjiang, China
| | - Xingjian Niu
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin 150081, Heilongjiang, China
| | - Hongfei Ji
- Institute of Cancer Prevention and Treatment, Harbin Medical University, Harbin 150081, Heilongjiang, China.,Heilongjiang Academy of Medical Sciences, Harbin 150081, Heilongjiang, China
| | - Yang Xu
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin 150081, Heilongjiang, China
| | - Lei Zhong
- Department of General Surgery, Second Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin 150081, Heilongjiang, China
| | - Shuye Wang
- Department of Hematology, First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin 150081, Heilongjiang, China
| | - Dabei Tang
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin 150081, Heilongjiang, China
| | - Xiaoping Zhou
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin 150081, Heilongjiang, China
| | - Qingyuan Zhang
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin 150081, Heilongjiang, China.,Institute of Cancer Prevention and Treatment, Harbin Medical University, Harbin 150081, Heilongjiang, China.,Heilongjiang Academy of Medical Sciences, Harbin 150081, Heilongjiang, China
| | - Jin Zhou
- Department of Hematology, First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin 150081, Heilongjiang, China
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Foo MY, Lee WP, Seah CMJ, Kam C, Tan S. Primary breast lymphoma: A single-centre experience. Cancer Rep (Hoboken) 2019; 2:e1140. [PMID: 32721093 PMCID: PMC7941582 DOI: 10.1002/cnr2.1140] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 09/01/2018] [Accepted: 09/05/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Primary non-Hodgkin lymphoma is an extremely rare entity, and this condition represents less than 0.5% of all malignant lesions involving the mammary gland. As such, there has been a paucity of relevant clinical data arising from Southeast Asia. AIMS Our study aims to review the clinical presentation, diagnostic methods, treatment, and survival outcomes of all patients diagnosed with primary breast lymphoma in our institution between 2011 and 2017. METHODS AND RESULTS Patients who had histologically proven lymphoma involving the breast were identified from a prospectively collected database in a single institution between 2011 and 2017. All seven patients were female, with a median age of 65 years old, and had presented with unilateral large breast or axillary masses. All the histological diagnosis was achieved with adequate tissue diagnosis either through core, incisional, or excisional biopsy. Five patients had diffuse large B cell lymphoma, one had marginal zone lymphoma, and the other had follicular lymphoma. Based on Ann Arbor classification, one patient had stage 1, three had stage 2, one with stage 3, and two patients with stage 4 disease. Five patients had received standard CHOP regimen with rituximab. At the time of analysis, patients who had nondisseminated disease had a median survival of 57 months. The overall mean survival time for all seven patients was 47 months. With the standard systemic chemotherapy treatment regimen, the estimated 3-year overall survival was found to be 64%. CONCLUSION Primary breast lymphoma, though uncommon, may present in a similar manner as breast carcinomas, but the main treatment modality remains nonsurgical with systemic chemotherapy. Hence, it is prudent to obtain accurate histological diagnosis of primary breast lymphoma. In this study, our patients with nondisseminated breast lymphoma have demonstrated a fairly good survival outcome following chemotherapy.
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Affiliation(s)
- Mang Yik Foo
- Division of Breast Surgery, Department of General SurgeryChangi General HospitalSingapore
| | - Wai Peng Lee
- Division of Breast Surgery, Department of General SurgeryChangi General HospitalSingapore
| | - Chin Mui Jaime Seah
- Division of Breast Surgery, Department of General SurgeryChangi General HospitalSingapore
| | - Carmen Kam
- Clinical Trials and Research UnitChangi General HospitalSingapore
| | - Su‐Ming Tan
- Division of Breast Surgery, Department of General SurgeryChangi General HospitalSingapore
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7
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Franco Pérez F, Lavernia J, Aguiar-Bujanda D, Miramón J, Gumá J, Álvarez R, Gómez-Codina J, Arroyo FG, Llanos M, Marin M, Alfaro J, Quero C, Delgado M, Nogales E, Menarguez F, Martinez N, Torrente M, Royuela A, Abreu D, Provencio M. Primary Breast Lymphoma: Analysis of 55 Cases of the Spanish Lymphoma Oncology Group. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2016; 17:186-191. [PMID: 27847267 DOI: 10.1016/j.clml.2016.09.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Revised: 09/03/2016] [Accepted: 09/08/2016] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Primary breast lymphoma is a rare form of localized extranodal lymphoma, which affects the mammary glands unilaterally or bilaterally, and can also affect the regional lymph nodes. MATERIALS AND METHODS We reviewed 55 patients, with disease stages IE and IIE, diagnosed in 16 Spanish institutions between 1989 and 2016. A serial of clinical variables and treatment were collected, and overall survival (OS) and progression-free survival (PFS) were calculated. RESULTS Of the 55 patients, 96.4% were women with an average age of 69 years. A total of 53 patients corresponded to non-Hodgkin lymphoma (NHL), of whom 36.3% had lymph node involvement upon diagnosis. Of the patients, 58.2% were stage IE, and 41.8% were stage IIE. Treatments received included radiotherapy (36.3%), chemotherapy (85.5%), and rituximab (in 38 of the 45 patients with NHL treated with chemotherapy). In all, 82.2% of complete responses were achieved. OS and progression-free survival at 5 years in NHL patients was 76% and 73%, respectively. CONCLUSION Current treatments (chemotherapy, immunotherapy, and radiotherapy) achieve good control of the disease, with an OS of 5 years in 80% of the patients, although there is no consensus in treatment, given the scarce incidence of these lymphomas.
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Affiliation(s)
- Fernando Franco Pérez
- Department of Medical Oncology, Hospital Universitario Puerta de Hierro, Majadahonda, Spain.
| | - Javier Lavernia
- Department of Medical Oncology, Instituto Valenciano de Oncología, Valencia, Spain
| | - David Aguiar-Bujanda
- Department of Medical Oncology, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canarias, Spain
| | - José Miramón
- Department of Medical Oncology, Hospital Serranía de Ronda, Málaga, Spain
| | - Josep Gumá
- Department of Medical Oncology, Hospital Universitari Sant Joan de Reus, Reus, Spain
| | - Rut Álvarez
- Department of Medical Oncology, Hospital Universitario Virgen de la Salud, Toledo, Spain
| | - José Gómez-Codina
- Department of Medical Oncology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | - Marta Llanos
- Department of Medical Oncology, Hospital Universitario de Canarias, San Cristóbal de La Laguna, Spain
| | - Miguel Marin
- Department of Medical Oncology, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Jesus Alfaro
- Department of Medical Oncology, Instituto Oncológico de Kutxa, Donistia, Spain
| | - Cristina Quero
- Department of Medical Oncology, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Mayte Delgado
- Department of Medical Oncology, Hospital Universitario San Cecilio, Granada, Spain
| | - Esteban Nogales
- Department of Medical Oncology, Hospital Universitario Virgen de la Macarena, Sevilla, Spain
| | - Francisco Menarguez
- Department of Medical Oncology, Hospital General Universitario de Elche, Alicante, Spain
| | - Natividad Martinez
- Department of Medical Oncology, Hospital General Universitario de Elche, Alicante, Spain
| | - Maria Torrente
- Department of Medical Oncology, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
| | - Ana Royuela
- Department of Biostatistics, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
| | - Delvys Abreu
- Department of Medical Oncology, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canarias, Spain
| | - Mariano Provencio
- Department of Medical Oncology, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
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8
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Aviv A, Tadmor T, Polliack A. Primary diffuse large B-cell lymphoma of the breast: looking at pathogenesis, clinical issues and therapeutic options. Ann Oncol 2013; 24:2236-44. [PMID: 23712546 DOI: 10.1093/annonc/mdt192] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Primary breast lymphoma is a rare form of non-Hodgkin lymphoma with some distinct clinical features. The most common histopathological type is diffuse large B-cell lymphoma (DLBCL), but other less frequent subtypes are also encountered. In this review, we describe the characteristics of primary breast DLBCL, with emphasis on pathogenesis, staging, risk stratification and prognosis. In addition, key issues regarding therapy and various available therapeutic modalities are addressed, as well as the role of rituximab in therapy and whether central nervous system prophylaxis is still routinely required. There are very few prospective clinical studies addressing therapy, and available data rely mostly on retrospective case series involving small numbers of patients. Our conclusions and proposed recommendations are therefore not offered as formal guidelines. This review attempts to represent an unbiased analysis of the published data and is intended as a useful aid for clinicians treating this uncommon type of extra nodal lymphoma.
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Affiliation(s)
- A Aviv
- Hematology Unit, Emek Medical Center, Afula, Israel
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9
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Said SM, Reynolds C, Jimenez RE, Chen B, Vrana JA, Theis JD, Dogan A, Shah SS. Amyloidosis of the breast: predominantly AL type and over half have concurrent breast hematologic disorders. Mod Pathol 2013; 26:232-8. [PMID: 23018872 DOI: 10.1038/modpathol.2012.167] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Amyloidosis is a disorder characterized by extracellular deposition of proteins in an abnormal fibrillar configuration. Amyloidosis can be localized or systemic and may affect any organ. Breast involvement by amyloidosis has rarely been reported. In this study, we described the characteristics of 40 cases of breast amyloidosis that were reviewed at the Division of Anatomic Pathology at Mayo Clinic from 1995 to 2011. The cohort included 39 women and 1 man with a mean age of 60 years. The type of amyloidosis, determined by immunohistochemistry or mass spectrometry-based proteomics in 26 patients, was immunoglobulin-associated in all cases (AL-kappa type in 15 (58%) cases, AL-lambda in 10 (38%) and mixed heavy and light chains (AH/AL) in 1 (4%) case). Mass spectrometry-based proteomics was able to determine the type of amyloidosis in 95% of cases tested compared with 69% of cases by immunohistochemistry. In addition to amyloidosis, the breast biopsy showed a hematologic disorder in 55% of cases, most commonly MALT lymphoma. One patient had concurrent intraductal carcinoma, but none had invasive carcinoma. Of the 15 patients seen in our institution, 53% had localized amyloidosis and 47% had extramammary amyloid involvement, which was diagnosed before breast amyloidosis in most patients. M-spike was detected in the blood in 62%. After a median follow-up of 33.5 months in 12 patients, 5 died, mostly of complications of lymphoma or leukemia. In conclusion, our findings indicate that breast amyloidosis is of the AL type in the vast majority of patients (usually kappa). It is associated with systemic amyloidosis in close to half of patients and with hematologic malignancy in the breast in over half of patients. Therefore, further work up to rule out hematologic malignancy and/or systemic amyloidosis is recommended. Mass spectrometry-based proteomics is superior to immunohistochemistry for typing of breast amyloidosis.
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Affiliation(s)
- Samar M Said
- Division of Anatomic Pathology, Mayo Clinic, Rochester, MN 55905, USA.
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10
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Caon J, Wai ES, Hart J, Alexander C, Truong PT, Sehn LH, Connors JM. Treatment and Outcomes of Primary Breast Lymphoma. Clin Breast Cancer 2012; 12:412-9. [PMID: 23018097 DOI: 10.1016/j.clbc.2012.07.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Revised: 05/10/2012] [Accepted: 07/09/2012] [Indexed: 10/27/2022]
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11
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Li D, Deng J, He H, Bu Y, Peng F, Tang X, Wang B, Lei Y, Zhang H, Xie P. Primary breast diffuse large B-cell lymphoma shows an activated B-cell–like phenotype. Ann Diagn Pathol 2012; 16:335-43. [PMID: 22569408 DOI: 10.1016/j.anndiagpath.2012.01.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Revised: 12/12/2011] [Accepted: 01/18/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Dan Li
- Department of Pathology, the First Affiliated Hospital, Chongqing Medical University, China
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12
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Tang TC, Chang H, Chuang WY. Primary breast lymphoma sequentially relapsed in the peripheral and central nervous system. Acta Neurol Belg 2012; 112:271-4. [PMID: 22426680 DOI: 10.1007/s13760-012-0052-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Accepted: 02/06/2012] [Indexed: 10/28/2022]
Abstract
Primary breast lymphoma (PBL) is an uncommon extranodal type of lymphoma, exhibiting more aggressive behavior and poorer prognosis. Patients with PBL have a higher incidence to relapse in central nervous system (CNS), which is always leading to a dismal outcome even treating with high intensity chemotherapy plus radiotherapy. Lymphoma involving the peripheral nervous system (PNS), either primarily or secondarily, is also rare. But no PBL with PNS relapse has been reported before. Herein, we reported a case of PBL who presented with subsequent relapse in two discrete sites of the PNS followed by the CNS.
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Abstract
OBJECTIVES To analyze the role of genotype in patients with diffuse large B-cell lymphoma primary of breast (DLBCL-PB) treated with chemotherapy or immunochemotherapy. METHODS We carried out a retrospective analysis in 104 patients with DLBCL-PB who were treated with CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) or immunochemotherapy: R-CHOP (adding rituximab) and also carried out an analysis of genotype, studied with immunohistochemistry, as a prognostic factor. RESULTS Seventy-seven percent of patients showed the non-GCB (germinal center B) genotype. Patients treated with CHOP had a complete response of 70%; actuarial curves at 5 years showed that disease-free survival was 66 % and overall survival was 52% and that it was not statistically different than patients treated with R-CHOP: 78%, 61%, and 53%, respectively. When genotype was analyzed to assess the impact in prognosis, no statistical differences were observed. Patients treated with R-CHOP and non-GCB genotype have a complete response of 77%, disease-free survival of 56%, and overall survival of 66% that were not statistically different than patients with GCB: 80%, 60%, and 60% respectively, (P: 0.81, 0.5, and 0.66, respectively). CONCLUSIONS We confirm that the non-GCB genotype is most frequent in DLBCL-PB, but the addition of rituximab did not improve outcome in primary breast lymphoma with non-GCB phenotype.
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14
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Fukuhara S, Watanabe T, Munakata W, Mori M, Maruyama D, Kim SW, Kobayashi Y, Taniguchi H, Maeshima AM, Tanosaki R, Matsuno Y, Tobinai K. Bulky disease has an impact on outcomes in primary diffuse large B-cell lymphoma of the breast: a retrospective analysis at a single institution. Eur J Haematol 2011; 87:434-40. [PMID: 21740461 DOI: 10.1111/j.1600-0609.2011.01679.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Primary breast lymphoma (PBL) is rare, and its clinical behavior and standard initial treatment are not yet established. METHODS We retrospectively analyzed the clinicopathological features and treatment outcomes of 14 patients with primary breast diffuse large B-cell lymphoma. RESULTS There were nine patients with stage IE and five with stage IIE disease. The median largest tumor diameter was 4.5 cm, and five patients had bulky disease >5 cm. The complete response rate was 94%. However, the 5-year progression-free survival rate was 52% with a median follow-up of 5.2 years. Patients with bulky disease had an unfavorable prognosis. All five patients with bulky disease progressed or relapsed. Of the four patients that recurred in the central nervous system (CNS), three had bulky disease although some received rituximab. There were no CNS recurrences in the three patients who received CNS prophylaxis. All eight patients who responded to radiotherapy (RT) did not have recurrences in the ipsilateral breast, although one patient with bulky disease relapsed in the adjacent regional lymph nodes within the RT field despite immunochemotherapy. CONCLUSIONS Patients with bulky disease had a poorer prognosis and recurred frequently in the CNS. CNS prophylaxis might yield better outcomes, but a larger, prospective trial is needed to elucidate the optimal initial treatment of PBL in the rituximab era.
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Affiliation(s)
- Suguru Fukuhara
- Department of Hematology, and Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, Japan
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Zhao S, Zhang QY, Ma WJ, Zhang MH, Sun WZ, Li HB, Zhang XS, Di WY, Wang XC. Analysis of 31 Cases of Primary Breast Lymphoma: The Effect of Nodal Involvement and Microvascular Density. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2011; 11:33-7. [DOI: 10.3816/clml.2011.n.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Duman BB, Şahin B, Güvenç B, Ergin M. Lymphoma of the breast in a male patient. Med Oncol 2010; 28 Suppl 1:S490-3. [DOI: 10.1007/s12032-010-9675-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Accepted: 08/27/2010] [Indexed: 11/28/2022]
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