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Feng R, Huang W, Chen L, Min J, Shu W, Yu Y, Wang X, Cao X, Liu B. Clinicopathological characteristics, local treatment, and prognostic factors in IE/IIE primary breast lymphoma: a retrospective study of 67 patients. World J Surg Oncol 2023; 21:127. [PMID: 37032326 PMCID: PMC10084664 DOI: 10.1186/s12957-023-03007-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 03/30/2023] [Indexed: 04/11/2023] Open
Abstract
INTRODUCTION Primary breast lymphoma (PBL) is a rare disease, treatment of which excerpts does not reach a consensus. This retrospective study was conducted to analyze clinical features and survival outcomes of different therapeutic methods. MATERIALS AND METHODS Records of 67 patients with stage IE/IIE primary breast lymphoma were reviewed from the medical record system. Survival information was gathered by searching the outpatient system. Clinicopathological characteristics were compared by chi-squared or Fisher's exact tests. A comparison of survival curves was performed by log-rank tests. The Cox proportional hazard model was applied for multivariate analysis. RESULTS At the median follow-up time of 65.23 months (range, 9-150 months), there were 27 (40.3%) relapses, 28 (41.8%) distant metastases, and 21 (31.3%) deaths. The 5-year progression-free survival (PFS) and overall survival (OS) were 52.1% and 72.4%. Pathological types (DLBCL vs. non-DLBCL, p = 0.001) and rituximab use (p < 0.001) were statistically associated with longer PFS in patients with PBL. Nodal sites involved and radiotherapy administration were significant predictors for 5-year OS. Multivariate analysis suggested that nodal sites involved (p = 0.005) and radiotherapy administration (p < 0.003) were independent prognostic factors for OS in patients with PBL (p < 0.05). Radical surgery was not an independent factor for patients with PBL. CONCLUSIONS Radiotherapy improved the survival of patients with PBL. Radical mastectomy offered no additional benefit in the treatment of PBL.
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Affiliation(s)
- Ruigang Feng
- The First Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Huan-Hu-Xi Road, He-Xi District, Tianjin, 300060, China
- Tianjin's Clinical Research Center for Cancer, Tianjin, 300060, China
- Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, 300060, China
- Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, China
- Department of General Surgery, Second Central Hospital of Baoding, Baoding, 072750, China
| | - Wenwen Huang
- The First Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Huan-Hu-Xi Road, He-Xi District, Tianjin, 300060, China
- Tianjin's Clinical Research Center for Cancer, Tianjin, 300060, China
- Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, 300060, China
- Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, China
- Department of General Surgery, The Second Hospital of Chifeng, Chifeng, 024000, China
| | - Lixuan Chen
- Five Department of Oncology, Shijiazhuang People's Hospital, Shijiazhuang, 050000, China
| | - Jie Min
- The First Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Huan-Hu-Xi Road, He-Xi District, Tianjin, 300060, China
- Tianjin's Clinical Research Center for Cancer, Tianjin, 300060, China
- Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, 300060, China
- Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, China
| | - Wenjun Shu
- The First Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Huan-Hu-Xi Road, He-Xi District, Tianjin, 300060, China
- Tianjin's Clinical Research Center for Cancer, Tianjin, 300060, China
- Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, 300060, China
- Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, China
| | - Yue Yu
- The First Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Huan-Hu-Xi Road, He-Xi District, Tianjin, 300060, China
- Tianjin's Clinical Research Center for Cancer, Tianjin, 300060, China
- Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, 300060, China
- Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, China
| | - Xin Wang
- The First Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Huan-Hu-Xi Road, He-Xi District, Tianjin, 300060, China
- Tianjin's Clinical Research Center for Cancer, Tianjin, 300060, China
- Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, 300060, China
- Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, China
| | - Xuchen Cao
- The First Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Huan-Hu-Xi Road, He-Xi District, Tianjin, 300060, China
- Tianjin's Clinical Research Center for Cancer, Tianjin, 300060, China
- Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, 300060, China
- Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, China
| | - Bowen Liu
- The First Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Huan-Hu-Xi Road, He-Xi District, Tianjin, 300060, China.
- Tianjin's Clinical Research Center for Cancer, Tianjin, 300060, China.
- Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, 300060, China.
- Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, China.
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Iyer SG, Kuker R, Florindez JA, Saul E, Trabolsi A, Rodriguez G, Chapman JR, Lossos IS, Alderuccio JP. A single-center analysis of patients with extranodal marginal zone lymphoma of the breast. Leuk Lymphoma 2021; 63:591-598. [PMID: 34672247 DOI: 10.1080/10428194.2021.1992764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Breast extranodal marginal zone lymphoma (EMZL) is a rare malignancy. We performed the largest published to date single-center retrospective analysis of 13 patients with breast EMZL focusing on clinical characteristics and treatment-related outcomes. The rarity of this disease at our center was concordant with the prevalence reported in the literature, with breast EMZL comprising 2% of 654 MZL cases. Most patients presented with stage I-II disease however four (30.8%) patients had stage IV disease mostly due to occult bone marrow (BM) involvement. Interestingly, EMZL was frequently non-FDG avid (66.7%) on staging PET/CT. With a median follow-up of 3.1 years (range 5 months to 10.2 years), the 3-year progression free survival was 68.7% (95%CI 30.2%-88.9%) and overall survival 80.2% (95%CI 40.3%-94.8%). No patient experienced higher-grade transformation. Herein we show that localized breast EMZL can be effectively treated with radiation therapy providing long term disease control.
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Affiliation(s)
- Sunil Girish Iyer
- Department of Medicine, Division of Hematology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Russ Kuker
- Department of Radiology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jorge A Florindez
- Division of Hospital Medicine, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Eduardo Saul
- Department of Medicine, Division of Hematology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Asaad Trabolsi
- Department of Medicine, Division of Hematology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA.,Department of Radiology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Gregor Rodriguez
- Department of Medicine, Division of Hematology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jennifer R Chapman
- Division of Hematopathology, Department of Pathology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Izidore S Lossos
- Department of Medicine, Division of Hematology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Juan Pablo Alderuccio
- Department of Medicine, Division of Hematology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
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Gluskin J, D'Alessio D, Kim AC, Morris EA, Chiu A, Noy A. Primary lymphoma of the breast: A report of two cases. Clin Imaging 2020; 68:295-299. [PMID: 32961512 DOI: 10.1016/j.clinimag.2020.08.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 07/06/2020] [Accepted: 08/18/2020] [Indexed: 11/19/2022]
Abstract
Primary breast lymphoma (PBL) should be distinguished from secondary breast lymphoma arising in the setting of lymphoma elsewhere in the body. Multimodality imaging is key to diagnosing PBL, and imaging manifestations thereof may indicate PBL and alter the treatment course. Treatment options including chemotherapy, radiation therapy, and/or surgery depend on histology. We report two cases of PBL, illustrating the transformative impact that multimodality imaging may have on clinical management.
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Affiliation(s)
- Jill Gluskin
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.
| | - Donna D'Alessio
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Andrew C Kim
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Elizabeth A Morris
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - April Chiu
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Ariela Noy
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Department of Medicine, Weill Cornell Medical College, New York, NY 10065, USA
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Emerging Treatment Strategies for Primary Breast Extranodal Marginal Zone Lymphoma of Mucosa-associated Lymphoid Tissue. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2019; 19:244-250. [PMID: 30686775 DOI: 10.1016/j.clml.2018.12.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 12/05/2018] [Accepted: 12/26/2018] [Indexed: 02/03/2023]
Abstract
INTRODUCTION We report our experience in treating patients with primary breast extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT) to better elucidate the natural history and optimal treatment approach for these patients. PATIENTS AND METHODS Patients with localized primary breast MALT lymphoma treated between 1995 and 2016 were included. Disease-related endpoints including progression-free survival (PFS) were analyzed. RESULTS Eleven patients met inclusion criteria; all patients were women with a median age of 62 years (range, 42-75 years). Most (73%) patients presented with stage I disease, and most (73%) patients were treated initially treated with radiation therapy (RT). Local control following RT was 100%; all patients with progression following RT experienced distant relapse. Additionally, none of the 3 patients treated with ultra-low-dose RT (4 Gy) experienced subsequent progression (local or distant). Six (55%) patients progressed after initial therapy, of whom 5 received initial RT; the 5-year PFS after initial therapy was 60%. Salvage systemic therapy was utilized in all patients with progression, with 5 of 6 patients receiving single-agent rituximab. Of the patients treated with salvage therapy, only 1 experienced second relapse, with a 5-year PFS of 100% after salvage systemic therapy. With a median follow-up of 8 years, there were no deaths in the cohort. CONCLUSIONS Patients with primary breast MALT lymphoma achieve excellent outcomes. Initial RT affords local control, and although subsequent distant progression is common, salvage rituximab yields high rates of PFS.
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Ludmir EB, Milgrom SA, Pinnix CC, Gunther JR, Westin J, Oki Y, Fayad LE, Medeiros LJ, Dabaja BS, Nastoupil LJ. Primary breast diffuse large B-cell lymphoma: treatment strategies and patterns of failure<sup/>. Leuk Lymphoma 2018; 59:2896-2903. [PMID: 29697005 DOI: 10.1080/10428194.2018.1460825] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Treatment strategies and outcomes were assessed in 25 patients with primary breast diffuse large B-cell lymphoma (PB-DLBCL) treated between 1995 and 2016. We specifically investigated the timing of recurrence, and the roles of radiotherapy (RT) and central nervous system prophylaxis (CNS PPX). Fifty-two percent of patients received RT, and 28% received CNS PPX. Fourteen patients (56%) experienced recurrence, with 76% of relapses occurring ≥24 months after diagnosis, in contrast to reports supporting the use of 24-month event-free survival as a surrogate endpoint in the general DLBCL population. Use of RT was associated with a trend toward improved progression-free survival (PFS). Twenty percent of patients experienced CNS relapse, with no clear benefit to CNS PPX. These data emphasize the importance of long-term follow-up for PB-DLBCL patients, suggest a PFS benefit with the addition of RT, and highlight high rates of CNS relapse.
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Affiliation(s)
- Ethan B Ludmir
- a Department of Radiation Oncology , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Sarah A Milgrom
- a Department of Radiation Oncology , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Chelsea C Pinnix
- a Department of Radiation Oncology , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Jillian R Gunther
- a Department of Radiation Oncology , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Jason Westin
- b Department of Lymphoma/Myeloma , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Yasuhiro Oki
- b Department of Lymphoma/Myeloma , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Luis E Fayad
- b Department of Lymphoma/Myeloma , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - L Jeffrey Medeiros
- c Department of Hematopathology , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Bouthaina S Dabaja
- a Department of Radiation Oncology , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Loretta J Nastoupil
- b Department of Lymphoma/Myeloma , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
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Abstract
Nodular fasciitis is a benign proliferation of myofibroblasts which presents clinically as a rapidly growing mass with nonspecific features on imaging and high cellular activity on histopathology. Nodular fasciitis can be mistaken for malignant fibrous lesions such as soft tissue sarcoma or breast carcinoma when located within breast tissue. This presents a problem for appropriate treatment planning as the natural history of nodular fasciitis is spontaneous regression. We present the mammographic, sonographic, computed tomography, and histopathologic characteristics of nodular fasciitis in a 68 year female initially presenting with a rapidly enlarging right axillary mass.
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Affiliation(s)
- Dejan Samardzic
- Department of Radiology, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Alison Chetlen
- Department of Radiology, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Jozef Malysz
- Department of Pathology, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
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Binesh F, Vahedian H, Akhavan A, Hakiminia M. Unusual breast neoplasm: primary breast lymphoma. BMJ Case Rep 2013; 2013:bcr-2013-009037. [PMID: 23749857 DOI: 10.1136/bcr-2013-009037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Primary breast lymphoma (PBL) is a rare clinical entity. The clinical and imaging findings in breast lymphoma can mimic those of breast carcinoma. As a result, the diagnosis of PBL relies on histological evaluation and confirmed by immunohistochemical staining. The treatment of choice of this rare disease is controversial. This case report highlights the diagnosis and management of a 48-year-old woman residing in Iran with PBL.
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Affiliation(s)
- Fariba Binesh
- Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
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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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Jung SP, Kim M, Han KM, Kim JH, Kim JS, Nam SJ, Bae JW, Lee JE. Primary breast lymphoma: a single institution's experience. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2013; 84:267-72. [PMID: 23646311 PMCID: PMC3641365 DOI: 10.4174/jkss.2013.84.5.267] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Revised: 02/11/2013] [Accepted: 03/08/2013] [Indexed: 11/30/2022]
Abstract
Purpose Primary breast lymphoma is a very rare disease, accounting for 0.4-0.5% of all breast malignancies. Due to the rarity, there are only limited reports of this disease in Korean women. In this reason, we report the experience of a single institution in Korea with primary breast lymphoma (PBL). Methods We retrospectively reviewed the medical records of 9 patients with PBL and evaluated the clinicopathologic characteristics and treatment outcomes. Results All nine patients were female and had diffuse large B-cell lymphoma (DLBL). The median age at diagnosis was 47.9 years and the median tumor size was 3.8 cm in diameter. The most common symptom was a painless palpable mass. Five patients were classified as stage IEA and four patients were IIEA according to the Ann Arbor staging system. Four patients underwent excisional biopsy and one patient underwent a lumpectomy with sentinel lymph node biopsy due to uncertain histology of the preoperative core needle biopsy. Nine patients received anthracycline containing combined chemotherapy; among them, five patients were treated with a rituximab containing regimen. Four patients received radiotherapy combined with chemotherapy. A complete response was achieved in eight patients. During the 44 months of the median follow-up period, three cases of relapse occurred, and among them, two patients died due to disease progression. Conclusion Most PBLs are B-cell origin, with DLBL being the most common histologic type. A combined treatment modality has been known to have positive effects on prognosis, and surgery should be limited to a diagnostic purpose.
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Affiliation(s)
- Seung Pil Jung
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. ; Division of Breast and Endocrine Surgery, Department of Surgery, Korea University Hospital, Korea University College of Medicine, Seoul, Korea
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Stage IAE Follicular Lymphoma of the Breast: Case Report and Review of the Literature. Case Rep Oncol Med 2013; 2013:597527. [PMID: 23738170 PMCID: PMC3664487 DOI: 10.1155/2013/597527] [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: 03/20/2013] [Accepted: 04/13/2013] [Indexed: 11/29/2022] Open
Abstract
Primary lymphoma of the breast is a rare entity in the field of oncological medicine and represents <0.5% of all breast malignancies. A definitive diagnosis is obtained by excisional biopsy as the clinical and radiographical presentation is similar to the more common primary breast carcinoma. Unlike primary breast carcinoma, localized radiation therapy is the mainstay of treatment. We report on a case of primary follicular lymphoma of the breast in a 67-year-old Caucasian woman treated with localized radiation as well as coinciding literature review regarding outcomes of different treatment modalities.
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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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La Mantia E, Cantile M, Liguori G, Di Bonito M, De Chiara A, D'Aiuto M, Pannone G, Franco R, Botti G. Breast systemic follicular lymphoma in a man: a case report. J Med Case Rep 2012; 6:217. [PMID: 22823980 PMCID: PMC3419691 DOI: 10.1186/1752-1947-6-217] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Accepted: 07/23/2012] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Breast involvement by non-Hodgkin lymphoma is particularly rare in men. We describe the case of a patient with a rapidly growing, painless gynecomastia-like nodule in the left breast. On ultrasonography, the nodule was suspicious for breast carcinoma. CASE PRESENTATION A breast biopsy from a 54-year-old Caucasian man showed the morphoimmunophenotypical features of grade 3 follicular lymphoma. Moreover, fluorescence in situ hybridization analysis showed a t(14,18) translocation suggesting breast involvement by a systemic lymphoma rather than a primary breast lymphoma. The histological diagnosis was subsequently confirmed after nodule excision. Mediastinal and abdominal node involvement was then identified on computed tomography and positron emission tomography scans during staging examinations. Our patient was treated with chemotherapy. After three years our patient experienced a right retro-areolar relapse. He then received two further cycles of chemotherapy but developed a myeloid acute leukemia and, as a result of this, he subsequently died. CONCLUSIONS The rarity of breast lymphomas, especially in men, and the problems related to the therapeutic choices with these tumors require molecular techniques in association with classical histological diagnosis.
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Affiliation(s)
- Elvira La Mantia
- Pathology Unit, National Cancer Institute, Pascale Foundation, Naples, Italy
| | - Monica Cantile
- Pathology Unit, National Cancer Institute, Pascale Foundation, Naples, Italy
| | - Giuseppina Liguori
- Pathology Unit, National Cancer Institute, Pascale Foundation, Naples, Italy
| | - Maurizio Di Bonito
- Pathology Unit, National Cancer Institute, Pascale Foundation, Naples, Italy
| | | | - Massimiliano D'Aiuto
- Department of Breast Surgery and Oncology, Division of Breast Surgery, National Cancer Institute, Pascale Foundation, Naples, Italy
| | - Giuseppe Pannone
- Department of Surgical Sciences, University of Foggia, Foggia, Italy
| | - Renato Franco
- Pathology Unit, National Cancer Institute, Pascale Foundation, Naples, Italy
| | - Gerardo Botti
- Pathology Unit, National Cancer Institute, Pascale Foundation, Naples, Italy
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Mouna B, Saber B, Tijani EH, Hind M, Amina T, Hassan E. Primary malignant non-Hodgkin's lymphoma of the breast: a study of seven cases and literature review. World J Surg Oncol 2012; 10:151. [PMID: 22800119 PMCID: PMC3490884 DOI: 10.1186/1477-7819-10-151] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Accepted: 06/18/2012] [Indexed: 11/16/2022] Open
Abstract
Introduction Primary breast lymphoma is an uncommon disease with poor clinical outcome. Breast lymphomas present less than 0.5% of malignant breast neoplasms and 2.2% of extranodal lymphomas. This study investigated the clinicopathological features and optimal treatment of PBL. Case presentations Clinical records of seven Moroccan PBL patients, treated at the National Institute of Oncology, Rabat, Morocco, from 2002 to 2010, were reviewed. Six of the patients were women and one a man, with ages ranging from 32 to 76. Five patients had stage IE and two stage IIE. All of the patients were classified with DLBCL. Of seven patients, one received a mastectomy and three excision of the breast lesion. Axillary dissection was performed in three patients. Two patients received chemotherapy followed by radiotherapy, while four received chemotherapy alone. Complete remission (CR) following primary treatment for all patients with PBL except in two cases was obtained. In one patient, recurrence occurred. Conclusions There is no consensus on the question of how to best treat PBL: Mastectomy offers no benefit in the treatment of PBL. The combined therapy approach, with chemotherapy and radiotherapy, is the most successful treatment. PBL is poorly represented in rituximab-containing trials in DLBCL patients; there is not much experience with this agent in breast DLBCL. Because of the high incidence of central nervous system (CNS) involvement in PBL patients, many authors strongly believe that patients with aggressive forms of PBL should receive CNS infiltration prophylaxis.
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Affiliation(s)
- Bourhafour Mouna
- Department of Medical Oncology, National Institute of Oncology, Rabat, Morocco.
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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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Joks M, Myśliwiec K, Lewandowski K. Primary breast lymphoma - a review of the literature and report of three cases. Arch Med Sci 2011; 7:27-33. [PMID: 22291729 PMCID: PMC3258687 DOI: 10.5114/aoms.2011.20600] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2010] [Revised: 06/13/2010] [Accepted: 08/04/2010] [Indexed: 11/23/2022] Open
Abstract
UNLABELLED Primary breast lymphoma (PBL) is a rare disease accounting for 0.4-0.5% of all breast malignancies. Diffuse large B-cell lymphoma (DLBCL) is the most common histological diagnosis. The clinical presentation of PBLs is usually no different from that of carcinoma. In this paper we review the literature on the clinical presentation, diagnosis, prognostic factors and treatment options of PBL. In the light of the information gained we discuss three patients with primary breast lymphoma (one with a central nervous system relapse) who were treated in our department in the years 2002-2007. IN CONCLUSION there is no consensus on the question of how to best treat PBL: chemotherapy, radiotherapy or combined therapy. However, the last approach to be the most successful one. Due to high incidence of central nervous system (CNS) involvement in PBL patients, many authors strongly believe that patients with aggressive forms of PBL should receive CNS infiltration prophylaxis, even in the early stages, as this may improve the outcome and significantly reduce the risk of a CNS disease relapse.
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Affiliation(s)
- Monika Joks
- Lord’s Transfiguration Hospital, Poznan, Poland
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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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18
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Seker M, Bilici A, Ustaalioglu BO, Yilmaz B, Ozturk B, Ünal A, Dane F, Ozdemir NY, Elkiran ET, Kalender ME, Gumus M, Benekli M. Clinicopathologic features of the nine patients with primary diffuse large B cell lymphoma of the breast. Arch Gynecol Obstet 2010; 284:405-9. [DOI: 10.1007/s00404-010-1683-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2010] [Accepted: 09/13/2010] [Indexed: 11/28/2022]
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Yhim HY, Kang HJ, Choi YH, Kim SJ, Kim WS, Chae YS, Kim JS, Choi CW, Oh SY, Eom HS, Kim JA, Lee JH, Won JH, Shim H, Lee JJ, Sung HJ, Kim HJ, Lee DH, Suh C, Kwak JY. Clinical outcomes and prognostic factors in patients with breast diffuse large B cell lymphoma; Consortium for Improving Survival of Lymphoma (CISL) study. BMC Cancer 2010; 10:321. [PMID: 20569446 PMCID: PMC2927999 DOI: 10.1186/1471-2407-10-321] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2009] [Accepted: 06/22/2010] [Indexed: 12/27/2022] Open
Abstract
Background The breast is a rare extranodal site of non-Hodgkin lymphoma, and primary breast lymphoma (PBL) has been arbitrarily defined as disease localized to one or both breasts with or without regional lymph nodes involvement. The aim of this study was to evaluate the clinical outcomes in patients with diffuse large B cell lymphoma (DLBCL) and breast involvement, and to find the criteria of PBL reflecting the outcome and prognosis. Methods We retrospectively analyzed data from 68 patients, newly diagnosed with DLBCL and breast involvement at 16 Korean institutions between January 1994 and June 2009. Results Median age at diagnosis was 48 years (range, 20-83 years). Forty-three (63.2%) patients were PBL according to previous arbitrary criteria, sixteen (23.5%) patients were high-intermediate to high risk of international prognostic index. The patients with one extranodal disease in the breast (OED) with or without nodal disease were 49 (72.1%), and those with multiple extranodal disease (MED) were 19 (27.9%). During median follow-up of 41.5 months (range, 2.4-186.0 months), estimated 5-year progression-free survival (PFS) was 53.7 ± 7.6%, and overall survival (OS) was 60.3 ± 7.2%. The 5-year PFS and OS was significantly higher for patients with the OED group than those with the MED group (5-year PFS, 64.9 ± 8.9% vs. 27.5 ± 11.4%, p = 0.001; 5-year OS, 74.3 ± 7.6% vs. 24.5 ± 13.0%, p < 0.001). In multivariate analysis, MED (hazard ratio [HR], 3.61; 95% confidence interval [CI], 1.07-12.2) and fewer than four cycles of systemic chemotherapy with or without local treatments (HR, 4.47; 95% CI, 1.54-12.96) were independent prognostic factors for worse OS. Twenty-five (36.8%) patients experienced progression, and the cumulative incidence of progression in multiple extranodal sites or other than breasts and central nervous system was significantly different between the OED group and the MED group (5-year cumulative incidence, 9.7 ± 5.4% vs. 49.0 ± 15.1%, p = 0.001). Conclusions Our results show that the patients included in OED group, reflecting different treatment outcome, prognosis and pattern of progression, should be considered as PBL in the future trial. Further studies are warranted to validate our suggested criteria.
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Affiliation(s)
- Ho-Young Yhim
- Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Korea
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20
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Martinelli G, Ryan G, Seymour JF, Nassi L, Steffanoni S, Alietti A, Calabrese L, Pruneri G, Santoro L, Kuper-Hommel M, Tsang R, Zinzani PL, Taghian A, Zucca E, Cavalli F. Primary follicular and marginal-zone lymphoma of the breast: clinical features, prognostic factors and outcome: a study by the International Extranodal Lymphoma Study Group. Ann Oncol 2009; 20:1993-9. [PMID: 19570964 DOI: 10.1093/annonc/mdp238] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
MESH Headings
- Breast Neoplasms/diagnosis
- Breast Neoplasms/pathology
- Breast Neoplasms/therapy
- Breast Neoplasms, Male/diagnosis
- Breast Neoplasms, Male/pathology
- Breast Neoplasms, Male/therapy
- Female
- Humans
- Lymphoma, B-Cell, Marginal Zone/diagnosis
- Lymphoma, B-Cell, Marginal Zone/pathology
- Lymphoma, B-Cell, Marginal Zone/therapy
- Lymphoma, Follicular/diagnosis
- Lymphoma, Follicular/pathology
- Lymphoma, Follicular/therapy
- Male
- Prognosis
- Treatment Outcome
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Affiliation(s)
- G Martinelli
- Division of Haematology, European Institute of Oncology, Milan, Italy.
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Most primary adrenal lymphomas are diffuse large B-cell lymphomas with non-germinal center B-cell phenotype, BCL6 gene rearrangement and poor prognosis. Mod Pathol 2009; 22:1210-7. [PMID: 19525926 DOI: 10.1038/modpathol.2009.87] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Primary adrenal lymphoma is extremely rare, accounting for <1% of non-Hodgkin lymphomas, and lymphoma-associated chromosomal translocations have yet to be reported in this entity. We performed a retrospective study of 10 cases in immunocompetent patients including 4 males and 6 females with a median age of 68 years. The most common presenting symptoms were abdominal pain and fever; unexpectedly, clinically evident adrenal insufficiency was detected only in one patient. The mean tumor size at diagnosis was 8.5 cm. Half of the patients had bilateral involvement. All cases presented with stage IE disease without regional nodal involvement. Histologically, eight cases were diffuse large B-cell lymphoma, all of which carried a non-germinal center B-cell phenotype. Fluorescence in situ hybridization revealed BCL6 gene rearrangement in 5 (83%) of 6 diffuse large B-cell lymphomas investigated. The remaining cases were one case each of plasmablastic lymphoma and extranodal NK/T-cell lymphoma, nasal type, the first and third case of primary adrenal lymphoma of these particular lymphoma subtypes in the English literature, respectively. At a median follow-up of 4.5 months, 7 patients died of lymphoma, 1 died of an unrelated disease, 1 was alive with disease, and 1 was alive without disease. The prognosis of these patients was poor as compared with those with nodal diffuse large B-cell lymphoma. We speculate that the poor outcome of primary adrenal lymphoma might be related to the bulky tumor size at presentation, non-germinal center B-cell phenotype, and frequent BCL-6 gene rearrangement.
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Oya M, Hirahashi M, Ochi M, Hashimoto M, Ohshima K, Kikuchi M, Tsuneyoshi M. Spontaneous regression of primary breast lymphoma. Pathol Int 2009; 59:664-9. [DOI: 10.1111/j.1440-1827.2009.02424.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Vigliotti ML, Dell'olio M, La Sala A, Di Renzo N. Primary breast lymphoma: outcome of 7 patients and a review of the literature. Leuk Lymphoma 2009; 46:1321-7. [PMID: 16109610 DOI: 10.1080/10428190500126083] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Primary breast lymphomas (PBL) are uncommon neoplasms. Seven PBL were diagnosed between March 1993 and October 2002. A lumpectomy (n=4) or radical mastectomy (n=3) was performed; 5 patients were in clinical stage (CS) II and 2 in CS IV; 6 patients received the CEOP regimen (cyclophosphamide, vincristine, epirubicin and prednisone) after surgery and 4 also had additional radiotherapy; 1 patient did not receive any treatment after local excision. Five patients (71%) achieved complete remission and 2 (29%) partial remission, with an overall response rate of 100%. All remitter patients are alive and well after a median follow-up of 75 months (range 10--121 months). Two patients in partial remission died of progressive disease. After a median follow-up of 99 months (range 84--111 months) for surviving patients, the 10 year overall and disease-free survival rates are both 71%, with 5 patients well and still free of disease. We conclude that the optimal sequence of full-dose anthracycline-containing regimens and radiation therapy should be the treatment of choice for patients with PBL.
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Lin Y, Guo XM, Shen KW, Wang JL, Jiang GL. Primary breast lymphoma: Long-term treatment outcomeand prognosis. Leuk Lymphoma 2009; 47:2102-9. [PMID: 17071483 DOI: 10.1080/10428190600679064] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Between 1980 and 2002, 32 cases diagnosed as primary breast lymphoma were reviewed. Among them, 18 patients were stage I and 14 were stage II. Four patients underwent mastectomy and the remainder underwent lumpectomy. Twenty-eight patients received postoperative chemotherapy and 20 patients received postoperative radiotherapy. After a median follow-up of 76 (range 25 - 245) months, the 5-year overall survival and relapse-free survival was 69.3% and 47.7%, respectively. Ann Arbor stage, International Prognostic Index (IPI) excluding stage, lactic dehydrogenase (LDH) and radiotherapy were significant factors for relapse-free survival. We conclude that younger age and elevated LDH were apparent characters of the patients in our study. IPI excluding stage was a valuable prognostic factor. Combined radiotherapy and chemotherapy appeared to be important for treatment.
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Affiliation(s)
- Yuan Lin
- Department of Radiation Oncology. Fudan University, Shanghai, PR China.
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Validire P, Capovilla M, Asselain B, Kirova Y, Goudefroye R, Plancher C, Fourquet A, Zanni M, Gaulard P, Vincent-Salomon A, Decaudin D. Primary breast non-Hodgkin's lymphoma: a large single center study of initial characteristics, natural history, and prognostic factors. Am J Hematol 2009; 84:133-9. [PMID: 19199367 DOI: 10.1002/ajh.21353] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The aims of this study were to define the initial pathological and clinical characteristics, and prognostic factors of patients with primary breast malignant lymphoma (PBL). All patients treated at the Institut Curie for lymphoma with breast involvement were reviewed. A pathological review of all cases was performed. Forty-five cases were selected in whom 38 cases were of diffuse large B-cell lymphoma. A complete analysis was then performed on these 38 patients. Twenty out of 28 cases (71%) of cases were Bcl-2 positive and four out of 28 (14%) had a CD10 positive staining. Peculiar initial characteristics showed nodal involvement in 58% of the cases and two or more extra-nodal sites in 31% of the cases. Among the 37 patients for whom all data were available, and according to the International Prognostic Index, 19 patients (51%) were classified in the low-risk group, 5 cases (14%) in the low- to intermediate-risk group, 6 patients (16%) in the intermediate- to high-risk group, and 7 (19%) case in the high-risk group. At the end of initial therapy, 34 patients (89%) achieved CR. With a median follow-up of 96 months, 18 patients (47%) relapsed of whom 3 had a relapse in central nervous system site. The 5-year disease-free (DFS) and overall survivals (OS) were 54% and 61%, respectively. In multivariate analysis, the presence of 2 or more extranodal sites was prognostic for lower DFS (P = 0.0008) and OS (P = 0.09), and a performance status > or = 1 was prognostic for lower OS (P = 0.005). Finally, when our series was compared with a historical series of 111 patients with aggressive nodal lymphomas, we observed significant lower survival rates in localized PBL (P < 0.03). Initial breast localization has a pejorative impact on the outcome of patients with Non-Hodgkin's Lymphoma (NHL), with an impressive adverse influence of additional extranodal sites. These results suggest a specific management of NHL with breast involvement.
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Primary non-Hodgkin’s lymphoma of the breast: eight-year follow-up experience. Int J Hematol 2008; 87:491-497. [DOI: 10.1007/s12185-008-0085-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2007] [Accepted: 03/03/2008] [Indexed: 10/22/2022]
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Jeanneret-Sozzi W, Taghian A, Epelbaum R, Poortmans P, Zwahlen D, Amsler B, Villette S, Belkacémi Y, Nguyen T, Scalliet P, Maingon P, Gutiérrez C, Gastelblum P, Krengli M, Raad RA, Ozsahin M, Mirimanoff RO. Primary breast lymphoma: patient profile, outcome and prognostic factors. A multicentre Rare Cancer Network study. BMC Cancer 2008; 8:86. [PMID: 18380889 PMCID: PMC2330152 DOI: 10.1186/1471-2407-8-86] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2007] [Accepted: 04/01/2008] [Indexed: 11/10/2022] Open
Abstract
Background To asses the clinical profile, treatment outcome and prognostic factors in primary breast lymphoma (PBL). Methods Between 1970 and 2000, 84 consecutive patients with PBL were treated in 20 institutions of the Rare Cancer Network. Forty-six patients had Ann Arbor stage IE, 33 stage IIE, 1 stage IIIE, 2 stage IVE and 2 an unknown stage. Twenty-one underwent a mastectomy, 39 conservative surgery and 23 biopsy; 51 received radiotherapy (RT) with (n = 37) or without (n = 14) chemotherapy. Median RT dose was 40 Gy (range 12–55 Gy). Results Ten (12%) patients progressed locally and 43 (55%) had a systemic relapse. Central nervous system (CNS) was the site of relapse in 12 (14%) cases. The 5-yr overall survival, lymphoma-specific survival, disease-free survival and local control rates were 53%, 59%, 41% and 87% respectively. In the univariate analyses, favorable prognostic factors were early stage, conservative surgery, RT administration and combined modality treatment. Multivariate analysis showed that early stage and the use of RT were favorable prognostic factors. Conclusion The outcome of PBL is fair. Local control is excellent with RT or combined modality treatment but systemic relapses, including that in the CNS, occurs frequently.
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Affiliation(s)
- Wendy Jeanneret-Sozzi
- Centre Hospitalier Universitaire Vaudois and University of Lausanne, Rue du Bugnon, CH-1011 Lausanne, Switzerland.
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Ryan G, Martinelli G, Kuper-Hommel M, Tsang R, Pruneri G, Yuen K, Roos D, Lennard A, Devizzi L, Crabb S, Hossfeld D, Pratt G, Dell'Olio M, Choo SP, Bociek RG, Radford J, Lade S, Gianni AM, Zucca E, Cavalli F, Seymour JF. Primary diffuse large B-cell lymphoma of the breast: prognostic factors and outcomes of a study by the International Extranodal Lymphoma Study Group. Ann Oncol 2007; 19:233-41. [PMID: 17932394 DOI: 10.1093/annonc/mdm471] [Citation(s) in RCA: 144] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Primary diffuse large B-cell lymphoma (DLBCL) of breast is rare. We aimed to define clinical features, prognostic factors, patterns of failure, and treatment outcomes. PATIENTS AND METHODS A retrospective international study of 204 eligible patients presenting to the International Extranodal Lymphoma Study Group-affiliated institutions from 1980 to 2003. RESULTS Median age was 64 years, with 95% of patients presenting with unilateral disease. Median overall survival (OS) was 8.0 years, and median progression-free survival 5.5 years. In multifactor analysis, favourable International Prognostic Index score, anthracycline-containing chemotherapy, and radiotherapy (RT) were significantly associated with longer OS (each P < or = 0.03). There was no benefit from mastectomy, as opposed to biopsy or lumpectomy only. At a median follow-up time of 5.5 years, 37% of patients had progressed--16% in the same or contralateral breast, 5% in the central nervous system, and 14% in other extranodal sites. CONCLUSIONS The combination of limited surgery, anthracycline-containing chemotherapy, and involved-field RT produced the best outcome in the pre-rituximab era. A prospective trial on the basis of these results should be pursued to confirm these observations and to determine whether the impact of rituximab on the patterns of relapse and outcome parallels that of DLBCL presenting at other sites.
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Affiliation(s)
- G Ryan
- Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, Australia.
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Louwman MWJ, Vriezen M, van Beek MWPM, Nolthenius-Puylaert MCBJET, van der Sangen MJC, Roumen RM, Kiemeney LALM, Coebergh JWW. Uncommon breast tumors in perspective: incidence, treatment and survival in the Netherlands. Int J Cancer 2007; 121:127-35. [PMID: 17330844 DOI: 10.1002/ijc.22625] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The relatively small group of patients with breast tumors other than the ductal, lobular or mixed ducto-lobular types, has reached nonnegligible numbers due to the ongoing increase in the incidence of breast cancer. We investigated stage and grade distribution of uncommon breast tumors using the nation-wide Netherlands Cancer Registry (population 16.5 million) and incidence patterns, treatment and long-term survival (up to 19 years) using the regional Eindhoven Cancer Registry (population 2.4 million). Incidence of all uncommon breast tumors together was 9.2/100,000 person years (age-standardized, ESR). The proportion of stage I tumors was 70% among patients with tubular (n = 3,456) and 40-50% for mucinous (n = 3,482), papillary (n = 1,078), cribriform (n = 503) and neuroendocrine (n = 76) tumors, contrasting to 27, 28 and 36%, respectively among patients with Signet ring cell cancer (n = 75), Paget's disease (n = 818) and the common invasive ductal carcinomas (n = 121,656). A better age-, stage-, and grade-adjusted prognosis was observed for patients with lobular (death risk ratio 0.8, 95%CI: 0.7-0.9), mucinous (0.5, 0.3-0.9), medullary (0.5, 0.3-0.9) and tubular (0.4, 0.2-0.6) carcinoma or phyllodes tumor (0.02, 0.0-0.2), compared with invasive ductal carcinomas. For patients with papillary (0.6, 0.2-1.6) and cribriform (0.1, 0.0-5.1) tumors better prognosis was not statistically significant. In conclusion, histologic type was an essential determinant of survival for about 10% of all newly diagnosed women with invasive breast cancer. Because patients with mucinous, tubular, medullary and phyllodes tumors have such a good prognosis, less aggressive treatment should be considered in some cases whereby specific guidelines are becoming increasingly desirable. Communication to patients with these specific histological types should reflect this.
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Affiliation(s)
- Marieke W J Louwman
- Eindhoven Cancer Registry, Comprehensive Cancer Centre South IKZ, Eindhoven, The Netherlands.
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Jennings WC, Baker RS, Murray SS, Howard CA, Parker DE, Peabody LF, Vice HM, Sheehan WW, Broughan TA. Primary breast lymphoma: the role of mastectomy and the importance of lymph node status. Ann Surg 2007; 245:784-9. [PMID: 17457172 PMCID: PMC1877073 DOI: 10.1097/01.sla.0000254418.90192.59] [Citation(s) in RCA: 109] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To construct and analyze a database comprised of all reported cases of primary breast lymphoma (PBL) that include treatment and follow-up information published during the last 3 decades. SUMMARY BACKGROUND DATA PBL accounts for 0.4% of breast malignancies and 2% of extranodal lymphomas. Surgical therapy has varied from biopsy to radical mastectomy. Chemotherapy and radiation therapy have been used as adjuvant or primary therapy. A standard consensus treatment of PBL is not available. METHODS We reviewed all published PBL reports from June 1972 to March 2005. A database was compiled by abstracting individual patient information, limiting our study to those reports that contained specific treatment and outcome data. Patient demographics such as survival, recurrence, and time to follow-up were recorded, in addition to surgical, radiation, and/or chemotherapy treatment(s). RESULTS We found 465 acceptable patients reported in 92 publications. Age range was 17 to 95 years (mean, 54 years). Mean tumor size was 3.5 cm. Diffuse large cell (B) lymphoma was the most common histologic diagnosis (53%). Disease-free survival was 44.5% overall. Follow-up ranged from one to 288 months (mean, 48 months). Treatment by mastectomy offered no survival benefit or protection from recurrence. Treatment that included radiation therapy in stage I patients (node negative) showed benefit in both survival and recurrence rates. Treatment that included chemotherapy in stage II patients (node positive) showed benefit in both survival and recurrence rates. Histologic tumor grade predicted survival. CONCLUSIONS Mastectomy offers no benefit in the treatment of PBL. Nodal status predicts outcome and guides optimal use of radiation and chemotherapy.
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Affiliation(s)
- William C Jennings
- Department of Surgery, University of Oklahoma College of Medicine, 4502 E. 41st Street, Tulsa, OK 74135, USA.
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Geffen DB, Cagnano E, Tokar M, Ariad S, Koretz M. Ipsilateral breast carcinoma following treatment for primary breast lymphoma. Oncol Res Treat 2007; 30:134-6. [PMID: 17341900 DOI: 10.1159/000099143] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The breast is an unusual site for primary non-Hodgkin's lymphoma. Carcinoma in the same breast after treatment for lymphoma poses therapeutic challenges, but there is only 1 case report in Japanese, which describes this occurrence. PATIENT AND METHODS A 59-year-old woman was diagnosed with infiltrating ductal carcinoma of the breast after receiving doxorubicinand vincristine-based chemotherapy for ipsilateral primary large cell breast lymphoma. The cancer was of high grade histology, with immunohistochemistry staining 3+ positive for HER2/neu. RESULTS After lumpectomy and sentinel node biopsy, adjuvant paclitaxel without anthracyclines was given but had to be stopped early because of neurotoxicity. Radiotherapy to the breast was administered, and a 1-year course of trastuzumab was planned. CONCLUSION Breast cancer can occur after breast lymphoma. For primary breast lymphoma, cumulative doses of cardiotoxic and neurotoxic drugs should be limited to 3-4 cycles of chemotherapy, using treatment protocols for stage I-II large cell lymphoma. Consolidation radiotherapy should be considered at a dose curative for microscopic breast cancer.
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MESH Headings
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Biomarkers, Tumor/analysis
- Breast/pathology
- Carcinoma, Ductal/diagnosis
- Carcinoma, Ductal/pathology
- Carcinoma, Ductal/therapy
- Chemotherapy, Adjuvant
- Combined Modality Therapy
- Female
- Follow-Up Studies
- Humans
- Lymphoma, B-Cell/diagnosis
- Lymphoma, B-Cell/pathology
- Lymphoma, B-Cell/therapy
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, Large B-Cell, Diffuse/therapy
- Mastectomy, Segmental
- Middle Aged
- Neoplasms, Second Primary/diagnosis
- Neoplasms, Second Primary/pathology
- Neoplasms, Second Primary/therapy
- Radiotherapy, Adjuvant
- Receptor, ErbB-2/analysis
- Retreatment
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Affiliation(s)
- David B Geffen
- Department of Oncology, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
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Chanan-Khan A, Holkova B, Goldenberg AS, Pavlick A, Demopoulos R, Takeshita K. Non-Hodgkin's lymphoma presenting as a breast mass in patients with HIV infection: a report of three cases. Leuk Lymphoma 2006; 46:1189-93. [PMID: 16085561 DOI: 10.1080/10428190500084175] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Breast involvement with non-Hodgkin's lymphoma (NHL) is rare. Patients with AIDS have an increased incidence of NHL, often with high-grade histology, extranodal presentation and aggressive clinical course. Lymphoma of the breast in patients with HIV-1 infection has not been reported. We reviewed our tumor registry database of all AIDS-associated NHL and report on the clinical presentation and long-term outcome of 3 patients with AIDS who presented with lymphomatous involvement of the breast.
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MESH Headings
- Adult
- Antigens, CD/biosynthesis
- Breast Neoplasms/complications
- Breast Neoplasms/immunology
- Breast Neoplasms/therapy
- Breast Neoplasms, Male/complications
- Breast Neoplasms, Male/immunology
- Breast Neoplasms, Male/therapy
- Disease Progression
- Fatal Outcome
- Female
- Follow-Up Studies
- HIV Infections/complications
- HIV Infections/immunology
- HIV Infections/therapy
- Humans
- Lymphoma, AIDS-Related/complications
- Lymphoma, AIDS-Related/immunology
- Lymphoma, AIDS-Related/therapy
- Lymphoma, Non-Hodgkin/complications
- Lymphoma, Non-Hodgkin/immunology
- Lymphoma, Non-Hodgkin/therapy
- Male
- Middle Aged
- Remission Induction/methods
- Treatment Outcome
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Affiliation(s)
- Asher Chanan-Khan
- Division of Lymphoma/Myeloma and Bone Marrow Transplantation, Roswell Park Cancer Institute, Buffalo, NY 14263, USA.
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Ryan GF, Roos DR, Seymour JF. Primary Non-Hodgkin's Lymphoma of the Breast: Retrospective Analysis of Prognosis and Patterns of Failure in Two Australian Centers. ACTA ACUST UNITED AC 2006; 6:337-41. [PMID: 16507213 DOI: 10.3816/clm.2006.n.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The breast is an uncommon site of presentation for primary non-Hodgkin's lymphoma, with prognosis and patterns of relapse still not clearly defined. A retrospective analysis of 21 patients presenting to 2 Australian centers during a 20-year period is presented. All patients were women and had a median age of 62 years. Fifteen patients (71%) had localized disease (12 unilateral and 3 bilateral), and 6 (29%) had regional lymph-node involvement. Histology was predominantly intermediate grade, with diffuse large B-cell lymphoma (DLBL) in 16 cases (76%). The most common treatment program was partial mastectomy followed by chemotherapy and radiation therapy (n = 12). Complete response (CR) to treatment was exhibited in 19 patients (90%), 11 of whom subsequently experienced relapse. Including the 2 patients who failed to exhibit an initial CR, the median time to disease progression was 23.4 months (range, 0-143 months), with a 5-year disease-free survival rate of 38% (+/- 12%). The actuarial median survival of all patients was 3.8 years, with bilateral breast involvement at presentation the only significant prognostic factor. The contralateral breast was the site of initial relapse in 3 patients (17%), all of whom subsequently died of disease. The actuarial rate of central nervous system (CNS) recurrence at 8 years was 39% (+/- 14%), occurring only in patients with diffuse large-cell histology. Our analysis suggests that DLBL presenting in the breast has a poor prognosis and characteristic patterns of failure. Targeted strategies such as CNS prophylaxis and contralateral breast irradiation might therefore improve prognosis and should be prospectively studied.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Breast Neoplasms/diagnosis
- Breast Neoplasms/mortality
- Breast Neoplasms/secondary
- Breast Neoplasms/therapy
- Central Nervous System Neoplasms/diagnosis
- Central Nervous System Neoplasms/mortality
- Central Nervous System Neoplasms/prevention & control
- Central Nervous System Neoplasms/secondary
- Combined Modality Therapy
- Disease-Free Survival
- Female
- Humans
- Lymphoma, B-Cell/diagnosis
- Lymphoma, B-Cell/mortality
- Lymphoma, B-Cell/therapy
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/mortality
- Lymphoma, Large B-Cell, Diffuse/therapy
- Middle Aged
- Neoplasm Recurrence, Local/diagnosis
- Neoplasm Recurrence, Local/mortality
- Neoplasm Recurrence, Local/therapy
- Prognosis
- Retrospective Studies
- Treatment Failure
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Affiliation(s)
- Gail F Ryan
- Peter MacCallum Cancer Centre, Melbourne, Australia.
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34
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Avilés A, Delgado S, Nambo MJ, Neri N, Murillo E, Cleto S. Primary Breast Lymphoma: Results of a Controlled Clinical Trial. Oncology 2005; 69:256-60. [PMID: 16166814 DOI: 10.1159/000088333] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2005] [Accepted: 05/04/2005] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To assess the efficacy and toxicity of the most employed therapeutic approaches in the treatment of primary breast lymphoma (PBL). METHODS Ninety-six patients with PBL in the early stage (I or II) were enrolled to receive radiotherapy (45 Gy); chemotherapy (six cycles of cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP), every 21 days), or combined therapy. RESULTS Complete response was achieved in 20 of 30 patients treated with radiotherapy, 19 of 32 who were treated with chemotherapy and 30 of 34 in the combined arm (p<0.01). Actuarial curves at 10 years showed that event-free survival was 50, 57 and 83%, respectively (p<0.01). Actuarial curves for overall survival were 50, 50 and 76% (p<0.01), respectively. The most common site of relapse was the central nervous system. Acute toxicity was mild. Until now, no second neoplasm or acute leukemia has been observed. CONCLUSIONS In our study combined therapy is the best treatment in this special setting of patients; with improvement in event-free survival and overall survival without acute or severe late side effects. Prophylaxis to the central nervous system will be considered in the initial treatment to improve outcome.
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Affiliation(s)
- Agustin Avilés
- Oncology Research Unit, National Medical Center, IMSS, Mexico, Mexico.
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35
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Fruchart C, Denoux Y, Chasle J, Peny AM, Boute V, Ollivier JM, Genot JY, Michels JJ. High Grade Primary Breast Lymphoma: is it a Different Clinical Entity? Breast Cancer Res Treat 2005; 93:191-8. [PMID: 16172797 DOI: 10.1007/s10549-005-5088-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Primary lymphoma of the breast (PBL) is a rare neoplasm, its outcome remains unclear compared to other lymphomas. We performed a retrospective study of 19 cases of high grade PBL. There were 17 Diffuse large B cell lymphoma (DLBCL) and 2 follicular and diffuse grade 3 lymphomas. Four patients were treated with local treatment only, 15 received chemotherapy including 11 treated with CHOP or ACVBP regimens followed by involved field radiotherapy. The actuarial survival for the whole population was 38%. Three of the 4 patients treated only with a local treatment died of their lymphoma. Three patients progressed on therapy and 5 relapsed in the first year of follow-up including 2 central nervous system recurrences. Among the 11 patients treated with chemotherapy, 2 died of their lymphoma. The overall survival of this subgroup was 73% (median follow-up of 57 months). We observed, like others in the literature, a better prognosis for lymphomas co-expressing Bcl6 and CD 10. The treatment should be based on the same modalities, but including a CNS prophylaxis even if poor prognosis factors are lacking. A radical mastectomy increases the risk of treatment failure and has to be avoided.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Breast Neoplasms/mortality
- Breast Neoplasms/pathology
- Breast Neoplasms/therapy
- Diagnosis, Differential
- Female
- France/epidemiology
- Humans
- Immunophenotyping
- Lymphoma, B-Cell, Marginal Zone/pathology
- Lymphoma, Follicular/mortality
- Lymphoma, Follicular/pathology
- Lymphoma, Follicular/therapy
- Lymphoma, Large B-Cell, Diffuse/mortality
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, Large B-Cell, Diffuse/therapy
- Middle Aged
- Neprilysin/metabolism
- Prognosis
- Proto-Oncogene Proteins c-bcl-6/metabolism
- Retrospective Studies
- Survival Rate
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36
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Liu MT, Hsieh CY, Wang AY, Pi CP, Chang TH, Huang CC, Huang CY. Primary breast lymphoma: a pooled analysis of prognostic factors and survival in 93 cases. Ann Saudi Med 2005; 25:288-93. [PMID: 16212120 PMCID: PMC6148022 DOI: 10.5144/0256-4947.2005.288] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Primary breast lymphoma is a rare disease. The small number of patients and the paucity of data make large-series studies difficult. We conducted a pooled analysis to evaluate the treatment outcome and prognostic factors in patients with primary breast lymphoma. METHODS In a search of PUBMED and MEDLINE we found 7 observational studies with 93 patientsthatwere eligible for inclusion. Treatments included single therapy or combined surgery, chemotherapy and radiotherapy. We analyzed the correlation between treatment protocols, tumor relapse and survival. Histopathology and cancer stage were analyzed to evaluate their significance in treatment outcome. RESULTS All 93 patients were female, with a mean age of 57 years. The histopathology of 63 patients (68%) was diffuse large cell lymphoma. According to Ann Arbor classification, 57% were stage I, 23% were stage II, 4% were stage III, and 16% were stage IV. Thirteen percent received surgery alone, 27% received chemotherapy alone, 7% received radiotherapy alone, 10% received surgery and chemotherapy, 10% received surgery and radiotherapy, 22% received chemotherapy and radiotherapy, and 11% received surgery combined with chemotherapy and radiotherapy. With a median follow-up duration of 34 months (mean, 53 months), 48% had relapse of disease, 50% had no relapse, while 2% had disease progression. The mean time to first tumor relapse after treatment was 20 months. The 3-year and 5-year overall survival rates were 70% and 56%, respectively. Radiotherapy was a significant prognostic factor predicting tumor relapse (P=0.044). Tumor stage was a significant prognostic factor affecting overall survival, disease-free survival and disease-specific survival (P=0.0231, 0.0015, 0.0124, respectively). CONCLUSION With a 3-year overall survival rate of 70%, the high relapse rate of 48% is a cause for concern. Patients who received chemotherapy and radiotherapy had better survival outcome and a lower relapse rate. We suggestthat chemotherapy and radiotherapy be the initial treatment for patients with primary breast lymphoma.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Breast Neoplasms/diagnosis
- Breast Neoplasms/epidemiology
- Breast Neoplasms/therapy
- Burkitt Lymphoma/diagnosis
- Burkitt Lymphoma/epidemiology
- Burkitt Lymphoma/therapy
- Disease-Free Survival
- Female
- Humans
- Lymphoma/classification
- Lymphoma/diagnosis
- Lymphoma/therapy
- Lymphoma, B-Cell, Marginal Zone/diagnosis
- Lymphoma, B-Cell, Marginal Zone/epidemiology
- Lymphoma, B-Cell, Marginal Zone/therapy
- Lymphoma, Follicular/diagnosis
- Lymphoma, Follicular/epidemiology
- Lymphoma, Follicular/therapy
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/epidemiology
- Lymphoma, Large B-Cell, Diffuse/therapy
- Middle Aged
- Neoplasm Staging
- Prognosis
- Survival Analysis
- Treatment Outcome
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Affiliation(s)
- Mu-Tai Liu
- Changhua Christian Hospital, Department of Radiation Oncology, Changua , Taiwan, ROC.
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37
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Vignot S, Ledoussal V, Nodiot P, Bourguignat A, Janvier M, Mounier N, Chérel P, Floiras JL, Turpin F. Non-Hodgkin's Lymphoma of the Breast: A Report of 19 Cases and a Review of the Literature. ACTA ACUST UNITED AC 2005; 6:37-42. [PMID: 15989705 DOI: 10.3816/clm.2005.n.025] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE Non-Hodgkin's lymphoma of the breast represents 0.04%-0.50% of malignant lesions of the mammary gland. In this article, we report a single institution's experience with this rare disease. MATERIALS AND METHODS Between 1982 and 1997, 19 patients with breast lymphoma were diagnosed, treated, and followed at this institution. RESULTS There were 18 female patients and 1 male patient. All but one were cases of aggressive B-cell lymphoma. Ann Arbor stages were IE (n=5), IIE (n=9), IIIE (n=2), and IV (n=3). International Prognosis Index scores were 0 (n=2), 1 (n=8), 2 (n=7), and 3 (n=2). According to the Wiseman and Liao classification established in 1972, 11 cases were primary lymphomas of the breast, and 8 cases were secondary involvement of the breast. Median survival time was 21.5 months (range, 5.1-114.7 months). The 5-year overall survival was 29%. Median event-free survival time was 8.3 months. The clinical, radiologic, and histologic patterns of presentation match previously published data, even if the response rates and the survival times seem disappointing, probably because of the initial treatment by tumorectomy or mastectomy for some patients. CONCLUSIONS Systemic chemotherapy should be the mainstay of treatment. Based on our experience and a review of the literature, the use of Wiseman and Liao's classification is questionable. In fact, it fails to detect whether some lymphomas of the breast present a specific natural history and therefore require specific management. New clinical and histologic criteria are to be identified.
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Affiliation(s)
- Stéphan Vignot
- Centre de Lutte Contre le Cancer René Huguenin, St Cloud, France
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38
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Kebudi A, Coban A, Yetkin G, Tanik C, Uludag M, Akgun I, Isgor A. Primary T-lymphoma of the breast with bilateral involvement, unusual presentation. Int J Clin Pract 2005:95-8. [PMID: 15875638 DOI: 10.1111/j.1368-504x.2005.00313.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Primary or secondary involvement of the breast is a rare form of extranodal lymphoma. Most reported primary non-Hodgkin lymphomas of the breast have a B-cell phenotype, those of T-cell phenotype are even more rare. Bilateral breast involvement at diagnosis also is very rare. We herein report a young female patient with bilateral breast involvement by low-grade T-cell malignant lymphoma.
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Affiliation(s)
- A Kebudi
- General Surgery Department, Sisli Etfal Training and Research Hospital, Sisli, Istanbul, Turkey.
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39
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Demirkan B, Balci P, Ozcan MA, Baskan Z, Alacacioglu A, Tuncel SA, Canda T, Kocdor MA, Topcu I, Undar B, Alakavuklar M. Primary non-hodgkin lymphoma of breast in a patient with rectal carcinoma and magnetic resonance spectroscopic examination. Breast 2005; 14:169-74. [PMID: 15767190 DOI: 10.1016/j.breast.2004.08.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2004] [Revised: 07/28/2004] [Accepted: 08/18/2004] [Indexed: 11/26/2022] Open
Abstract
A 62-year-old woman being treated for stage IIIC rectal adenocarcinoma was diagnosed with primary non-Hodgkin lymphoma of the breast after a 4-year follow-up. This case illustrates the importance of close and long-term follow-up as well as of differential diagnostic procedures for second primary malignancies after the initial diagnosis and treatment of a solid tumor.
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Affiliation(s)
- Binnaz Demirkan
- Department of Internal Medicine, Division of Hematology-Oncology, School of Medicine, Dokuz Eylul University, 35340 Izmir, Turkey
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40
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Yoshida S, Nakamura N, Sasaki Y, Yoshida S, Yasuda M, Sagara H, Ohtake T, Takenoshita S, Abe M. Primary breast diffuse large B-cell lymphoma shows a non-germinal center B-cell phenotype. Mod Pathol 2005; 18:398-405. [PMID: 15492762 DOI: 10.1038/modpathol.3800266] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Primary breast diffuse large B-cell lymphoma has a poor prognosis relative to other extranodal diffuse large B-cell lymphoma. Recently, diffuse large B-cell lymphoma has been subclassified as germinal center B-cell-like and nongerminal center B-cell types using tissue microarrays. The 5-year overall survival rate of the germinal center B-cell group is better than that of the nongerminal center B-cell group. To elucidate the reason for which primary breast diffuse large B-cell lymphoma has a poor clinical outcome, we investigated 15 patients with primary breast diffuse large B-cell lymphoma (stage IE; 13 cases, stage IIE; two cases) by immunohistochemistry using various markers including CD10, Bcl-6, MUM1 and MIB-1 and by molecular analysis of the immunoglobulin heavy chain gene variable region. Immunohistochemistry showed 0/15 (positive cases/examined cases) for CD10, 5/15 for Bcl-6, 15/15 for MUM1, 10/15 for Bcl-2, 2/15 for CD5 and 4/15 for CD40. The expression pattern of CD10(-) MUM1(+) in primary breast diffuse large B-cell lymphoma corresponded to the nongerminal center B-cell group. Moreover, the MIB-1 index was distributed from 60 to 95% with a mean of 79%, indicating a high proliferation of the lymphoma cells. The immunoglobulin heavy chain gene variable region of primary breast diffuse large B-cell lymphoma had a mutation frequency of 1-10% (seven cases) and 0-1 additional mutations in ongoing mutation analysis (five cases). Primary breast diffuse large B-cell lymphoma had characteristics of the nongerminal center B-cell group. In conclusion, primary breast diffuse large B-cell lymphoma has a nongerminal center B-cell phenotype and has a high MIB-1 index. These features might therefore be associated with poor prognosis.
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MESH Headings
- Aged
- Aged, 80 and over
- Antigens, CD20/analysis
- B-Lymphocytes/metabolism
- B-Lymphocytes/pathology
- Breast Neoplasms/genetics
- Breast Neoplasms/metabolism
- Breast Neoplasms/pathology
- CD40 Antigens/analysis
- DNA-Binding Proteins/analysis
- Female
- Germinal Center/pathology
- Humans
- Immunoglobulin Heavy Chains/genetics
- Immunoglobulin Variable Region/genetics
- Immunohistochemistry
- Interferon Regulatory Factors
- Ki-67 Antigen/analysis
- Lymphoma, B-Cell/genetics
- Lymphoma, B-Cell/metabolism
- Lymphoma, B-Cell/pathology
- Lymphoma, Large B-Cell, Diffuse/genetics
- Lymphoma, Large B-Cell, Diffuse/metabolism
- Lymphoma, Large B-Cell, Diffuse/pathology
- Middle Aged
- Mutation
- Phenotype
- Proto-Oncogene Proteins/analysis
- Proto-Oncogene Proteins c-bcl-2/analysis
- Proto-Oncogene Proteins c-bcl-6
- Transcription Factors/analysis
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Affiliation(s)
- Sayaka Yoshida
- Second Department of Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan.
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41
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Maounis N, Ellina E, Papadaki T, Ioannides G, Kiale K, Finokaliotis N, Blana AK. Bilateral primary lymphoma of the breast: A case report initially diagnosed by FNAC. Diagn Cytopathol 2005; 32:114-8. [PMID: 15637680 DOI: 10.1002/dc.20184] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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.
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Affiliation(s)
- N Maounis
- Department of Cytology, Sismanoglion General Hospital, Marousi, Athens, Greece.
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42
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Carrascosa LA, Jose BO, Spanos WJ. Synchronous Primary Bilateral Breast Lymphoma. Am J Clin Oncol 2004; 27:635. [PMID: 15577444 DOI: 10.1097/01.coc.0000146412.28800.80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Luis A Carrascosa
- Department of Radiation Oncology, James Graham Brown Cancer Center, University of Louisville, Louisville, Kentucky 40212, USA.
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43
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Pruthi S, Stafyla VK, Phillips SW, Porrata LF, Reynolds CA. Primary mammary (non-Hodgkin) lymphoma presenting as locally advanced breast cancer. Mayo Clin Proc 2004; 79:1310-4. [PMID: 15473415 DOI: 10.4065/79.10.1310] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Primary mammary lymphoma is a rare tumor that presents commonly as a large mass with no specific mammographic appearance and can be confused with poorly differentiated carcinoma on frozen section. With appropriate treatment, this breast malignancy has a relatively good prognosis. We report a case of primary mammary non-Hodgkin lymphoma in a 74-year-old woman that originally presented as locally advanced breast cancer with secondary inflammatory skin changes. Clinical findings, diagnostic work-up, and follow-up are provided along with a review of the literature on primary mammary lymphoma.
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Affiliation(s)
- Sandhya Pruthi
- Division of General Internal Medicine, Mayo Clinic College of Medicine, 200 First St SW, Rochester, MN 55905, USA
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44
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Giron GL, Hamlin PA, Brogi E, Mendez JE, Sclafani L. Primary Lymphoma of the Breast: A Case of Marginal Zone B-Cell Lymphoma. Am Surg 2004. [DOI: 10.1177/000313480407000813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A case of primary marginal zone B-cell lymphoma in an elderly female patient is presented. Primary breast lymphomas are rare, comprising less than 1 per cent of all breast malignancies. These tumors have no clinical, pathologic, or radiologic pathognomonic features to distinguish them from breast adenocarcinoma. The diagnosis is usually made with an excisional biopsy, and more extensive surgery should be avoided. Delivery of radiation therapy and chemotherapy is tailored according to the histologic grade, stage of disease, and overall patient condition. This report summarizes the current knowledge reflected in the literature.
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Affiliation(s)
- Gladys L. Giron
- Breast Service, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Paul A. Hamlin
- Lymphoma Service, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Edi Brogi
- Breast Service, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Jane E. Mendez
- Breast Service, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Lisa Sclafani
- Breast Service, Memorial Sloan-Kettering Cancer Center, New York, New York
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45
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Abstract
Primary breast lymphoma (PBL) is a rare form of localized extranodal lymphoma. Few reports are available in the literature concerning its treatment and outcome. Of the 34 cases of PBL seen at our institution over a 25-year period, 20 consecutive cases were treated with CHOP or CHOP-like chemotherapy regimen and had adequate biopsy specimens for histological review. All these 20 PBL were of B-cell origin including one case of Burkitt lymphoma, and 2 cases of low-grade histologic type. Sixteen of the 20 patients achieved a complete remission (CR) and 2 achieved a partial remission (PR) (>75% tumor regression). Two patients had progressive disease while on therapy. With a median follow-up period of 80 months, 6 patients relapsed. Median time to relapse from diagnosis was 23 months (range, 3-41 months). Two of the relapses involved the central nervous system (CNS): isolated CNS relapse in one case and associated with other relapse sites in 1 case. The two patients who achieved a PR after chemotherapy also had disease progression to the CNS, 4 and 8 months after the end of CHOP chemotherapy. All 4 patients died of their disease 3, 6, 10 and 13 months after CNS involvement. Of the 16 centroblastic diffuse large B-cell lymphoma (DLCL), 3 had CNS disease at relapse. Three (15%) of our study patients developed a controlateral breast relapse. Twelve of the initial 20 patients were alive, including 11 with a persistent CR, 6 patients died of their lymphoma and 2 of unrelated diseases. In conclusion, we observed a high incidence of CNS relapse in this group of localized extranodal lymphoma, strongly suggesting that CNS prophylaxis should be associated with systemic chemotherapy in localized PLB.
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Affiliation(s)
- D Gholam
- Department of Medicine, Institut Gustave Roussy, Villejuif, France
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46
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Wong WW, Schild SE, Halyard MY, Schomberg PJ. Primary non-Hodgkin lymphoma of the breast: The Mayo Clinic Experience. J Surg Oncol 2002; 80:19-25; discussion 26. [PMID: 11967901 DOI: 10.1002/jso.10084] [Citation(s) in RCA: 108] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND OBJECTIVES To retrospectively evaluate the characteristics, natural history, results of treatment, and prognostic factors for patients diagnosed with primary breast lymphoma. METHODS Between 1973 and 1998, 25 women and 1 man with the diagnosis of primary breast non-Hodgkin lymphoma (PNHLB) were seen at Mayo Clinic Rochester and Mayo Clinic Scottsdale. Patient characteristics, treatment methods, and outcome were analyzed. RESULTS The median follow-up for surviving patients was 6.6 years (range: 1.8-22.1 years). There were 11 low-grade NHL, 13 intermediate-grade NHL, and 2 high-grade NHL. Three patients underwent mastectomy while 23 had local excision. The Ann Arbor stage of disease included: Stage I-21 patients, Stage II-5 patients. Sixteen patients received radiation after surgery (15 after biopsy, 1 after mastectomy). Chemotherapy was given to 10 patients as part of the initial treatment. Four patients with low-grade disease were treated with excision only. The 5-year overall survival rate was 70% and relapse-free survival rate 42%, while local control rate was 75% and distant control rate 51%. Five-year survival and relapse-free survival rates for patients with low-grade disease were 91 and 61%, respectively. Three of four patients with low-grade disease treated with excision alone were free of local recurrence. For intermediate- and high-grade PNHLB, 5-year survival rate was 61% for those treated with chemotherapy, compared to 31% for those without chemotherapy (P = 0.35), and the 5-year relapse-free survival rates were 49%, compared to 0%, respectively (P = 0.0017). Three patients with intermediate- or high-grade disease developed central nervous system (CNS) dissemination. On univariate analysis, Ann Arbor stage was the only significant prognostic factor for survival (P = 0.0021). CONCLUSIONS The management of PNHLB should be based on histologic grade. Patients with low-grade disease may be managed with local therapy alone. The role of chemotherapy in this group is unclear. Patients with intermediate- or high-grade disease have better outcome if chemotherapy is included. An unusual site of distant dissemination for these patients is the CNS. The only significant prognostic factor for survival is Ann Arbor stage.
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Affiliation(s)
- William W Wong
- Department of Radiation Oncology, Mayo Clinic Arizona, Scottsdale, Arizona 85259, USA.
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47
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Domchek SM, Hecht JL, Fleming MD, Pinkus GS, Canellos GP. Lymphomas of the breast: primary and secondary involvement. Cancer 2002; 94:6-13. [PMID: 11815954 DOI: 10.1002/cncr.10163] [Citation(s) in RCA: 158] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The involvement of the breast by lymphoma is a rare form of extralymph node lymphoma and represents either primary disease or systemic involvement. The authors hypothesized that screening mammography may influence the detection of lymphomatous involvement of the breast. METHODS All patients (n = 81 patients) who were diagnosed with lymphomatous involvement of the breast at the study institution between 1988 and 1999 were evaluated retrospectively. RESULTS Clinical information was available for 73 patients who could be classified into three major groups according to their diagnosis: primary breast lymphoma (PBL) (44%), breast involvement from disseminated disease at the time of initial diagnosis (29%), and recurrence of preexisting lymphoma to the breast (27%). The majority of PBL were of intermediate or high grade, and the majority of disseminated lymphomas involving the breast were of low grade. Lymphomatous recurrence to the breast was slightly more likely to be of intermediate grade rather than low grade. In 91% of patients, the diagnosis of lymphoma was made after the evaluation of a palpable mass. All patients who were identified after the evaluation of an abnormal screening mammogram (9%) had low-grade lymphomas. Of the 32 patients with PBL, screening mammography discovered only 1. Nineteen percent of patients with PBL also had a history of an autoimmune disorder. CONCLUSIONS These findings suggest that screening mammography has not altered substantially the detection of breast lymphoma. The clinical outcome of patients with breast lymphoma is dependent on histology and appears to parallel that of patients with lymphoma of similar histology involving other sites.
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Affiliation(s)
- Susan M Domchek
- Department of Adult Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.
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Ribrag V, Bibeau F, El Weshi A, Frayfer J, Fadel C, Cebotaru C, Laribi K, Fenaux P. Primary breast lymphoma: a report of 20 cases. Br J Haematol 2001; 115:253-6. [PMID: 11703318 DOI: 10.1046/j.1365-2141.2001.03047.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Limited data are available concerning treatment and outcome of primary lymphoma of the breast (PLB), especially after CHOP (cyclophosphamide, hydroxydoxorubicin, vincristine, prednisone) chemotherapy. We retrospectively reviewed 20 consecutive cases of localized PLB seen at our institution over a 20 year period. All PLB were of B-cell origin: treatment was CHOP or a CHOP-like regimen in all patients. Sixteen of the 20 patients achieved complete remission (CR) and two achieved partial remission (> 75% tumour regression). Two patients had progressive disease on therapy. With a median follow-up of 54 months, six patients relapsed after 8-66 months. Two of the relapses involved the central nervous system (CNS) (isolated in one case, associated with other sites of relapse in the other). The two patients who achieved partial remission also had progression in the CNS, 4 and 8 months after the end of CHOP chemotherapy. All four patients have died as a result of their disease 3, 6, 10 and 13 months after CNS relapse. Of the 16 centroblastic diffuse large B-cell lymphoma (DLCL), three had CNS disease at relapse. We also observed three (15%) controlateral breast relapses. Thirteen of the initial 20 patients are alive in CR, six patients have died as a result of their lymphoma and one of unrelated disease. In conclusion, we observed a high incidence of CNS relapse in this group of localized extranodal lymphoma, strongly suggesting that CNS prophylaxis should be associated with systemic chemotherapy in localized PLB.
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Affiliation(s)
- V Ribrag
- Département de Médecine, Institut, Gustave-Roussy, Villejuif, France.
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Kersgard C, Osswald MB. Primary breast lymphoma and bone marrow transplantation. Am J Clin Oncol 2001; 24:320-1. [PMID: 11404511 DOI: 10.1097/00000421-200106000-00025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Pasquini E, Rinaldi P, Nicolini M, Papi M, Fabbri P, Bernardi L, Ravaioli A. Breast involvement in immunolymphoproliferative disorders: report of two cases of multiple myeloma of the breast. Ann Oncol 2000; 11:1353-9. [PMID: 11106127 DOI: 10.1023/a:1008380525834] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Breast involvement by immunolymphoproliferative disorders is rare. Primary and secondary malignant lymphomas of the breast are much more common than multiple myeloma, of which only 16 cases have been described. We report two cases of patients with an established diagnosis of multiple myeloma in whom breast involvement appeared during the course of the disease. We underline diagnostic difficulties caused by the lack of clinical and radiological features which allow us to differentiate between breast carcinoma and breast involvement by lymphoproliferative disease. Only fine needle aspiration and/or excisional biopsy can differentiate between immunolymphoproliferative disorders and epithelial or mesenchymal tumors of the breast.
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Affiliation(s)
- E Pasquini
- Oncology Service, D. Cervesi City Hospital, Cattolica, Italy.
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