Chronic lymphocytic leukemia involving the breast parenchyma, mimicker of invasive breast cancer: differentiation on breast MRI

An overview of the correlation between IPI and prognosis in primary breast lymphoma

Primary breast lymphoma (PBL), with diffuse large B-cell lymphoma (DLBCL) as the most histopathological type, is a rare disease with a poor prognosis. The International Prognostic Index (IPI) is an important clinical characteristic for risk stratification of PBL patients with different prognoses. However, the prognostic value of the IPI in PBL is controversial and needs to be refined. In this review, we described the clinical characteristics, pathogenesis, and treatment of PBL, with emphasis on the prognostic value of the IPI, its updated versions and IPIs for certain subtypes. A total of 9 types of IPIs were presented. In addition, the key issues with the various treatment modalities available were addressed, as well as the role of rituximab in therapy. We also summarized the current evidence and future challenges facing other types of prognostic indices. In particular, prospective clinical studies of treatment are rare, and the available data were mainly obtained from retrospective case series that included a small number of patients. Therefore, our conclusions and recommendations cannot serve as formal guidelines. However, this review attempts to provide an unbiased analysis of published data to provide clinicians with useful assistance in the treatment of this uncommon form of extranodal lymphoma.

Small Lymphocytic Lymphoma Presenting as a Breast Lump: A Rare Presentation of Non-Hodgkin's Lymphoma

Approximately one-fourth of non-Hodgkin's lymphomas (NHLs) present with an extranodal origin. Primary and secondary involvements of the breast by lymphoma are rare because of the paucity of lymphoid tissue in the breast. Primary breast small lymphocytic lymphoma (SLL) typically presents as a manifestation of widespread chronic lymphocytic leukemia (CLL). A 58-year-old female presented to our clinic with a palpable breast mass. She had no cytopenias and her absolute peripheral B lymphocyte count was less than 5000/microL. The mass was biopsied and histology with immunohistochemistry showed neoplastic cells positive for CD23 and CD5 confirming the diagnosis of small B cell lymphocytic lymphoma of the breast. Further imaging revealed extensive mediastinal and retroperitoneal lymphadenopathy. Histopathology of bone marrow biopsy revealed diffuse infiltration with SLL. The patient was treated with six cycles of fludarabine, cyclophosphamide and rituximab (FCR) with excellent clinical response. To our knowledge, this is the first case of SLL infiltration of the breast without CLL treated successfully with FCR.

An unusual presentation of chronic lymphocytic leukemia/small lymphocytic lymphoma on mammography: Case report

Although rare, breast CLL/SLL should be considered in the differential diagnosis of a breast mass. A high index of suspicion is needed to differentiate this neoplasm from more common breast carcinomas like solid variant of invasive lobular carcinoma.

Male breast involvement in chronic lymphocytic leukemia. A case report and review of the literature

Male breast lymphoma is a rare extranodal lymphoma occupying the mammary gland, and it could be either primary or secondary. A 78-year-old man presented an enlargement of the right breast. He had no medical history of interest. On physical examination, a unilateral, painless breast lump was found, with no skin changes or nipple discharge. There was no palpable lymphadenopathy. Routine laboratory tests revealed leukocytosis and lymphocytosis. Excisional biopsy of the breast lesion revealed mammary tissue infiltration by chronic lymphocytic leukemia (CLL) with plasmacytoid features and immunoglobulin G/kappa monotypic expression. To our knowledge, this is the first report of male breast involvement by CLL. Considering important the collection of clinicopathological data of all reported male breast lymphoma cases, a literature review is presented.

Sonographic Features of a Myeloid Sarcoma of the Breast as a Relapse of Acute Myeloid Leukemia After Stem-Cell Transplantation: A Case Report

Patient: Female, 24

Final Diagnosis: Myeloid sarcoma of the breast

Symptoms: Breast lump

Medication: —

Clinical Procedure: Core needle biopsy

Specialty: Radiology

Knowledge database assisted gene marker selection for chronic lymphocytic leukemia

Objective

To investigate whether previously curated chronic lymphocytic leukemia (CLL) risk genes could be leveraged in gene marker selection for the diagnosis and prediction of CLL.

Methods

A CLL genetic database (CLL_042017) was developed through a comprehensive CLL-gene relation data analysis, in which 753 CLL target genes were curated. Expression values for these genes were used for case-control classification of four CLL datasets, with a sparse representation-based variable selection (SRVS) approach employed for feature (gene) selection. Results were compared with outcomes obtained by using analysis of variance (ANOVA)-based gene selection approaches.

Results

For each of the four datasets, SRVS selected a subset of genes from the 753 CLL target genes, resulting in significantly higher classification accuracy, compared with randomly selected genes (100%, 100%, 93.94%, 89.39%). The SRVS method outperformed ANOVA in terms of classification accuracy.

Conclusion

Gene markers selected from the 753 CLL genes could enable significantly greater accuracy in the prediction of CLL. SRVS provides an effective method for gene marker selection.

Hematolymphoid lesions of the breast

Hematolymphoid malignancies of the breast are most commonly neoplasms of mature B-lymphocytes, and may arise as a primary disease or by secondary involvement of a systemic disease. Primary breast lymphomas (PBL) account for 0.04-0.5% of breast malignancies, less than 1% of all non-Hodgkin's lymphomas (NHL), and less than 5% of extranodal lymphomas (Lakhani et al., 2012; Swerdlow et al., 2008; Joks et al., 2011; Barişta et al., 2000; Giardini et al., 1992; Brogi and Harris, 1999; Topalovski et al., 1999).^1-7 Secondary breast lymphomas (SBL) are also rare, with an estimated annual incidence of 0.07% (Domchek et al., 2002; Talwalkar et al., 2008).^8,9 Recognition of breast lesions as hematolymphoid is critical to distinguish them from other entities that can occur in the breast.