Hodgkin Lymphoma Mimicking Inflammatory Breast Carcinoma: A Rare Case with Diagnostic Challenge and Novel Treatment

Primary Hodgkin Lymphoma of the Breast: A Case Report and Literature Review Examining the Use of Different Chemotherapy Regimens

Primary classic Hodgkin lymphoma (HL) of the breast is a rare type of breast disease. The diagnosis is mostly confirmed by an excisional biopsy. The first line of treatment commonly used for Hodgkin lymphoma is doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD). Our case report is about a 48-year-old lady who was diagnosed with bilateral breast Hodgkin lymphoma following an excisional biopsy and was treated with brentuximab vedotin plus doxorubicin, vinblastine, and dacarbazine (BV-AVD). The patient responded positively after the initiation of the regimen. There is scarce data on the classic Hodgkin lymphoma of the breast, and even with the wide use of first-line treatment using ABVD, the disease is still difficult to manage. Hence, patients with breast masses should be screened for classic HL of the breast, and larger studies are needed to establish specific treatment guidelines concerning HL of the breast to prevent relapse and other complications.

Immunohistochemistry Applied to Breast Cytological Material

Fine-needle aspiration biopsies (FNABs) of the breast are minimally invasive procedures enabling the diagnosis of suspicious breast lesions. Unfortunately, they are often perceived as inferior to core-needle biopsies, namely because they are supposedly unable to differentiate between high-grade ductal carcinoma in situ and invasive carcinoma or provide material for ancillary testing. Several studies have shown, however, that FNAB samples, when handled properly, are indeed capable of providing sufficient and adequate material for ancillary testing, namely immunocytochemistry (ICC). We reviewed the published literature regarding the use of ICC for both diagnostic and theranostic uses in the different types of cytological samples obtained from FNABs of the breast, including smears, liquid-based cytology samples, and cellblocks. We found that p63 and 34βE12 show promise in aiding in the differential diagnosis between in situ and invasive lesions and that most other diagnostic markers may be used as in tissue. Regarding theranostic ICC markers, results vary between publications, but with care, these can successfully be performed in cytological samples. Air-dried smears should be avoided, and cellblocks are overall more versatile than cytology slides, enabling the evaluation of not only hormonal receptors and HER2 by ICC, but also of Ki-67. Particular attention should be paid to fixation and antigen retrieval procedures in all cases. We recommend that laboratories without experience perform short validation runs before adopting these techniques into clinical practice.