Primary malignant non-Hodgkin's lymphoma of the breast: a study of seven cases and literature review

Primary breast lymphoma: A rare case report

INTRODUCTION AND IMPORTANCE

Primary breast lymphoma (PBL) is an extremely rare neoplasm, accounting for less than 1 % of breast malignancies and less than 2 % of extranodal non-Hodgkin lymphomas (NHLs).

CASE PRESENTATION

This case report discusses a 60-year-old female patient presenting with a primary breast lymphoma, specifically diffuse large B-cell lymphoma. The patient had no personal history of breast cancer but exhibited a painless, palpable mass in the left breast with axillary lymphadenopathy.

CLINICAL DISCUSSION

Diagnostic challenges in distinguishing PBL from primary breast carcinoma are addressed, emphasizing the importance of considering PBL in cases of rapidly enlarging breast masses. Radiological examinations, including mammography and ultrasound, play a crucial role in diagnosis, and excisional biopsy with immunohistochemical staining is essential for accurate histopathological subcategorization.

CONCLUSION

The presented case underscores the rarity of PBL in the Middle East and highlights the diagnostic and classification challenges, emphasizing the central role of accurate techniques in guiding treatment decisions.

Thirteen-Centimeter Breast Lymphoma

Lymphoma of the breast is a rare diagnosis, accounting for less than 0.5% of all breast malignancies. Presentation is usually similar to that of breast cancer, with a painless palpable mass. This report describes a unique case of a 13 cm breast lymphoma. The patient is a 74 year old female who presented to clinic with a right breast mass that has been present since the 1970s. She had previously undergone multiple excisions of lesions on both breasts, always with benign pathology. In 2017, screening mammogram revealed a suspicious lesion in the right upper outer breast with associated axillary lymphadenopathy. She was lost to follow up but presented again after the mass significantly grew in size over several months. Mammography showed a large 13 x 8.7 cm lobulated mass. Biopsy of the lesion revealed diffuse large B-cell lymphoma. Treatment for this patient will begin with chemotherapy.

Intravascular Large B Cell Lymphoma of the Breast: A Rare Entity

Intravascular large B-cell lymphoma (IVLBCL) is a rare and high-grade disease of neoplastic lymphoid cells within the vascular lumina of small- to medium-sized vessels. The disease carries a grim prognosis despite robust treatment protocols. We discuss the case of a 58-year-old female who presented with mammographic screening abnormality which led to more investigations and ultimately to this diagnosis. The patient had no prior history of a lymphoma or in situ and invasive carcinoma of the breast. To our knowledge, IVLBCL of the breast is a very rare and an unusual location for this type of a lymphoma and so far, only five reported cases. Through our case report, we not only discuss the case but also review literature on this rare entity.

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.

Primary breast lymphoma initially diagnosed as invasive ductal carcinoma: A case report

A malignant tumor in the breast may not be conclusive of breast cancer. It is important to keep the possibility of primary breast lymphoma in rare scenarios. For the diagnosis of primary breast lymphoma, immunohistochemical staining is necessary.

Epidemiological features of primary breast lymphoma patients and development of a nomogram to predict survival

BACKGROUND

Studies on the epidemiology and prognosis of primary breast lymphoma (PBL) are lack for low incidence. Therefore, we aimed to investigate the epidemiological characteristics of PBL and develop nomograms to predict patient survival.

METHODS

Data of patients who were diagnosed with PBL from 1975 to 2011 and incidence rate of PBL from 1975 to 2017 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Time-varying multivariable Cox regression analysis was performed to identify independent prognostic factors for overall survival (OS) and disease-specific survival (DSS). Nomograms were constructed based on the independent prognostic factors identified in multivariate Cox regression analysis.

RESULTS

A total of 1427 patients diagnosed with PBL were identified with the average age of 67.1 years. The overall incidence of PBL is 1.35/1,000,000 (adjusted to the United States standard population in 2000) from 1975 to 2017, with a significant upward trend by an annual percentage change (APC) of 2.91 (95%CI 2.29-3.94, P < 0.05). Age, sex, race, year of diagnosis, marital status, histological subtype, Ann Arbor Stage, and treatment modality were assessed as independent prognostic factors for OS and DSS by multivariable Cox regression (P < 0.05). Nomograms were constructed to predict the 1-, 3-, 5-, and 10- year OS and DSS. The concordance index (C-index) and calibration plots showed robustness and accuracy of the nomogram.

CONCLUSION

The overall incidence of PBL was steadily increasing over the past four decades. Nomograms constructed can predicting 1-, 3-, 5-, and 10-year OS and identify patients with high-risk PBL.

Primary breast lymphoma: A single-centre experience

BACKGROUND

Primary non-Hodgkin lymphoma is an extremely rare entity, and this condition represents less than 0.5% of all malignant lesions involving the mammary gland. As such, there has been a paucity of relevant clinical data arising from Southeast Asia.

AIMS

Our study aims to review the clinical presentation, diagnostic methods, treatment, and survival outcomes of all patients diagnosed with primary breast lymphoma in our institution between 2011 and 2017.

METHODS AND RESULTS

Patients who had histologically proven lymphoma involving the breast were identified from a prospectively collected database in a single institution between 2011 and 2017. All seven patients were female, with a median age of 65 years old, and had presented with unilateral large breast or axillary masses. All the histological diagnosis was achieved with adequate tissue diagnosis either through core, incisional, or excisional biopsy. Five patients had diffuse large B cell lymphoma, one had marginal zone lymphoma, and the other had follicular lymphoma. Based on Ann Arbor classification, one patient had stage 1, three had stage 2, one with stage 3, and two patients with stage 4 disease. Five patients had received standard CHOP regimen with rituximab. At the time of analysis, patients who had nondisseminated disease had a median survival of 57 months. The overall mean survival time for all seven patients was 47 months. With the standard systemic chemotherapy treatment regimen, the estimated 3-year overall survival was found to be 64%.

CONCLUSION

Primary breast lymphoma, though uncommon, may present in a similar manner as breast carcinomas, but the main treatment modality remains nonsurgical with systemic chemotherapy. Hence, it is prudent to obtain accurate histological diagnosis of primary breast lymphoma. In this study, our patients with nondisseminated breast lymphoma have demonstrated a fairly good survival outcome following chemotherapy.

Primary breast lymphoma: A mimic of inflammatory breast cancer

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Primary breast lymphoma (PBL) is a rare disease accounting for 0.04–0.5% of all breast malignancies.

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The clinical and imaging findings in breast lymphoma can mimic those of breast carcinoma.

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Sometimes, PBL presentation is suggestive of Inflammatory breast cancer.

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Diagnosis depends on adequate tissue sampling for histology examination and immunophenotyping.

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The therapeutic management of PBL is controversial and is not clearly established, but many studies support that it is not a surgical disease and can be treated successfully with combined chemotherapy and radiotherapy.

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Imaging is a useful method to monitor a patient’s response to therapy.

Introduction

Primary breast lymphoma (PBL) is a rare disease accounting for 0.04–0.5% of all breast malignancies.

Presentation of case

This article reports a clinical case of a 81-year-old woman with a history of right breast erythema and edema associated to breast pain, with over two weeks duration. Physical examination demonstrated mammary asymmetry and inflammatory signs with orange peel skin. She had the right upper limb swollen and palpable axillar and supraclavicular lymph nodes. The principal suspicion was an inflammatory breast cancer. Imaging was unspecific. Core needle biopsy of an axillary lymph node and of the breast mass identified morphological and immunophenotypic features consistent with diagnosis of primary non-Hodgkin DLBCL. Patient was guided by Hematology.

Discussion

The clinical and imaging findings in breast lymphoma can mimic those of breast carcinoma. Sometimes, PBL presentation is suggestive of Inflammatory breast cancer. Diagnosis depends on adequate tissue sampling for histology examination and immunophenotyping. The therapeutic management of PBL is controversial and is not clearly established, but many studies support that it is not a surgical disease and can be treated successfully with combined chemotherapy and radiotherapy.

Conclusion

Breast lymphoma must be considered in the differential diagnosis of a breast lump, even in the presence of cutaneous inflammatory changes. PBL can be treated successfully with combined therapy.

Unusual Breast Neoplasm with Diagnostic and Management Challenges

With the growing awareness and availability of proper screening methods, detection of breast lump is increasing globally and is now a very sensitive issue for females. The treatment of these lumps ranges from lumpectomy to wide local excision to mastectomy; hence, a proper diagnosis is very important to prevent under- or overtreatment in patients. Breast lesions are the heterogeneous diseases encompassing several distinct entities with remarkably different characteristics. While the more common forms of breast cancers are well recognized and understood better, there are many important unusual lesions and malignancies that are less known and less appreciated and can be challenging to diagnose. In such cases, due to rarity of the disease and lack of adequate treatment protocol, managing the patients can be a challenging task for surgeons and oncologist as well. In this article, we have shared our institutional experience in unusual breast lesions with emphasis on diagnostic as well as management challenges faced.

Hematologic Malignancies Discovered on Investigation of Breast Abnormalities

OBJECTIVES

Hematological malignancies of the breast share a presentation similar to primary breast carcinomas but differ substantially in therapeutic approach and clinical outcomes. In this study, we investigate the frequency of hematological malignancies, their relative primary and secondary occurrences, and further characterize the distinct histopathologies of these malignancies with a special focus on lymphomas. To our knowledge this is one of the largest and most comprehensive studies of breast hematologic malignancies.

METHODS

We conducted a retrospective review of our institution's pathology database for hematologic neoplasms diagnosed in breast tissue during a period of 22 years (1992-2014). Clinical characteristics, patient history, histologic subtype, and patient outcomes were analyzed.

RESULTS

We identified 52 cases; 46 lymphomas, 4 plasmacytomas, and 2 myeloid sarcomas. The lymphoma cases were 15 diffuse large B-cell lymphomas (DLBCLs), 14 follicular lymphomas (FLs), 8 marginal zone lymphomas (MZLs), 2 anaplastic large T-cell lymphomas, 2 peripheral T-cell lymphomas-not otherwise specified, 1 each of small lymphocytic lymphoma, Burkitt lymphoma, mantle cell lymphoma, B-cell lymphoblastic lymphoma, and T-cell lymphoblastic lymphoma. In total, 30 cases were primary and 22 cases were secondary to the breast. Primary lymphomas accounted for 60% of lymphomas. Most FLs and almost all MZLs were primary.

CONCLUSIONS

Primary hematological malignancies of the breast are more common than secondary: 58 % versus 42%. This finding is more evident in lymphomas: 63% versus 37%. The most common hematological malignancy in our study was DLBCL, followed by FL and MZL. Most FLs and almost all MZLs were primary. At the same time, the percentage of primary DLBCLs in our study is lower than the percentage reported in previous studies. We suggest that this could be the result of transformation from low-grade lymphomas. Although rare, hematological malignancies of the breast warrant a higher level of clinical suspicion as they present similarly to breast carcinomas but require a substantially different therapeutic approach.

Diffuse Large B-Cell Breast Lymphoma: A Case Series

Primary breast lymphoma (PBL) is a rare disease, and few clinicohistopathologic features of the disease have been discussed in previous studies. It represents 2.2% of extranodal lymphomas and constitutes 0.04% to 0.5% of malignant breast neoplasms, despite the clinical and radiographic similarities between breast lymphoma and carcinoma, the prognosis, as reported in the literature, varies. No consensus exists on the best way to treat PBL. However, radiotherapy and chemotherapy were used alone or in combination to treat various cases of PBL. We retrospectively studied 3 cases of PBL of the breast seen in patients attending a tertiary cancer center in Qatar, between 2012 and 2015, in an attempt to determine the common clinical features, therapy, and prognosis of PBL.

Primary Breast Lymphoma: Analysis of 55 Cases of the Spanish Lymphoma Oncology Group

INTRODUCTION

Primary breast lymphoma is a rare form of localized extranodal lymphoma, which affects the mammary glands unilaterally or bilaterally, and can also affect the regional lymph nodes.

MATERIALS AND METHODS

We reviewed 55 patients, with disease stages IE and IIE, diagnosed in 16 Spanish institutions between 1989 and 2016. A serial of clinical variables and treatment were collected, and overall survival (OS) and progression-free survival (PFS) were calculated.

RESULTS

Of the 55 patients, 96.4% were women with an average age of 69 years. A total of 53 patients corresponded to non-Hodgkin lymphoma (NHL), of whom 36.3% had lymph node involvement upon diagnosis. Of the patients, 58.2% were stage IE, and 41.8% were stage IIE. Treatments received included radiotherapy (36.3%), chemotherapy (85.5%), and rituximab (in 38 of the 45 patients with NHL treated with chemotherapy). In all, 82.2% of complete responses were achieved. OS and progression-free survival at 5 years in NHL patients was 76% and 73%, respectively.

CONCLUSION

Current treatments (chemotherapy, immunotherapy, and radiotherapy) achieve good control of the disease, with an OS of 5 years in 80% of the patients, although there is no consensus in treatment, given the scarce incidence of these lymphomas.

Diffuse large B-cell lymphoma of the breast: prognostic factors and treatment outcomes

Background

The breast is a rare site of extranodal involvement of diffuse large B-cell lymphoma (DLBCL). We aimed to assess the clinical characteristics, prognostic factors, and treatment outcomes of breast DLBCL.

Patients and methods

We retrospectively analyzed 113 patients (from our institution and the literature) between 1973 and 2014. The primary end point was overall survival (OS). Kaplan–Meier OS curves were compared with the log-rank test. Cox regression analysis was applied to determine the prognostic factors for OS, progression-free survival (PFS), local control (LC), and cause-specific survival (CSS).

Results

A total of 113 patients were included in the study: 42 cases from our hospital and 71 cases from 12 publications. The median age at diagnosis was 58 years. With a median follow-up time of 39.2 months, the estimated 5-year OS, PFS, LC, and CSS were 71.4%, 58.8%, 75.6%, and 74.9%, respectively. In multivariate analysis, more than four cycles of chemotherapy, having localized cancer, lumpectomy with or without axillary lymph node (ALN) dissection, and low to low-to-intermediate International Prognostic Index were favorable factors for OS. For PFS, significant prognostic factors were rituximab use, B symptoms, and tumor size. As for the local group, lumpectomy with or without ALN dissection and more than four cycles of chemotherapy were favorable factors for OS. Tumor size >4 cm and nonuse of rituximab were adverse factors for PFS. Twenty-one patients (18.6%) developed local relapse and 33 (29.2%) developed systemic relapse. Eight patients had central nervous system relapse (7.3%).

Conclusion

Our results reveal that local and extended staging criteria can reflect the different prognosis and treatment outcomes of breast DLBCL. Rituximab use, lumpectomy, and more than four cycles of chemotherapy are recommended as a treatment regimen. However, further study is warranted to validate our data.

Primary Breast Lymphoma in a Woman: A Case Report and Review of the Literature

Patient: Female, 43

Final Diagnosis: Primary breast lymphoma

Symptoms: —

Medication: —

Clinical Procedure: CT scan • PET • chemotherapy • radiotherapy

Specialty: Oncology

A Case of Primary Breast Diffuse Large B-Cell Lymphoma Treated with Chemotherapy Followed by Elective Field Radiation Therapy: A Brief Treatment Pattern Review from a Radiation Oncologist's Point of View

We here report a case of primary breast lymphoma (PBL). A 44-year-old woman presented with a painless mass in the right breast. Fine needle aspiration cytology and excisional biopsy were performed. Excisional biopsy revealed low grade lymphoma, which was subsequently confirmed with histopathology and diagnosed as diffuse large B-cell lymphoma (DLBCL). A chest computed tomography scan revealed a 3.5 cm sized breast mass with skin thickening and a small sized lymphadenopathy in the ipsilateral axilla. Radiation therapy including the right whole breast and ipsilateral axilla and supraclavicular lymph node was performed after the patient received four courses of R-CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisolone plus rituximab) chemotherapy. At the follow-up period of 42 months, the patient is surviving with no evidence of disease. No morbidities occurred in this patient during the follow-up period. We also briefly review the current practice pattern in PBL patients with DLBCL.

Primary malignant non-Hodgkin's lymphoma of the breast: A case report

Primary malignant lymphoma of the breast (PLB) is a rare disease. Treatment options include surgical resection, systemic chemotherapy, radiation and immunotherapy. At present, the optimum treatment combination remains controversial. The present study reports the case of a 39-year-old female with a six month history of a painless mass in the left breast. The mass was excised following medical examination. A diagnosis of diffuse large B-cell lymphoma was determined as a result of histological and immunohistochemical profile analysis. Further examinations excluded metastatic disease. Thus, finally, PLB (diffuse large B-cell lymphoma type) was diagnosed. The patient was treated with adjuvant systemic chemotherapy and consolidated radiation and a positive response was observed. During the 10 months of follow-up, no evidence of disease recurrence was identified. At present, the patient is scheduled for regular follow-up appointments. As the prevalence of PLB is increasing, the details of this rare case may aid clinicians treating similar patients, and highlight the importance of this disease.

Primary breast diffuse large B cell lymphoma - report of 6 cases from South India with review of literature

The breast is an uncommon site of involvement in non-Hodgkin lymphoma, and primary breast lymphoma (PBL) is a disease localized to one or both breasts with or without regional lymph nodes involvement. The objectives of the study were to review the clinical profile, epidemiological parameters and assess the outcomes exclusively in women with primary diffuse large B cell lymphoma (DLBCL) of breast. This was a retrospective observational study done at Kidwai Memorial Institute of Oncology, Bangalore, India. We studied 6 consecutive female patients, diagnosed with primary DLBCL of breast between January 2007 and December 2011. Median age at diagnosis was 45 years (range 33-56 years). B symptoms were present in 3 patients. One patient had central nervous system involvement with high risk International Prognostic Index (IPI). 3 patients underwent lumpectomy and 3 core biopsy. All received anthracycline based chemotherapy, with rituximab in one patient and 3 received involved field radiotherapy. Three patients achieved complete response; one is disease free at 15 months. Two relapsed at 8 and 53 months and both were alive with disease. One achieved partial response, one had progressive disease and response was not assessed in one (but died due to toxicity). Primary breast DLBCL is a rare entity and multi modality combination therapy involving chemotherapy and radiation can give a longer overall survival and thus avoiding the morbidity of mastectomy.

Primary diffuse large B-cell lymphoma of the breast: looking at pathogenesis, clinical issues and therapeutic options

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.

Is mammary not otherwise specified-type sarcoma with CD10 expression a distinct entity? A rare case report with immunohistochemical and ultrastructural study

Mammary sarcoma is extremely rare and the diagnosis is established only after metaplastic carcinomas and malignant phyllodes tumours are excluded. A rare case of not otherwise specified-type sarcoma with CD10 expression in the left breast in a 45-year-old female was presented. It was a high-grade tumour composed of spindle cells histologically. The immunohistochemical results showed that CD10, vimentin and EGFR were positive diffusely and SMA presented focally, whereas epithelial markers and other myoepithelial or myogenic markers were all negative. The electron microscope investigation demonstrated fibroblast-like features. The exact entity of the tumour remains to be studied because it resembles undifferentiated sarcoma or sarcomatoid metaplastic carcinoma to some degree, as well as high-grade malignant phyllodes tumour in particular.

VIRTUAL SLIDES

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