Non-Hodgkin's Lymphoma of the Breast: A Report of 19 Cases and a Review of the Literature

Clinicopathological characteristics, local treatment, and prognostic factors in IE/IIE primary breast lymphoma: a retrospective study of 67 patients

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.

Linfoma no Hodgkin de células B primario de mama. Reporte de caso y revisión de la literatura

OBJETIVOS

reportar un caso de linfoma no Hodgkin de células B primario de mama (LPM) y realizar una revisión de la literatura de su diagnóstico y tratamiento. Materiales y métodos: se reporta el caso de una paciente de 80 años que acudió a una institución privada de referencia en México por un LPM. Además, se diagnosticó un melanoma primario de hígado, mediante biopsia dirigida y estudio de patología. La paciente recibió tratamiento con R-CHOP (rituximab, ciclofosfamida, doxorrubicina, vincristina y prednisona), cuadrantectomía, resección de cadenas ganglionares y radioterapia. La paciente presenta adecuada respuesta del LPM, sin embargo, el segundo tumor primario progresa llevando a la paciente a cuidados paliativos. Se realizó una búsqueda bibliográfica en Medline vía PubMed, LILACS y Google Scholar. Se incluyeron estudios de cohortes, reportes y series de casos en pacientes con LPM que abordaran el diagnóstico, tratamiento y pronóstico de esta patología, publicados en inglés y español entre los años 2000 a 2022.

RESULTADOS

se identificaron 23 títulos, de los cuales 17 cumplieron con los criterios de inclusión, estos fueron reportes de caso y series de caso. La mayoría de las pacientes recibió un esquema quimioterapéutico R-CHOP, el cual se complementó con radioterapia. Cerca del 80 % presentó remisión completa. El sitio más frecuente de recaída fue el sistema nervioso central. La sobrevida a 5 años fue del 83,6 % en los estudios incluidos.

CONCLUSIONES

en la actualidad, el esquema CHOP -con o sin rituximab- es el más empleado y el único que ha mostrado tener un impacto positivo en la supervivencia, este suele acompañarse de radioterapia. Se requieren más estudios clínicos aleatorizados para establecer de manera más clara la efectividad y seguridad de estos tratamientos.

How to prioritize treatment in dual malignancy: A case report of patient with non-Hodgkin lymphoma and breast cancer

Introduction

Clinicians often encounter dilemma upon treating multiple primary malignancies.

Case presentation

We report a case of a female patient, 72, complained of a lump under her left eye since January 2019. Patient was diagnosed with infiltrating ductal carcinoma grade III of the right breast in June 2018 with ER+, PR+, and HER2-, treated with hormonal treatment. Histopathology examination of the lump revealed Non Hodgkin Lymphoma (NHL), B cell type, high grade. Patients received rituximab, cyclophosphamide, epirubicin, vincristin, and prednisone (RHCOP) for 6 cycles to overcome lymphoma then received hormonal therapy afterwards.

Clinical discussion

According to earlier published case reports, it's advised to start hormonal therapy after RHCOP. The survival time was 21 months (5.1–114.7 months) with 5-year overall survival 29%

Conclusion

Unfortunately, we could not have a follow-up on the patient after finishing 6 cycles of RHCOP due to the COVID-19 pandemic situation.

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A patient may experience multiple primary malignancies.

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Non-hodgkin lymphoma (NHL) as the secondary malignancy in BC is a rare case.

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In a BC patient with secondary NHL, we should consider to treat NHL first using anthracycline-based treatment and rituximab, in this case, RHCOP, if the CD20 turns out positive.

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Hormonal therapy would be the next agenda.

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.

Lymphoma of the breast: A clinicopathologic analysis of 51 cases with a specific emphasis on patients with a history of breast carcinoma

We herein report our experience with 51 breast lymphoma (BL) cases from 46 patients with a specific focus on patients with a history of breast carcinoma. The overall most common subtype was diffuse large B-cell lymphoma, followed by MALT lymphoma and follicular lymphoma. Eleven of 46 (24%) patients had either previous history of or concurrent breast carcinoma. There was no significant difference in clinicopathologic characteristics between patients with primary and secondary BL. On follow-up, patients with secondary BL had a worse disease-free survival with no difference in overall survival between the two groups.

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

We report a case of primary breast lymphoma in a 75-year-old woman who noticed a lump in her right breast after trauma. Mammographic, ultrasonographic, and pathologic correlations are provided. The typical appearance of primary breast lymphoma on mammography is a solitary, uncalcified, circumscribed, or indistinctly marginated mass with adjacent lymphadenopathy. On ultrasound, primary breast lymphoma is usually hypoechoic with circumscribed or microlobulated margins demonstrating increased vascularity. The differential diagnosis for a mass with this appearance is discussed in detail and includes hematoma, abscess, primary breast lymphoma, invasive ductal carcinoma, phyllodes tumor, and metastatic disease.

Primary anaplastic lymphoma kinase-negative anaplastic large-cell lymphoma of the breast in a male patient

Anaplastic large-cell lymphoma is an extremely rare lymphoma subtype. We describe the mammographic and ultrasonographic findings in a 51-year-old male patient who suffered from a palpable lump caused by this rare disease.

Primary breast lymphoma with sudden death

Primary breast lymphoma is a rare form of extranodal lymphoma. B cells constitute the most common type involving the breast. T cells represents only 3%. Even though lymphomas have a high predilection to metastasize to the heart, there are no specific clinical or radiological findings, and most of the cases are diagnosed at autopsy. We discuss the case of a 49-year-old woman with primary breast lymphoma who presented with sudden death. Autopsy revealed a primary T-cell lymphoma of the breast with tumoral infiltration of the atrioventricular node and transmural myocardial permeation with focal necrosis.

FDG PET-CT in the management of primary breast lymphoma

OBJECTIVE

Primary breast lymphoma (PBL) is a rare disease and its management differs from other breast cancers. The purpose of this study is to evaluate the role of FDG PET-CT in the management of PBL. We carried out 16 PET-CT scans and reviewed the literature.

MATERIALS AND METHODS

A total of 16 FDG PET-CT scans were done in 8 female patients with PBL with a median age of 49 years (range: 27-68). Of the 16 PET-CT scans, 1 scan was done for primary diagnosis and staging (1 patient), 2 for staging (2 patients), 7 for evaluation of treatment response (6 patients), and 6 for detecting recurrence (4 patients). PET-CT image interpretation and analysis were performed qualitatively (visually) and semiquantitatively using standardized uptake value (SUV). Absence of uptake in the postchemotherapy follow-up PET-CT scan was considered as a complete response, and a fall of more than 50% of baseline SUV was considered as a significant response.

RESULTS

One patient was successfully diagnosed to have PBL and staged using PET-CT. Two patients were correctly staged with the help of FDG PET-CT. Complete response was noted in all 6 patients (3 had a positive baseline scan and showed complete resolution of FDG uptake, the other 3 who did not have baseline PET-CT and lesions were detected on CT, and also showed complete resolution). Of the 4 patients evaluated for recurrence, 1 patient was positive and 3 patients were negative for recurrence in follow-up PET-CT scans done after 18, 22, and 24 months, respectively.

CONCLUSION

FDG PET-CT has a definitive role in every step of management (diagnosis, staging, treatment response evaluation, and detection of recurrence) in patients with primary breast lymphoma.

Primary ALK-positive anaplastic large cell lymphoma of the breast: a case report and review of the literature

BACKGROUND

Non-Hodgkin lymphomas of the breast are uncommon, which represent less than 1% of all breast malignancies and predominantly are of B-cell origin.

OBSERVATION

In this report, a rare case of anaplastic lymphoma kinase (ALK)-positive anaplastic large T-cell lymphoma in the breast of a 16-year-old female without breast implant is described. The patient presented with a 3-month history of progressive right breast swelling and erythema. Clinically, inflammatory breast carcinoma was highly suspected. A tru-cut needle biopsy of the right breast demonstrated infiltration of tumoral cells around the breast lobules and soft tissue and also in angiolymphatic spaces. The immunohistochemical profile showed positivity for CD30 and ALK and confirmed the diagnosis of ALK-positive anaplastic large T-cell lymphoma of the breast.

CONCLUSION

Anaplastic large T-cell lymphoma of the breast is rare, and can clinically mimic inflammatory breast carcinoma in adolescence.

Primary anaplastic large cell lymphoma of the breast arising in reconstruction mammoplasty capsule of saline filled breast implant after radical mastectomy for breast cancer: an unusual case presentation

BACKGROUND

Primary non-Hodgkin lymphoma (NHL) of the breast represents 0.04-0.5% of malignant lesions of the breast and accounts for 1.7-2.2% of extra-nodal NHL. Most primary cases are of B-cell phenotype and only rare cases are of T-cell phenotype. Anaplastic large cell lymphoma (ALCL) is a rare T-cell lymphoma typically seen in children and young adults with the breast being one of the least common locations. There are a total of eleven cases of primary ALCL of the breast described in the literature. Eight of these cases occurred in proximity to breast implants, four in relation to silicone breast implant and three in relation to saline filled breast implant with three out of the eight implant related cases having previous history of breast cancer treated surgically. Adjuvant postoperative chemotherapy is given in only one case. Secondary hematological malignancies after breast cancer chemotherapy have been reported in literature. However in contrast to acute myeloid leukemia (AML), the association between lymphoma and administration of chemotherapy has never been clearly demonstrated.

CASE PRESENTATION

In this report we present a case of primary ALCL of the breast arising in reconstruction mammoplasty capsule of saline filled breast implant after radical mastectomy for infiltrating ductal carcinoma followed by postoperative chemotherapy twelve years ago.

CONCLUSION

Primary ALK negative ALCL arising at the site of saline filled breast implant is rare. It is still unclear whether chemotherapy and breast implantation increases risk of secondary hematological malignancies significantly. However, it is important to be aware of these complications and need for careful pathologic examination of tissue removed for implant related complications to make the correct diagnosis for further patient management and treatment. It is important to be aware of this entity at this site as it can be easily misdiagnosed on histologic grounds and to exclude sarcomatoid carcinoma, malignant melanoma and pleomorphic sarcoma by an appropriate panel of immunostains to arrive at the correct diagnosis of ALCL.

Primary breast non-Hodgkin's lymphoma: a large single center study of initial characteristics, natural history, and prognostic factors

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.

Primary breast lymphoma: patient profile, outcome and prognostic factors. A multicentre Rare Cancer Network study

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.

Secondary breast lymphoma diagnosed by vacuum-assisted breast biopsy: a case report

INTRODUCTION

Breast lymphoma, either as a manifestation of primary extranodal disease or as secondary involvement, is a rare malignancy, and its diagnosis, prognosis, and treatment have not been clearly defined. On the other hand, Vacuum-assisted breast biopsy (VABB) is a minimally invasive technique with ever-growing use for the diagnosis of mammographically detected, non-palpable breast lesions.

CASE PRESENTATION

A symptom-free, 56-year-old woman presented with a non-palpable BI-RADS 4B lesion without microcalcifications. She had a positive family history for breast cancer and a history of atypical ductal hyperplasia in the ipsilateral breast four years ago. She reported having been treated for non-Hodgkin lymphoma 12 years ago. With the suspicion of breast cancer, mammographically guided VABB with 11-gauge probe (on the stereotactic Fisher's table) was performed. VABB made the diagnosis of a non-Hodgkin, grade II, B-cell germinal-center lymphoma. VABB yielded enough tissue for immunohistochemistry/WHO classification.

CONCLUSION

This is the first case in the literature demonstrating the successful diagnosis of breast lymphoma by VABB, irrespectively of the level of clinical suspicion. It should be stressed that VABB was able to yield enough tissue for WHO classification. In general, lymphoma should never be omitted in the differential diagnosis, since no pathognomonic radiologic findings exist for its diagnosis.

Primary diffuse large B-cell lymphoma of the breast: prognostic factors and outcomes of a study by the International Extranodal Lymphoma Study Group

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.

Metastatic tumors in the breast: a report of 5 cases and review of the literature

Breast cancer is the most common malignancy in women. However, metastases to the breast from nonmammary malignant neoplasms are rare and were detected at a rate of 0.28% in our series. Clinical and pathologic findings in 5 cases of metastatic tumors (malign mesenchymal tumor, squamous cell carcinoma of the tongue, non-Hodgkin lymphoma, and Sézary syndrome) in the breast are presented and discussed with respect to the literature. Detailed clinical history and a multidisciplinary approach are useful in establishing correct diagnosis and preventing unnecessary radical surgery.

Ipsilateral breast carcinoma following treatment for primary breast lymphoma

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.

Findings of fluorine-18-FDG PET in extranodal origin lymphoma —In three cases of diffuse large B cell type lymphoma—

F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) is an excellent modality for non-invasive functional imaging of malignant lymphoma and is highly sensitive and specific for the detection of lymphoma lesions. Here, we report the findings of FDG-PET for three cases of diffuse large B cell type lymphoma (DLBCL) with extranodal tumors in the breast, stomach, and liver plus spleen, respectively. The whole body FDG-PET findings showed no evidence of lymph node (LN) involvement or distant metastasis. Strong FDG accumulations were observed in the only extranodal sites by whole body FDG-PET. Therefore, we could confirm that these cases were extranodal primary origins. Whole body PET is useful to determine the primary sites, that is, extranodal origin DLBCL with its clear images.

Anaplastic large-cell non-Hodgkin’s lymphoma of the breast in periprosthetic localisation 32 years after treatment for primary breast cancer—a case report

Primary, as well as secondary, lymphomas of the breast are rare diseases and might, in some cases, be misdiagnosed as breast cancer on routine hematoxylin/eosin stainings. We report a case of an anaplastic large cell lymphoma in a 72-year-old woman with a history of breast cancer treated with breast-ablative surgery and a subsequent silicon implant 32 years ago. Clinically, she presented with an ulceration of the skin, which had developed within a few months. On conventional histology, the tumor cells were mimicking poorly differentiated invasive ductal carcinoma with a prominent leukocytic infiltrate. The immunoprofile of the tumor showed negativity for cytokeratins and led to the diagnosis of a CD30-positive anaplastic large cell lymphoma.