Lymphoma affecting the breast: a pictorial review of multimodal imaging findings

A rare case of primary breast lymphoma presenting as calcifications on screening mammography

Extranodal marginal zone lymphoma (EMZL) is a low-grade subtype of B-cell non-Hodgkin lymphoma that can affect any mucosal tissue, most commonly the GI tract. Primary involvement of the breast, known as primary breast lymphoma (PBL), is a very rare manifestation. We report an unusual case of a 65-year-old woman with primary breast EMZL presenting as calcifications discovered during screening mammography. This represents an exceedingly atypical appearance of primary breast lymphoma that is rarely described in the literature.

Secondary breast lymphoma: A case report

Lymphoma is the most frequent hematologic malignancy that involves the breast. It represents less than 1% of all breast cancer. The most common subtype is the secondary B-cell lymphoma. Clinically, lymphomas are divided into primary and secondary breast lymphoma. We presented a case of 49-year-old female, who has diagnosed of Non-Hodgkin's Lymphoma, finalizing the treatment 2 months ago. Currently, she came for a check-up due to a palpable lump in the right breast. Mammography shows a dense, oval, and circumscribed mass. Ultrasound revealed a 3.6 cm oval, hypoechoic, lobulated mass with internal vascularity at color Doppler. Axillary nodes show cortical thickening of 7 mm, cortical blood flood, and absence of fatty hilum. The histopathology report corresponds to infiltration of the right breast and bilateral axillary nodes by Non-Hodgkin Lymphoma. This case corresponds with lymphoma recurrence manifested in breast. The diagnosis of lymphoma is an imaging challenge that simulates benign and malignant pathologies.

Primary small lymphocytic lymphoma of the breast: a rare presentation of non-Hodgkin's lymphoma

Primary Small Lymphocytic Lymphoma of the breast is a rare presentation of Non-Hodgkin's lymphoma. In this report, we present the case of primary small lymphocytic lymphoma of the breast in a 65-year-old female who presented with an abnormal breast ultrasound significant for a nodule of the right breast consistent with BI-RADS 4, indicating follow-up with ultrasound-guided biopsy for further diagnostic evaluation. The patient had no prior history of extramammary lymphoma or widespread disease. A sample of the breast mass was obtained via ultrasound-guided core needle biopsy and the pathology report revealed low-grade B-cell Lymphoma. After discussion with medical oncology and the explanation of risks, benefits and alternatives to surgery, a lumpectomy was performed, and the final pathology report of the mass revealed primary low-grade B-cell lymphocytic lymphoma of the breast. On follow up, the PET scan was unremarkable and showed no evidence of abnormal glucose metabolism or adenopathy.

Unusual US Findings of Diffuse Large B-Cell Lymphoma of the Breast: A Case Report

Lymphoma is an uncommon type of breast malignancy, with low prevalence. The ultrasonographic findings of breast lymphoma have been described as nonspecific. Breast lymphoma most commonly appears as a solitary hypoechoic mass on US, and usually shows hypervascularity on color Doppler US. Herein, we report an unusual case of breast lymphoma that presented as multiple bilateral hyperechoic nodules on US.

Multiple bilateral breast masses due to lymphoma metastases: A report of 2 cases highlighting the mammographic and sonographic features

Metastases within breast usually occur due to a primary malignancy in the contralateral breast. Breast metastases from extra mammary malignancies are known to be very rare and the primary tumors are reported to be melanoma, lung cancer, gastro-intestinal primary tumors, neuroendocrine tumors, sarcomas, ovarian tumors and lymphomas. Breast lymphomas comprise 0.04%-0.7% of all cases of breast malignancies and may manifest either as a primary or a secondary variety. A primary breast lymphoma is known to be more infrequent than a secondary breast lymphoma. In patients with breast metastases the usual clinical presentation is with multiple palpable masses and imaging evaluation is the mainstay for initial diagnosis. We report the imaging features seen in 2 almost identical cases of secondary breast lymphoma. At mammography, multiple, round to elliptical, sharply circumscribed, high-density masses were seen, in which spiculation, calcification and architectural distortion were conspicuously absent. On sonography, these round /oval masses were homogenously hypoechoic, sharply circumscribed, showed a thin echogenic rim with posterior acoustic enhancement and were moderately to profusely vascular on color Doppler examination. These imaging features should suggest the possible diagnosis of metastases from a hematogenous malignancy and an ultrasound guided biopsy should be performed. Once the etiology of lymphoma is confirmed, a rigorous multi- modality imaging work up to identify the primary site, stage the disease and document other sites of dissemination is warranted.

Rare Lymphoma of the Breast: A Case Report

Lymphoma of the breast is a rare malignancy of the breast lymphoid tissue. It can present as either a primary or a secondary malignancy due to metastasis from a systemic disease. Secondary breast lymphoma (SBL) is one of the most common malignancies to metastasize to the breast. Once present in the breast, these masses are often difficult to distinguish from primary breast carcinoma on both physical examination and diagnostic imaging modalities. Differentiating these tumors is imperative because each has a different management plan. This report presents a rare case of SBL in a 55-year-old Hispanic female and includes a review of its presentation, radiologic imaging findings, and management.

Secondary diffuse large B-cell breast lymphoma developed in subcutaneous fat layer of the breast with cardiac involvement

We present a rare case of diffuse large B-cell lymphoma developed in subcutaneous fat layer of the breast with cardiac involvement. Radiologists should perform an image-guided biopsy for pathologic confirmation of breast lymphomas and avoidance of unnecessary invasive treatment.

Multimodal Ultrasonography Features of Breast Lymphomas: 3 Cases Report

To investigate the multimodal ultrasonography (US) features of breast lymphomas (BLs). Multimodal ultrasonography was performed on three patients who had been diagnosed BLs by pathology in our hospital. Two cases of primary BLs appeared hyper hyperechoic and hypoechoic, and one case of second BL appeared isoechoic and hypoechoic. Elastography of two lesions was soft elasticity and the elasticity score was 2 points. Contrast-enhanced ultrasound (CEUS) revealed rapid uniform high enhancement with clearly defined after injection. There are some common features in ultrasound. Combined with those features can help to improve the sonographer's understanding and diagnosis of the BLs.

A Spectrum of Metastases to the Breast: Radiologic-Pathologic Correlation

Metastases to the breast from non-mammary origin are rare. The majority of these lesions appear as secondary manifestations of melanoma and lymphoma, followed by lung carcinomas, gynecological carcinomas, and sarcomas. There has been a steady trend of an increase in diagnosis of intramammary metastases owing to the current advances in imaging technology. Imaging features depend on the type of primary neoplasm and route of dissemination, some of which resemble primary breast cancer and benign breast entities. There are certain imaging features that raise the level of suspicion for metastases in the correct clinical context. However, imaging manifestations of intramammary metastases do not always comply with the known classic patterns. The aim of this review is to clarify these features, emphasizing radiologic-pathologic correlation and a multidisciplinary approach, since most cases are found in patients with advanced disease.

Male Breast Imaging Uncovers Lymphoma

Background

A 36-year-old man presented with a palpable mass in the right axillary tail for four months. He was referred to breast imaging for diagnostic work-up. He does not have a family history of breast cancer.

Aim

Breast imaging work-up for diagnosis of lymphoma is unusual and even more so in a male patient.

Case presentation

After Breast Mammography and targeted Ultrasound of the axillary tail and axilla, Magnetic Resonance Imaging (MRI) was performed and suggested lymphoproliferative disorder. Excisional biopsy was performed after the breast MRI with removal of right axillary tissue measuring 15.0 × 5.5 × 2.0 cm and containing multiple lymph nodes. Excisional biopsy revealed Classic Hodgkin lymphoma of nodular sclerosis type. Staging [18F]-FDG PET/CT revealed early stage of disease.

Conclusion

The presentation and diagnostic elements of Hodgkin Lymphoma are described in this case report emphasizing the significance of breast imaging in multiple populations.

Bilateral primary breast Burkitt's lymphoma in pregnancy

Pregnancy-associated cancer is defined as malignancy diagnosed during gestation or up to 1 year post partum. Treatment of cancer during pregnancy is complicated by the risk of harm to the fetus and limitations in safety data. Postpartum patients receiving chemotherapy, tyrosine-kinase inhibitors or hormonal agents should avoid breast feeding to avoid drug excretion in breast milk. Patients who will receive cytotoxic chemotherapy should be advised of the potential impact on their future fertility and offered fertility-preservation options. Breast cancer is the most common pregnancy-associated malignancy and is most frequently either invasive ductal or lobular carcinoma. Breast lymphoma is an exceedingly rare diagnosis that typically presents with unilateral disease in the seventh decade of life. Here, we present the case of a woman who presented with bilateral breast masses during the second trimester of pregnancy and was ultimately diagnosed with primary breast Burkitt's lymphoma.

Coexistence of primary central nervous system lymphoma and primary breast lymphoma: Clinical presentation, imaging features, and treatment management

The presence of synchronous dual hematological diseases is an uncommon finding. We report an unusual case of coexistence of primary central nervous system lymphoma and primary breast lymphoma without systemic involvement in an immunocompetent patient. To our knowledge a similar case has not yet been reported in the literature. We especially focus on presenting the imaging features, the associated clinical findings and treatment management of each entity, with the aim of raising awareness on these two rare types of lymphomas and the possibility of their coexistence.

A novel cross-species differential tumor classification method based on exosome-derived microRNA biomarkers established by human-dog lymphoid and mammary tumor cell lines' transcription profiles

Background and Aim:

Exosome-derived microRNA (miRNA) has been widely studied as a non-invasive candidate biomarker for tumor diagnosis in humans and dogs. Its application, however, was primarily focused on intraspecies usage for individual tumor type diagnosis. This study aimed to gain insight into its application as a cross-species differential tumor diagnostic tool; we demonstrated the process of identifying and using exosome-derived miRNA as biomarkers for the classification of lymphoid and mammary tumor cell lines in humans and dogs.

Materials and Methods:

Exosome-derived miRNA sequencing data from B-cell lymphoid tumor cell lines (n=13), mammary tumor cell lines (n=8), and normal mammary epithelium cultures (n=4) were pre-processed in humans and dogs. F-test and rank product (RP) analyses were used to select candidate miRNA orthologs for tumor cell line classification. The classification was carried out using an optimized support vector machine (SVM) with various kernel classifiers, including linear SVM, polynomial SVM, and radial basis function SVM. The receiver operating characteristic and precision-recall curves were used to assess the performance of all models.

Results:

MIR10B, MIR21, and MIR30E were chosen as the candidate orthologs from a total of 236 human-dog miRNA orthologs (p≤0.01, F-test score ≥10, and RP score ≤10). Their use of polynomial SVM provided the best performance in classifying samples from various tumor cell lines and normal epithelial culture.

Conclusion:

The study successfully demonstrated a method for identifying and utilizing candidate human-dog exosome-derived miRNA orthologs for differential tumor cell line classification. Such findings shed light on a novel non-invasive tumor diagnostic tool that could be used in both human and veterinary medicine in the future.

Case reports of shear-wave elastography (SWE) features of lymphoma involving the breast

Breast lymphoma is a rare malignancy that is often difficult to distinguish from other breast diseases. Elastography has been proven to facilitate the diagnosis of breast lesions. However, only few reports have focused on the elastographic features of breast lymphoma. Therefore, we herein present 2 cases of breast lymphomas with a focus on the elastographic findings.

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.

Blastic plasmacytoid dendritic cell neoplasm of the breast: A case report and review of the literature

RATIONALE

Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is an uncommon and aggressive hematologic malignancy that arises from plasmacytoid dendritic cells. BPDCN typically presents with skin lesions with or without involvement of lymph nodes, peripheral blood, or bone marrow. However, breast involvement of BPDCN is rare and there has been no report describing the radiologic features of BPDCN within breast parenchyma.

PATIENT CONCERNS

We report a case of a 47-year-old woman who presented with an incidentally detected hypermetabolic breast lesion on PET/CT with concurrent right cheek plaque.

DIAGNOSES

Skin biopsy was performed for the right cheek plaque. Mammography and breast ultrasonography were performed to evaluate the breast lesion. The lesion was depicted as a 2.5 cm sized focal asymmetry on mammogram and an irregular heterogeneous echoic mass within the mammary zone of the right upper outer breast. Core needle biopsy was performed for the breast lesion. Histologic diagnosis of the two lesions was BPDCN.

INTERVENTIONS

The patient was treated with induction and consolidation chemotherapy and received allogenic peripheral blood stem cell transplantation.

OUTCOMES

The patient remains in complete remission state without relapse at 34 months since initial diagnosis.

LESSONS

This is the first case of BPDCN manifested as a breast parenchymal mass and assessed by diagnostic breast imaging tools (mammography and ultrasonography). This case report is significant for BPDCN within the breast parenchyma and presenting rare radiologic description of BPDCN.

Hyperechoic Lesions on Breast Ultrasound: All Things Bright and Beautiful?

Ultrasound (US) lexicon of the Breast Imaging Reporting and Data System (BI-RADS) defines an echogenic breast mass as a lesion that is hyperechoic in comparison with subcutaneous adipose tissue. However, at sonography, only 0.6 to 5.6% of breast masses are echogenic and the majority of these lesions are benign. approximately, 0.5% of malignant breast lesions appear hyperechoic. The various benign pathologic entities that appear echogenic on US are lipoma, hematoma, seroma, fat necrosis, abscess, pseudoangiomatous stromal hyperplasia, galactocele, etc. The malignant diagnoses that may present as hyperechoic lesions on breast US are invasive ductal carcinoma, invasive lobular carcinoma, metastasis, lymphoma, and angiosarcoma. Echogenic breast masses need to be correlated with mammographic findings and clinical history. Lesions with worrisome features such as a spiculated margin, interval enlargement, interval vascularity, or association with suspicious microcalcifications on mammography require biopsy. In this article, we would like to present a pictorial review of patients who presented to our department with echogenic breast masses and were subsequently found to have various malignant as well as benign etiologies on histopathology.

T-cell non-Hodgkin's lymphoma of both breasts: An uncommon presentation of a common disease

Secondary T-cell non-Hodgkin's lymphoma of the breasts is a very rare disease and can be easily missed as inflammatory carcinoma at initial presentation. High index of suspicion and radiological investigations has a big role in identifying the primary lymphoma.

It's Not Always Gynecomastia: A Case of Diffuse Large B-Cell Lymphoma Presenting as Breast Mass in a Male Patient

We report a case of diffuse large B-cell breast lymphoma that presented as a palpable breast lump in a male patient evaluated with digital mammography and targeted breast ultrasound (US) but ultimately confirmed by US-guided core needle biopsy. We will discuss the appropriate workup algorithm for a palpable breast lump in a male patient as outlined by the American College of Radiology (ACR) Appropriateness Criteria. While gynecomastia is the most common reason for a new palpable breast lump in a male patient, male breast cancer (including lymphoma and metastasis) can have a similar appearance on imaging. Our goal is to provide clarity on proper radiographic assessment protocols and imaging features of palpable breast masses in men by emphasizing the role of anatomical location and symmetry in distinguishing it from more common causes, such as gynecomastia, in future diagnostic imaging scenarios.

Bilateral Primary Marginal Zone Lymphoma of the Breast - A Rare Breast Malignancy

Extranodal marginal zone lymphoma (EMZL) presents only rarely within the breast, although the incidence of breast EMZL has increased in the past decade for unclear reasons. Due to its rarity, the etiology, course, and treatment response of this cancer are less studied. Case Report: We present the case of a 64-year-old female who had bilateral diffuse irregularity in a trabecular pattern on screening mammogram. Random ultrasound-guided breast biopsy of the right breast demonstrated an extra-nodal marginal zone B-cell lymphoma. She also had approximately 25% marrow involvement by mucosa-associated lymphoid tissue-type marginal zone lymphoma and splenomegaly. Clinically she remained asymptomatic during a 1-year follow-up. Although she presented with advanced-stage disease involving both breasts, spleen and bone marrow, given her lack of associated symptoms, she was observed with active surveillance. Conclusion: Asymptomatic cases of breast EMZL can be managed with close observation as exemplified by our case.

Ultrasound Diagnosis of Breast Lymphoma and the Identification of Breast Infiltrating Ductal Carcinoma

OBJECTIVES

By analyzing the B-mode ultrasound and color Doppler flow imaging characteristics of breast lymphoma (BL) and breast infiltrating ductal carcinoma (BIDC), we expected to discriminate these diseases.

METHODS

Thirty-two patients with BL and 30 with BIDC confirmed pathologically were selected. The BL group was divided into nodular and diffuse groups. We analyzed and compared the general and imaging characteristics of the BL subgroups and the BIDC group.

RESULTS

The mean maximum diameter of BL was 54.93 ± 43.74 cm, and that of BIDC was 23.90 ± 6.79 cm (P < .05). The differences between the nodular BL and BIDC groups in a circumscribed margin (60.00% versus 20.00%), calcification (20.00% versus 53.33%), aggregation characteristics (0.00% versus 53.33%), and density (73.33% versus 10.00%) were statistically significant (P < .05). The differences between the diffuse BL and BIDC groups in calcification (6.67% versus 53.33%), aggregation characteristics (6.67% versus 53.33%) and density (40.00% versus 10.00%) were statistically significant (P < .05). The difference in a circumscribed margin (60% versus 13.33%) between the BL subgroups was statistically significant (P < .05). The blood flow signal in BL lesions was richer than that in BIDC lesions (P < .05).

CONCLUSIONS

Extrasuperior-quadrant single lesions in the BL group were larger than those in the BIDC group. The edges of the lesions in the nodular BL group were circumscribed and dense. Lesions in the diffuse BL group did not have a circumscribed margin, calcification, aggregation characteristics, or density. The blood flow signal in BL lesions was richer than that in BIDC lesions.

Imaging Characteristics of Breast Lymphoma; a Case Series

Introduction

Breast involvement by lymphoma is rare. It can occur as a primary breast tumour or as an extranodal manifestation of the systemic disease. The imaging features of breast lymphoma (BL) are not characteristic. Biopsy is necessary for diagnosis due to non-specific imaging features.

Materials and Methods

A retrospective electronic medical chart review was conducted of patients diagnosed with lymphoma of breast that underwent diagnostic radiological procedures (including mammography, ultrasound breast, computed tomography (CT) scan and positron emission tomography (PET/CT) scan from 1 July 2018 to 31 March 2019 at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Pakistan.

Results

Four patients were identified. On mammogram, the most common finding consisted of the presence of high-density masses with circumscribed or indistinct margins. On ultrasound, hypoechoic masses and indistinct diffuse infiltrative patterns were observed. PET/CT and CT were helpful in detecting extramammary sites of disease and for classifying the disease into primary or secondary BL.

Conclusion

The early diagnosis of the BL is important. The radiologists should include lymphoma in the differential diagnosis when there is the absence of microcalcifications or spiculated margins on mammography and ultrasound.

A Case Report of a Breast Implant-Associated Plasmacytoma and Literature Review of Non-ALCL Breast Implant-Associated Neoplasms

Lymphomas associated with breast implants are rare, with the most common being anaplastic large cell lymphoma (ALCL). Non-ALCL breast implant-associated lymphomas are even more rare, with only a small handful of such neoplasms reported to date. Given the need to better understand these pathologies as well as the increasing clinical and media attention being paid to these diseases, we review the available literature of hematolymphoid neoplasms other than ALCL associated with breast implants and describe the first case of a patient diagnosed with a primary breast implant-associated plasmacytoma.

LEVEL OF EVIDENCE: 5

A Case Series of Breast Metastases from Different Extramammary Malignancies and Their Literature Review

Metastasis to the breast from all other primary sites is unusual. Twelve patients were diagnosed between 2007 and 2017 at National Cancer Institute, Mexico. Solitary or multiple masses, round or oval, and hypoechoic and solid lesions with posterior acoustic shadowing were patterns commonly reported in these patients; other arrangements include diffuse involvement of the breast simulating an inflammatory carcinoma. The development of a breast metastasis is revealed, in our experience, as a negative prognostic factor. Thus, the radiologist should know about the varied appearance of metastatic breast lesions and provide radiopathological correlations when available.

Primary lymphoma of the breast: A case series

Primary breast lymphoma has been defined as localized involvement of one or both breasts with or without ipsilateral axillary nodal involvement, usually as a rare manifestation of extranodal non-Hodgkin's lymphoma. We describe three cases of this uncommon disease seen at our institution. Two of these cases presented as palpable breast lumps and one was screening detected. None of the patients had a prior history of lymphoma; only one reported B symptoms night sweats and weight loss. Diagnosis was established on ultrasound-guided core biopsy and no evidence of metastatic disease was identified. Even though the imaging features are not specific to this diagnosis, the radiologists should be aware of the clinical and imaging presentation of this rare malignancy to recommend appropriate management and establish radiologic–pathologic concordance.

Breast Involvement by Hematologic Malignancies: Ultrasound and Elastography Findings with Clinical Outcomes

Objective:

Hematological malignancies very rarely involve the breast. The aim of this study is to retrospectively evaluate B-mode ultrasound (US) and elastography (ES) findings of breast involvement by hematologic malignancies with clinical outcomes.

Materials and Methods:

All core-needle biopsy results that were performed at our tertiary breast center from January 2013 to September 2016 were searched. Our search revealed 9 patients with breast involvement either by leukemia or lymphoma. All patients were examined using B-mode US and ES. US and ES findings were analyzed with the consensus of two radiologists, and clinical outcomes were noted.

Results:

The mean age of the study population was 41.6 years (range, 20–83 years). Two patients showed diffuse hypoechoic parenchymal infiltration. The elasticity assessments of these lesions were soft and intermediate. The remaining 7 patients had mass lesions. The elasticity assessment of these masses according to Breast Imaging Reporting and Data System US was as follows: Soft (n = 1), intermediate (n = 4), high (n = 2).

Conclusions:

It is important to consider that hematologic malignancies may appear as soft or intermediate lesions on ES. Patients’ history and clinical background should help us to consider breast involvement. In addition, the clinical outcomes may not be related with elasticity assessments.

Spectrum of CT Findings in Thoracic Extranodal Non-Hodgkin Lymphoma

Non-Hodgkin lymphoma (NHL) frequently manifests in extranodal structures in the chest, often in the form of secondary involvement but occasionally as primary disease. Because staging and treatment are affected by the presence of extranodal disease at imaging, radiologists' interpretation and management of suspicious findings are critical to patient care. Unfortunately, owing to considerable imaging overlap with other diseases, primary extranodal lymphoma is difficult to diagnose with imaging alone. Radiologists should have a heightened degree of suspicion in patients at risk (including patients with immune compromise, autoimmune diseases, or a history of stem cell or solid organ transplant) or with particular imaging appearances (including the vertebral wraparound sign, nonresolving consolidation, an infiltrative soft-tissue mass, and lesions demonstrating vascular encasement without invasion). For patients with known NHL, positron emission tomography/computed tomography (PET/CT) using fluorine 18 (¹⁸F)-labeled fluorodeoxyglucose (FDG) is now preferred for routine staging in most cases. CT remains heavily used, and identification of subtle extranodal involvement with CT can be improved with use of intravenous contrast material and careful review of multiplanar images. Pericardial effusion, pleural soft tissue (even when mild), mass-like consolidation, perilymphatic nodularity, and new lytic bone lesions are particularly suggestive of secondary involvement in a patient with known NHL. Magnetic resonance imaging is a helpful problem-solving tool when equivocal findings would change staging and treatment. This comprehensive review illustrates the spectrum of CT manifestations of extranodal NHL in the chest, including the pleura, lung, airways, heart, pericardium, esophagus, chest wall, and breast. ^©RSNA, 2017.

Shear-Wave Elastography Features of Primary Non-Hodgkin's Lymphoma of the Breast: A Case Report and Literature Review

Lymphoma is a rare malignancy of the breast, comprising approximately 0.04 to 0.5% of breast malignancies. Because the clinical findings of breast lymphoma are nonspecific and similar to those of breast carcinoma, it is important to distinguish breast lymphoma from other breast disease on the basis of radiologic findings. Elastography is an interesting imaging tool that reflects the tissue stiffness, increasingly being used in the evaluation of breast tumours. However, only a limited number of studies have focused on the elastographic findings of breast lymphoma. In this report, we review the radiologic characteristics of primary breast lymphoma including elastographic feature. A 57-year-old woman presented with a painless palpable mass of the left breast. Ultrasonography revealed an irregular-shaped complex cystic and solid mass with increased vascularity in upper outer breast. On shear wave elastography, the mass was relatively stiff with maximum elasticity value (E_max) of 100.5 kilopascal (kPa). The mass was confirmed as diffuse large B-cell lymphoma by US-guided core needle biopsy.

MRI features of breast lymphoma: preliminary experience in seven cases

PURPOSE

We aimed to evaluate the imaging features of breast lymphoma using magnetic resonance imaging (MRI).

METHODS

This retrospective study consisted of seven patients with pathologically confirmed breast lymphoma. The breast lymphomas were primary in six patients and secondary in one patient. All patients underwent preoperative dynamic contrast-enhanced MRI and one underwent additional diffusion-weighted imaging (DWI) with a b value of 600 s/mm2. Morphologic characteristics, enhancement features, and apparent diffusion coefficient (ADC) values were reviewed.

RESULTS

On MRI, three patients presented with a single mass, one with two masses, two with multiple masses, and one with a single mass and a contralateral focal enhancement. The MRI features of the eight biopsied masses in seven patients were analyzed. On MRI, the margins were irregular in six masses (75%) and spiculated in two (25%). Seven masses (87.5%) displayed homogeneous internal enhancement, while one (12.5%) showed rim enhancement. Seven masses (87.5%) showed a washout pattern and one (12.5%) showed a plateau pattern. The penetrating vessel sign was found in two masses (25%). One patient with two masses underwent DWI. Both masses showed hyperintense signal on DWI with ADC values of 0.867×10-3 mm2/s and 0.732×10-3 mm2/s, respectively.

CONCLUSION

Breast lymphoma commonly presents as a homogeneously enhancing mass with irregular margins and displays a washout curve pattern on dynamic MRI. A low ADC value may also indicate a possible diagnosis of breast lymphoma.

Imaging Findings of Plasmacytoma of Both Breasts as a Preceding Manifestation of Multiple Myeloma

Breast plasmacytoma is an extremely rare tumor. It can occur as a primary isolated tumor or as an extramedullary manifestation in multiple myeloma. This report describes the unusual case of a primary extramedullary plasmacytoma that progressed to multiple myeloma within 15 months in a 35-year-old woman. The patient had been initially diagnosed with a primary extramedullary plasmacytoma of the epidural soft tissue at the cervical 6-thoracic 1 spine level and the stomach. The patient had received chemotherapy and the disease had been in remission. One year later, the disease recurred, affecting both breasts, right clavicle, and orbit. Three months later, the disease had progressed to multiple myeloma. I report this case, focusing on the findings of mammography, ultrasonography, magnetic resonance imaging, and positron emission tomography of bilateral breast plasmacytoma, and provide a review of the literature.

[Primary non-Hodgkin's lymphoma of the breast. A case report]

BACKGROUND

Primary breast lymphomas, a rare subtype of non-Hodgkin's lymphoma, represent 0.04 to 0.5% of all breast cancers, 0.38 to 0.7% of all lymphomas, and 1.7 to 2.2% of extranodal lymphomas. The treatment choice is based on chemotherapy containing anthracycline and rituximab. Surgery is limited to being less invasive and only for diagnostic purposes. Radiotherapy has an important role as consolidation therapy, particularly in patients with negative nodes.

CLINICAL CASE

A 70 year old woman with a breast nodule in the left upper outer quadrant, with slow growth, expansive, painless, and accompanied by skin changes, malaise, weight loss, fatigue, chill, and sweating. There was tissue replacement by the mammary gland tumour, skin changes due to invasion, and a 5cm axillary lymphadenopathy. The mammography showed skin thickening and a dense pattern of 80% of breast tissue replacement, and the lymphadenopathy with loss of radiolucent centre and soft tissue invasion. The biopsy confirmed a diffuse high grade large cell lymphoma. She received an Rituximab (R-CHOP) chemotherapy scheme and radiotherapy with tangential and supraclavicular and axillary fields. After completing the chemotherapy, the patient is on follow-up, and at 15 months she is alive without disease activity.

CONCLUSIONS

Primary lymphoma of the breast is a rare entity. Multimodal treatment with combined chemo-radiotherapy is the cornerstone. Surgery is reserved only for diagnostic purposes.

Rare Malignant Tumors of the Breast

While the more common forms of breast cancer are well understood and recognized, there are many important rare malignancies that are less appreciated. Many of these cancers have imaging findings that, when understood, help to formulate a more educated differential diagnosis. In this article, the clinical features, imaging, and pathologic findings of rare breast malignancies will be discussed.

Breast implant-associated anaplastic large cell lymphoma: a case report and literature review

Breast implant-associated anaplastic large cell lymphoma (ALCL) is a rare new clinical entity. The incidence is 0.3 % per 100,000 women per year. Patients present with non-specific implant-related complications resulting in delayed diagnosis. We present such a case to raise awareness and discuss management. A 48-year-old female presented with a 3-month history of left breast pain and swelling. She had undergone multiple bilateral augmentations 8 years previously. Triple assessment revealed a seroma, and a magnetic resonance imaging scan excluded implant rupture. Cytology showed a typical cells with mitotic activity which lead to removal of implants and a left capsulectomy. Final histology revealed an anaplastic lymphoma kinase (ALK) negative ALCL confined to the capsule. A computerised tomography scan and bone marrow biopsy excluded systemic disease, but due to later identified B symptoms, she received CHOP chemotherapy under the care of the haematologists. ALK-negative ALCL is associated with breast implants, and any persistent late onset seroma or breast symptoms should raise the suspicion of ALK-negative ALCL as a differential diagnosis. The recommended treatment is surgical removal of the implant including a full capsulectomy, highlighting the suspicion of ALCL to the pathologist. Exclusion of systematic disease is also recommended in all patients, and the need for adjuvant therapy should be addressed on an individual case basis. For disease confined to the capsule, adjuvant chemoradiotherapy is not needed.

LEVEL OF EVIDENCE V

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Imaging features of bilateral breast plasmacytoma as unusual initial presentation of multiple myeloma: case report and literature review

Breast plasmacytoma (BP) is an extremely rare extramedullary manifestation of multiple myeloma (MM). We report the imaging findings of an unusual case in which BP was the initial presentation of MM. A 53-year-old woman with no contributory medical history underwent chest computed tomography to evaluate intermittent nocturnal anterior chest pain, and bilateral multiple breast masses were found. Following an ultrasound-guided core needle biopsy, these lesions were confirmed to be BP.

Systemic granulomatous diseases associated with multiple palpable masses that may involve the breast: case presentation and an approach to the differential diagnosis

Palpable mass is a common complaint presented to the breast surgeon. It is very uncommon for patients to report breast mass associated with palpable masses in other superficial structures. When these masses are related to systemic granulomatous diseases, the diagnosis and initiation of specific therapy can be challenging. The purpose of this paper is to report a case initially assessed by the breast surgeon and ultimately diagnosed as granulomatous variant of T-cell lymphoma, and discuss the main systemic granulomatous diseases associated with palpable masses involving the breast.

Breast imaging findings in haematological malignancies

Objectives

The objectives of this article are to review and illustrate the imaging appearances of haematological malignancies in the breast.

Methods

With Institutional Review Board approval, a search of the surgical pathology records from 1st January 2000 to 1st July 2012 was performed for haematological malignancies.

Results

Forty-eight cases of haematological malignancies (42 women and 6 men) were identified with imaging available for review: 39 cases of breast lymphoma, 6 cases of chronic lymphocytic leukaemia, 2 cases of acute leukaemia and 1 case of known multiple myeloma.

Conclusions

Breast manifestations of haematological malignancies are rare. They can have a variable appearance at imaging and can mimic primary breast carcinoma. In the setting of suspicious breast imaging findings, pathological diagnosis of haematological malignancy is concordant. Correlation with a clinical history of prior haematological malignancy can be helpful in suggesting the diagnosis and help prevent unnecessary surgical treatment.

Teaching Points

• Breast haematological malignancies are rare but the imaging appearances can mimic breast carcinoma.

• Breast lymphoma, most often B-cell non-Hodgkin lymphoma, may be primary or due to secondary disease.

• At ultrasound, haematological malignancies may present as a heterogeneous or predominantly echogenic mass.

• Haematological malignancies show intense activity on PET/CT except myeloma which has low FDG uptake.