Linfoma primario de mama. Reporte de un caso / Primary breast lymphoma Report of a case

RESUMEN El linfoma primitivo de la mama es una forma rara de linfoma extraganglionar localizado, con una incidencia de 1,7 a 2,2 % de los linfomas extraganglionares y de un 0,04 a un 0,50 % de las lesiones malignas de la glándula mamaria de todos los linfomas no Hodgkin. El linfoma no Hodgkin primario de la mama crece con rapidez, con diseminación a la médula ósea y sistema nervioso central, generalmente de corta sobrevida. Se presentó un caso de una paciente femenina de 65 años de edad, blanca, que refirió haberse notado una tumoración en la mama derecha, de 3 cm de diámetro. Al examen físico se constató una tumoración, dolorosa a la palpación, localizada en el cuadrante superior externo. No existían adenopatías axilares a la palpación. La paciente no reportó síntomas específicos. Se realizó un ultrasonido diagnóstico que arrojó una imagen hipoecoica de 2,5 cm, de bordes no bien definidos. En un estudio mamográfico realizado se apreció una masa de alta densidad, irregular, que fue clasificado como BIRADS 4C. El diagnóstico de linfoma maligno no fue sospechado clínicamente. Fue operada, realizando biopsia por congelación que resultó positiva. Se le ejecutó una mastectomía total ampliada cuyo informe histopatológico fue: linfoma linfocítico pobremente diferenciado sin metástasis ganglionares axilares (0/29). Como tratamiento adyuvante se utilizó la poliquimioterapia asociada a la radioterapia. La paciente en la actualidad no ha presentado recaída y se mantiene viva tras 13 años de seguimiento.

ABSTRACT Primary lymphoma of the breast is an unusual kind of located extranodal lymphoma, with an incidence from 1.7 % to 2.2% of extranodal lymphomas, and from 0.04 % to 0.50 % of the mammary glands malignant lesions of all non-Hodgkin lymphoma. The primary non-Hodgkin's lymphoma of the breast grows rapidly, with dissemination to the bone marrow and central nervous system, generally of short over-life. The case presented is the one of a female, white patient, aged 65 years who told she perceived a tumor in her right breast of 3 cm diameter. At the physical examination a tumor was noted, painful at palpation, located in the higher external quadrant. Axillary adenopathy were not found at palpation. The patient did not reported specific symptoms. An ultrasound diagnosis was carried out showing a hypo-echoic image of 2.5 cm, with non well-defined margins. An irregular, high density mass was found in a mammographic study; it was classified as BIRADS 4C. The diagnosis of malignant lymphoma was not clinically suspected. The patient underwent a surgery, and a frozen section biopsy was positive. A total wide mastectomy was carried out and its pathological inform was: poorly-differentiated lymphocytic lymphoma without axillary nodal metastasis (0/29). Polychemotherapy associated to radiotherapy was used as adjuvant treatment. Currently, after a 13-years follow-up, the patient did not relapsed and is still alive.

Primary breast lymphoma:a prognostic analysis and literature review / 中华放射肿瘤学杂志

Objective To summarize the clinical characteristics and evaluate the feasible treatments of primary breast lymphoma (PBL).Methods The clinical data of 34 PBL patients (age 24-79 years) who were treated in our hospital between April 2006 and December 2013 were reviewed.Of these 34 patients, 18 had stage ⅠE PBL and 16 had stage ⅡE PBL.Pathological types included diffuse large B cell lymphoma (29 patients), anaplastic large cell lymphoma (2 patients), marginal zone lymphoma (2 patients), and mantle cell lymphoma (1 patient).Two patients underwent surgery, four patients received chemotherapy alone, five patients received chemoradiotherapy, fourteen patients underwent surgery plus chemotherapy, and nine patients underwent surgery plus chemoradiotherapy.The 5-year overall survival (OS) and progression-free survival (PFS) rates were determined by the Kaplan-Meier estimator.Results During follow-up, 26 patients were alive without lymphoma and 8 patients had died by the end of follow-up (7 died from lymphoma and 1 died from chemotherapy-related hepatic failure).Among the 6 patients who relapsed, 5(83.3%) had recurrence within the first 2 years of treatment.In particular, 1 patient who had bilateral breast involvement developed left breast relapse after bilateral mastectomy and chemotherapy, 2 patients had bone marrow metastasis, 1 patient had lung and mediastinal lymph node metastases, and 2 had skin relapse.The 5-year OS and PFS rates of all patients were 75% and 75%, respectively.Conclusions Since PBL is a rare malignancy, its overall prognosis is fair and the incidence of local relapse is low with chemotherapy alone or in combination with other treatments.However, further studies on the development of more effective treatments will be required for patients who have failed the existing treatments.

Research progress of diagnosis and treatment in primary breast diffuse large B-cell lymphoma / 白血病·淋巴瘤

Primary breast lymphoma is a rare form of extranodal lymphoma with distinct characteristics.It comprises diverse histologic subtypes with diffuse large B-cell lymphoma (DLBCL) as the most common one.In this review,the primary breast DLBCL was focused and the definition,staging,the role of systemic chemotherapy,local adjuvant radiotherapy and rituximab in treatment of primary breast DLBCL were described.

Linfoma primário da mama: relato de caso e revisão da literatura / Primary breast lymphoma: Case report and literature review

Introdução: O linfoma primário da mama (LPM) é um tumor raro, sendo responsável por 0,04% a 0,5% de todos os tipos de câncer de mama. O tipo mais comum de LPM é o linfoma não Hodgkin de grandes células B (LNHDGCB), correspondendo a 40% a 70% dos casos. Relato do caso: Paciente de 59 anos de idade apresentava uma massa mamária de cerca de 13 cm de extensão, aumento progressivo e dor local. O diagnóstico foi realizado através de biópsia incisional da mama. A análise imuno-histoquímica confirmou o diagnóstico de linfoma não Hodgkin, com expressão dos marcadores CD20, MUM-1, Bcl2. O tratamento foi realizado com quatro ciclos de quimioterapia com esquema R-CHOP (rituximab, ciclofosfamida, adriamicina, vincristina e prednisona) e complementação com radioterapia, tendo apresentado resposta clínica completa. Conclusão: O LPM é um subtipo raro de neoplasia mamária. O tratamento do LPM é similar ao de linfomas de mesmo estádio e histologia de outras localizações.

Clinical analysis of 11 patients with bilateral primary breast lymphoma / 肿瘤

Objective: To investigate the clinicopathological features, treatment and prognosis of patients with bilateral primary breast lymphoma (BPBL). Methods: The clinical records of 11 patients with BPBL were collected, and the clinicopathological features, treatment and prognosis were retrospectively analyzed. Results: The medium age of 11 patients was 34 years old (ranged from 13 to 63 years). The breast tumors grew quickly, and the largest diameter of tumor was up to 20 cm. The occurrence of bilateral breast tumors was more often in synchronism than in heterochronism. The incidence rates of B symptoms and high level of serum LDH were both low in BPBL patients, and the axillary lymph node metastasis and distant metastasis were frequent. The BPBL was originated mainly from B cells, and the most common pathological grade of BPBL was grade high/intermediate. The median survival of BPBL was 33 months. Furthermore, chemotherapy played an important role in the treatment of BPBL. Conclusion: In consideration of BPBL which has a high rate of diagnostic errors, the clinicopathological features and medical imagings should be applied in the diagnosis of BPBL. The major modality used in the treatment of BPBL is chemotherapy. Copyright© 2011 by TUMOR.

A Case of Primary Breast Lymphoma with Brain Metastasis Detected during Pregnancy

Primary breast lymphoma (PBL) is a rare clinical presentation of localized non-Hodgkin's lymphoma (NHL), and it makes up 0.04~1.1% of all breast tumors and it is 0.38~0.7% of all NHLs. The prognosis and patterns of relapse of PBL are still not clearly defined. The clinical features of PBL are different from those of breast carcinoma and the usual form of lymphoma. These features are a rapidly enlarging breast mass, multiple lesions, the absence of nipple discharge and retraction, and softer axillary lymph nodes as compared to the metastatic lymph nodes from breast carcinoma. B symptoms are unusual in PBL. A 30-year-old pregnant woman was admitted due to dysarthria and right side weakness that she had experienced for 7 days. She had several medical problems: intrauterine pregnancy at 34 weeks, some neurologic deficits and enlargement of both breasts. A biopsy from the breast and a brain magnetic resonance image (MRI) revealed diffuse large B cell lymphoma and multiple brain metastases, respectively. After delivery of a healthy, premature infant by Cesarean section, whole brain radiation therapy and combination chemotherapy (rituximab, cyclophosphamide, adriamycin, vincristine and prednisone) were started. She showed good response to therapy. We report here on this unusual case and we review the related literature.

Primary Malignant Lymphoma of the Breast: Case report

The authors report a case of primary breast lymphoma in a 29-year-old female patient. The patient had a growing, nontender, palpable mass in the left breast. Film-screen mammogram showed a sharply marginated mass with a thin perimeter of radiolucency, halo and slight lobulation.Sonography revealed a well marginated hypoechoic mass with posterior acoustic enhancement. The patient had undergone wide excision of mass and ipsilateral axillary dissection. Histologic examination and immuno-histochemistry confirmed a diagnosis of diffuse B-cell type non-Hodgkin's lymphoma. Abdominal ultrasonography, thoracic computed tomography and bone scan, checked postoperatively, showed non-specific findings. We concluded a final diagnosis of primary breast lymphoma, and report the case with a brief review of the literatures.

Primary breast lymphoma

We report the case of a 20-year-old female with lymphoma of the breast. Mammography showed an asymmetric pattern of confluent densities without any discrete mass. Sonography revealed diffuse heterogenous echoic mass intermingled with low-and medium level echoes. We present the clinical, radiographic and histologic features of primary breast lymphoma with a brief review of the literatures.