Primary bilateral mucosa-associated lymphoid tissue lymphoma of the breast with atypical ductal hyperplasia and localized amyloidosis. A case report and review of the literature.

Primary non-Hodgkin lymphoma of the breast is a rare disease. Primary mucosa-associated lymphoid tissue lymphoma is even rarer, and bilateral involvement is exceptional. We describe a case of primary bilateral breast mucosa-associated lymphoid tissue lymphoma with bilateral atypical ductal hyperplasia and bilateral localized amyloidosis in a 64-year-old woman with a history of arthritis and systemic lupus erythematosus and its clinical, histologic, and immunohistochemical features. Microscopic examination of the breast lesion showed dense periductal and perilobular small and plasmacytoid lymphocytes with eosinophilic amyloid in the vessels and the stroma. Bilateral single foci of atypical ductal hyperplasia were also noted. Fine needle aspiration showed small and large lymphocytes and plasma cells. Molecular analysis demonstrated a heavy chain immunoglobulin H gene rearrangement. Flow cytometry studies showed an abnormal B-cell population. The combined histologic, paraffin immunohistochemistry, flow cytometry, and molecular results were considered diagnostic for low-grade mucosa-associated lymphoid tissue lymphoma. The patient underwent bilateral local breast radiation without other organ or site involvement.

Benign breast aspirates: two decades of experience.

OBJECTIVE: To evaluate the reliability of benign breast aspirates. DESIGN: A 20-year retrospective study of cytologically benign aspirates from palpable breast lesions followed by surgery and review of false negatives. RESULTS: Data encompassed 1518 benign aspirates followed by benign histology, and 99 by malignant histology. Of the latter, 89% underwent biopsy within 1 month. Review of 52 available false negatives revealed 10 (19%) with no change in the original diagnosis, 16 (31%) reviewed as unsatisfactory specimens, and 26 (50%) reviewed as specimens with focal cytologic atypia (dyshesion, nuclear enlargement, and contour irregularity). Cellularity (>20 epithelial groups per slide) was an important criterion in postmenopausal women. CONCLUSION: Our study confirms the reliability of benign breast aspirates interpreted in light of clinical and mammographic findings and demonstrates the importance of adequacy evaluation and focal atypia in preventing false negatives.

Occult breast lesions and aspiration biopsy: the Lankenau experience.

With the increased use of screening mammography, many occult lesions are being identified. Despite the availability of ultrasonography and stereotaxis, their use in conjunction with fine-needle aspiration biopsy for further examination of these lesions, at the time when cost containment is a serious consideration, must be evaluated. Consequently, the role of cytopathologist becomes important in identifying lesions requiring timely follow-up and surgical treatment. To assist the clinicians in evaluating the best approach to occult lesions, we reviewed the results from ultrasonographic guided aspiration biopsies (100) and stereotactic guided aspiration biopsies (61) at our institution. Our findings and review of the literature suggest that the former should only be used sparingly. By contrast, stereotactic biopsies interpreted as a part of an interdisciplinary approach can provide critical information for decision-making.