A male with primary breast lymphoma

Abstract

A 64-year-old man was referred to our hospital with a history of painless, gradually growing lump in his left breast. On physical examination, nontender, irregular surface, demarcated elastic firm tumor (6 cm 3 7 cm in size) was palpable in the medial area of his left breast (Image 1A). Fine needle aspiration cytology of the tumor cells showed that lymphocytic cells with prominent nucleoli were dispersed as single cells (Image 1B). Microscopic examination of the tumor with core needle biopsy (CNB) confirmed diffuse proliferation of CD20-positive large atypical lymphocytes (Image 1C,D). A magnetic resonance imaging (MRI) examination showed a lobulated, well-demarcated breast tumor of high-intensity in T2-weighted fat-saturated image (T2WI F-SAT, Image 1E) and of isointensity in T1-weighted image (T1WI) to the adjacent muscles (Image 1F). The breast tumor was diagnosed with non-Hodgkin lymphoma, classified as diffuse large B-cell lymphoma. Blood examination was normal including serum lactate dehydrogenase and soluble interleukin-2 receptor. There was no evidence of lymphoma involvement in bone marrow and cerebrospinal fluid. A [ 18 F]-fluorodeoxyglusoce (FDG) positron emission tomography/computed tomography (PET/ Image 1. (A) Appearance of breast lump (blue arrows). Histological findings of the breast tumors, (B) Papanicolou stain shows dispersed lymphocytic cells with prominent nucleoli, (C) HE stain shows diffuse proliferation of large atypical lymphocytes, and (D) the atypical lymphocytes are positive for CD20, a B-cell marker, confirmed by the immunohistochemical analysis. (E-J) Radiological findings of the breast tumors. A lobulated, well-demarcated, high-intensity tumor in T2-weighted fat-saturated image (T2WI F-SAT) of MRI before the treatment (E, blue arrow) is disappeared after six cycles of chemotherapy (J). (F) The breast tumor with iso-intensity to the adjacent muscle in T1-weighted image (T1WI) of MRI before the treatment (blue arrow). A PET/CT demonstrates increased focal FDG uptake in the breast tumor before treatment (G and H, blue arrow) whereas no FDG uptake is observed after the chemotherapy (I).