Rev. Bras. Hematol. Hemoter. vol.39 número1

revbrashematolhemoter.2017;39(1):89–90

w w w . r b h h . o r g

Revista

Brasileira

de

Hematologia

e

Hemoterapia

Brazilian

Journal

of

Hematology

and

Hemotherapy

Letter

to

the

Editor

Primary

breast

lymphoma:

a

case

report

DearEditor,

Primarybreastlymphoma(PBL)isaclinicopathologicalentity characterizedbytheappearanceofaunilateralbreastmass ofmonthsofevolution, infrequentlyaccompaniedbysigns ofskinedema,retraction,erythemaandnippleinvolvement. Thisraresituation isespeciallyobservedduringpregnancy orpostpartum, suggestingthat tumorgrowth isinfluenced byhormonalstimulation,althoughitsassociationwithother processes such as antecedent autoimmune diseases have beendocumented.1

Wereportthecaseofa46-year-oldfemale,withno medi-calhistoryofinterest,whoconsultedduetotheappearance ofa4-cmtumorintheleftbreastofsixmonthsofevolution. Weproceededwiththe study,making radiological imaging (mammogramandmagneticresonance)and histopatholog-icalinvestigations. The examinationsconducted, including blood count, biochemistry, serologies, and tumormarkers, werenormalhighlightingslightlyelevated␤2-microglobulin levels (2.9mg/L). Mammography and magnetic resonance

Figure1–ThetumorcellsarepositiveforCD20,CD10,BCL2,BCL6andMUM1.Originalmagnificationimages200×.

findingsweresuggestiveofbreastcancer.Histological exam-ination showed a tumor composed of a large-sized cell infiltrate,withscarcecytoplasm,irregularnuclearmembrane, splitcellswithprominentnucleoli,and numerousmitoses. Theimmunohistochemicalstudyshowedpositivityfortumor populationsCD19,CD20,CD79a,PAX-5,bcl-2,bcl-6and MUM-1andfocallyforCD10andnegativityforcyclinD1andCD38 (Figure 1). Ki 67 was 80%. Giventhe combination of clini-cal,histopathological,andimmunohistochemicalfindings,a diagnosis ofprimary diffuselarge B-cellnon-Hodgkin lym-phomawasestablished,warrantinganextendedstudywith a cervico-thoraco-abdomino-pelvic scan and bone marrow biopsy to rule out lymphadenopathies and bone marrow infiltration. Withthe diagnosis of primary diffuse large B-cellnon-Hodgkinlymphoma,chemotherapywasestablished using the R-CHOP scheme (rituximab, cyclophosphamide, adriamycin,vincristineandprednisone).

90

Figure2–Leftcraniocaudalmammogramofthebreastina patientwithprimarybreastlynphomashowingaround, densemass.

with the most common subtype being diffuse large B-cell non-Hodgkin lymphoma.It ischaracterizedbythe appear-ance ofa unilateral breast massparticularly in the upper quadrant of the right side. The incidence increases with age. Patients with PBL infrequently present with signs of skinedema, retraction,erythema, and nipple involvement. Althoughitsetiologyisunknown,itsassociationwith differ-entprocesses,amongwhichareestrogenandautoimmune

diseases,3_{hasbeendescribed;noneoftheseassociationswere}

foundinourpatient.Otherentitiesthatpresentwithsimilar breast swellingand symptomsshouldbeconsideredinthe differentialdiagnosis.Todothis,cliniciansrelyonadetailed anamnesis,andcomplementaryanalyticalandimaging stud-ies (Figure2). Thediagnosis,regardlessoftheclinical data providedbythepatientandtheexclusionofotherentities,is establishedwhenaconsistenthistologicalpatternis demon-strated.

Conflicts

of

interest

Theauthorsdeclarenoconflictsofinterest.

r

e

f

e

r

e

n

c

e

s

1.AvivA,TadmorT,PolliackA.PrimarydiffuselargeB-cell lymphomaofthebreast:lookingatpathogenesis,clinical issuesandtherapeuticoptions.AnnOncol.2013;24(9):2236–44.

2.JoksM,My´sliwiecK,LewandowskiK.Primarybreast lymphoma–areviewoftheliteratureandreportofthree cases.ArchMedSci.2011;7(1):27–33.

3.CheahCY,CampbellBA,SeymourJF.Primarybreast lymphoma.CancerTreatRev.2014;40(8):900–8.

MaríaMarHerráez-Albendea∗_{,MaríaCastillo}

Jarilla-Fernández, FranciscoJavierJiménez-Burgos

HospitalSantaBárbara,Puertollano,Spain

∗_{Correspondingauthorat:HospitaldeSantaBárbara,C/Malagón}

S/N,13500Puertollano,CiudadReal,Spain. E-mailaddress:marherraez@gmail.com

(M.M.Herráez-Albendea).

Received19June2016 Accepted21September2016 Availableonline21October2016

1516-8484/

©2016Associac¸ ˜aoBrasileiradeHematologia,Hemoterapiae TerapiaCelular.PublishedbyElsevierEditoraLtda.Thisisan openaccessarticleundertheCCBY-NC-NDlicense(http:// creativecommons.org/licenses/by-nc-nd/4.0/).