Primary breast non‐Hodgkin's lymphoma: A large single center study of initial characteristics, natural history, and prognostic factors

Abstract

The aims of this study were to define the initial pathological and clinical characteristics, and prognostic factors of patients with primary breast malignant lymphoma (PBL). All patients treated at the Institut Curie for lymphoma with breast involvement were reviewed. A pathological review of all cases was performed. Fortyfive cases were selected in whom 38 cases were of diffuse large B-cell lymphoma. A complete analysis was then performed on these 38 patients. Twenty out of 28 cases (71%) of cases were Bcl-2 positive and four out of 28 (14%) had a CD10 positive staining. Peculiar initial characteristics showed nodal involvement in 58% of the cases and two or more extra-nodal sites in 31% of the cases. Among the 37 patients for whom all data were available, and according to the International Prognostic Index, 19 patients (51%) were classified in the low-risk group, 5 cases (14%) in the low-to intermediate-risk group, 6 patients (16%) in the intermediate-to high-risk group, and 7 (19%) case in the high-risk group. At the end of initial therapy, 34 patients (89%) achieved CR. With a median follow-up of 96 months, 18 patients (47%) relapsed of whom 3 had a relapse in central nervous system site. The 5-year disease-free (DFS) and overall survivals (OS) were 54% and 61%, respectively. In multivariate analysis, the presence of 2 or more extranodal sites was prognostic for lower DFS (P 5 0.0008) and OS (P 5 0.09), and a performance status ‡1 was prognostic for lower OS (P 5 0.005). Finally, when our series was compared with a historical series of 111 patients with aggressive nodal lymphomas, we observed significant lower survival rates in localized PBL (P < 0.03). Initial breast localization has a pejorative impact on the outcome of patients with Non-Hodgkin's Lymphoma (NHL), with an impressive adverse influence of additional extranodal sites. These results suggest a specific management of NHL with breast involvement. Am. J. Hematol. 84:133-139, 2009. V

Primary Breast T Cell Lymphoma Involving Nipple-Areolar Complex in a Young Patient

“…About 2 % of extra-nodal lymphomas and less than 1 % of all Non-Hodgkin's lymphoma present with breast as the primary organ of involvement [1][2][3].…”

“…Breast lymphoma is a rare form of breast malignancy comprising up to 0.5 % of all breast malignancies [1][2][3][4]. It needs multimodality treatment in form of surgery, chemotherapy, and radiation therapy.…”

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“…In conclusion, primary DLBCL of the breast had a poor prognosis relative to nodal DLBCL and a pejorative impact on both disease survival and overall survival. Moreover, CNS relapses in spite of neurological profilaxis were seen in patients with primary DLBCL of the breast in higher proportion than in patients presenting with nodal DLBCL [13].…”

“…In these lymphomas, an intriguing features is the low association (four out of 28 cases) with CD10 expression by tumor cells as shown in the article by Validire et al [13] and the close [14]. In nodal DLBCL these features are usually associated with poor prognosis [2,15].…”

“…In nodal DLBCL these features are usually associated with poor prognosis [2,15]. Altogether these results indicate the need for a specific management for primary DLBCL of the breast [13,16] taking into account of the recent results obtained in clinical and molecular subtypes of CD20 positive DLBCL [17,18]. Furthermore, a more precise knowledge of the clinical behavior of lymphomas arising in extranodal sites is necessary, since the optimal management of DLBCL might vary by the primary site of involvement (nodal versus extranodal DLBCL; primary DLBCL of the breast versus other primary extranodal DLBCL).…”