Report of a case of primary breast lymphoma highlighting the importance of fine needle aspiration cytology as an initial diagnostic tool

Abstract

Primary non-Hodgkin lymphoma of breast is a rare pathology, representing 0.5% of malignant breast tumors. We report a case of 52 year old female presenting with a large painful mass in left breast with ipsilateral axillary lymph node diagnosed on fine needle aspiration cytology as non-Hodgkin's lymphoma. Breast lymphoma should be differentiated from other breast malignancies because of the differences in their treatment modalities. When breast lymphoma presents as a lump with axillary node, it clinically mimics breast carcinoma. Ultrasonogram and mammogram shows no characteristic features that can distinguish it from other breast malignancy. In such cases, FNAC becomes an important diagnostic tool that can differentiate PBL from other breast malignancy and avoid unnecessary surgery.

Primary breast diffuse large B cell lymphoma

“…4 Although the management of PBL has not been standardised yet, a diagnostic biopsy followed by chemotherapy and radiotherapy is recommended. 9 Existing literature has demonstrated that mastectomy results in higher mortality and poorer prognosis. 16 PBL is a haematological malignancy, and its pathogenesis and progression differ significantly from breast carcinoma.…”

“…PBL usually presents with a rapidly growing, painless, palpable, solitary mass and relatively mobile, with or without ipsilateral axillary lymphadenopathy, mimicking a breast carcinoma 7 8. It occurs almost exclusively in women in the fifth to sixth decade of life 2 6 7 9. The right breast is the most frequently involved site 6 7.…”

“…B cell breast lymphomas are more common than the T cell type 4 9. PBLs have diverse histological subtypes.…”

Breast MALT lymphoma and AL amyloidosis complicating Sjögren’s syndrome

“…In our case, MALT lymphoma coexisted in breast and submandibular and parotid glands. Most cases arise primarily in the breast, but secondary involvement of the breast by MALT lymphomas arising at other sites can be seen 5. SS patients have a 1000-fold increased risk of MALT lymphoma of the parotid gland.…”

Primary breast lymphoma: A mimic of inflammatory breast cancer

“…According to the WHO classification system for breast tumors, malignant lymphomas of the breast are subdivided into diffuse large B-cell lymphoma (DLBCL), Burkitt lymphoma, extra-nodal marginal zone (MALT) lymphoma, and follicular type. PBL are usually non-Hodgkin with a B-cell lineage [ 27 , 28 ]. DLBCL have worse prognosis than other histologic subtypes and have a significant higher risk of contralateral breast involvement [ 11 ].…”