Sarcomatoid variant of anaplastic large cell lymphoma mimicking a primary breast cancer: a challenging diagnosis.
ABSTRACT The sarcomatoid variant of anaplastic large cell lymphoma is one of the rarest histologic variants of this neoplasm. Due to its sarcomatoid features, it is frequently misdiagnosed as a poorly differentiated sarcoma, anaplastic carcinoma, or melanoma. We report the case of a 92-year-old woman with a sarcomatoid anaplastic large cell lymphoma mimicking a primary breast neoplasm. The patient presented with a rapidly enlarging lump in the left breast and nodules in the right axilla. The immunohistochemical profile showed reactivity for leukocyte common antigen, UCHL-1, vimentin, and CD30, but immunoexpression of anaplastic lymphoma kinase was lacking. Anaplastic large cell lymphomas are lymphoid neoplasms of T-cell/null-cell lineage that consistently express the activation marker CD30 and usually carry a gene rearrangement of the anaplastic lymphoma kinase gene. To the best of our knowledge, this is the first reported case of sarcomatoid anaplastic large cell lymphoma presenting as a primary breast neoplasm in which anaplastic lymphoma kinase expression was assessed.
- SourceAvailable from: PubMed Central[Show abstract] [Hide abstract]
ABSTRACT: Primary non-Hodgkin lymphoma (NHL) of the breast represents 0.04-0.5% of malignant lesions of the breast and accounts for 1.7-2.2% of extra-nodal NHL. Most primary cases are of B-cell phenotype and only rare cases are of T-cell phenotype. Anaplastic large cell lymphoma (ALCL) is a rare T-cell lymphoma typically seen in children and young adults with the breast being one of the least common locations. There are a total of eleven cases of primary ALCL of the breast described in the literature. Eight of these cases occurred in proximity to breast implants, four in relation to silicone breast implant and three in relation to saline filled breast implant with three out of the eight implant related cases having previous history of breast cancer treated surgically. Adjuvant postoperative chemotherapy is given in only one case. Secondary hematological malignancies after breast cancer chemotherapy have been reported in literature. However in contrast to acute myeloid leukemia (AML), the association between lymphoma and administration of chemotherapy has never been clearly demonstrated. In this report we present a case of primary ALCL of the breast arising in reconstruction mammoplasty capsule of saline filled breast implant after radical mastectomy for infiltrating ductal carcinoma followed by postoperative chemotherapy twelve years ago. Primary ALK negative ALCL arising at the site of saline filled breast implant is rare. It is still unclear whether chemotherapy and breast implantation increases risk of secondary hematological malignancies significantly. However, it is important to be aware of these complications and need for careful pathologic examination of tissue removed for implant related complications to make the correct diagnosis for further patient management and treatment. It is important to be aware of this entity at this site as it can be easily misdiagnosed on histologic grounds and to exclude sarcomatoid carcinoma, malignant melanoma and pleomorphic sarcoma by an appropriate panel of immunostains to arrive at the correct diagnosis of ALCL.Diagnostic Pathology 05/2009; 4:11. DOI:10.1186/1746-1596-4-11 · 2.41 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Primary breast lymphoma (PBL) is a rare disease, which comprises 0.04-0.53% of all primary malignant tumors of the breast. The most frequent histological subtype is diffuse large B-cell type (DLBCL) (40-70%). Differentiation of PBLs from other breast tumors such as poorly differentiated carcinomas and lobular carcinoma may at times be difficult on cytomorphology alone. An audit of breast lymphomas diagnosed on fine needle aspiration cytology (FNAC) over a period of 9 years (2001-2009) was performed. Ten cases were retrieved and the cytomorphology was reviewed along with immunochemistry (IHC), flow cytometry as well as histopathology, wherever available. The age of patients ranged from 17 to 83 years. Eight cases were diagnosed as non-Hodgkin's lymphoma, high-grade on FNAC. Histopathology was available in four of these cases and cell block was available in one case. Lymphoid cells were positive for leukocyte-common antigen (LCA) and CD20 and negative for CD3 in these cases. The same was confirmed by flow cytometry on aspirated material in one case. A diagnosis of DLBCL was offered in these five cases. One case was a low-grade NHL and another case was a young male, a known case of acute leukemia and had leukemic infiltration in the breast lump. We wish to emphasize the potential importance of FNAC in breast lymphoma and the same can be helpful to avoid unnecessary surgery in these cases. The differential diagnostic entities have been discussed. IHC and flow cytometry can be performed on the aspirated material and provide valuable information. Diagn. Cytopathol. 2011; © 2011 Wiley-Liss, Inc.Diagnostic Cytopathology 01/2013; 41(1). DOI:10.1002/dc.21763 · 1.52 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Although primary carcinomas account for the majority of breast malignancies, nonepithelial malignancies form a subset that must be differentiated accurately for treatment purposes. The purpose of this study was to identify cytological characteristics that differentiate between these two entities. Twenty-six fine-needle aspiration (FNA) specimens with histological correlation were reviewed (five lymphomas, two myelomas, six sarcomas, seven melanomas, and six carcinomas). On review, nonepithelial tumors presented as single cells with scant or ill-defined cytoplasm with rare cluster formations present. In contrast, carcinomas were arranged predominantly in clusters and contained more-defined, abundant, and sometimes vacuolated cytoplasm. Moreover, a major aid to diagnosis was an accurate clinical history. We conclude that nonepithelial malignancies of the breast are best differentiated from epithelial malignancies by a combination of cytological features and clinical information. These findings emphasize the importance of the triple test, in which integration of cytological findings and clinical information play a key role. Diagn. Cytopathol. 2004;31:352–357. © 2004 Wiley-Liss, Inc.Diagnostic Cytopathology 11/2004; 31(5):352 - 357. DOI:10.1002/dc.20147 · 1.52 Impact Factor