Primary malignant lymphoma of the breast

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Two cases of primary malignant lymphoma of the breast were found, with breast cancer as the provisional clinical diagnosis for these two cases. Estrogen receptor determination via monoclonal antibody technology was performed in one case and the result was negative. Frozen section examination of another case during operation revealed chronic inflammation. The definite diagnosis of these two cases was finally obtained by paraffin section histological examination. Primary malignant lymphoma of the breast, although rare, should be included in the differential diagnoses of a breast lump in order to achieve earlier diagnosis and to thus plan an optimal therapy.

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... Scheliga et al., 2012;Ferbeyre-Binelfa et al., 2013). En una serie de 132 linfomas no Hodgkin primarios de la mama, Fisher y cols., encontraron que el 41% de las pacientes habían sido sometidas a mastectomía total más disección axilar y el 16% a mastectomía simple; en un 43% se realizó una cirugía más conservadora ( Fisher & Chideckel, 1984). En algunos casos la mastectomía se realizó porque la biopsia contemporánea estableció el diagnóstico de cáncer mamario. ...
... Posteriormente se realizaron cirugías más conservadoras como la mastectomía parcial, agregando radioterapia para mejorar el control local de la enfermedad. La mastectomía total se reservó para tumores de gran volumen, infectados o ulcerados ( Fisher & Chideckel, 1984). Actualmente se orienta el tratamiento sistémico, la quimioterapia, con el objetivo de obtener tanto un control local como también evitar una falla a distancia, con o sin radioterapia, relegando la cirugía para casos especiales; el 80% de las recurrencias son a distancia. ...
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El linfoma no Hodgkin primario de la mama es una patología poco frecuente, constituye menos del 0,5% de todos los tumores mamarios malignos, debido a que carecen de características propias, tanto clínicas, mamográficas como ultrasonográficas. Es difícil el diagnóstico preoperatorio, la citología mediante BAAF tiene mejor rendimiento que el estudio con material congelado ya que este último tiende a confundirse con el carcinoma. En la actualidad se prefiere el tratamiento con quimioterapia tanto para el tratamiento local como para el regional. Presentamos el caso de un linfoma no Hodgkin primario de la mama en una paciente de 72 años.
... Several series have reported varying incidences of primary and secondary cases. Primary breast lymphoma has a reported incidence ranging from 0.04-0.5% of malignant breast neoplasms [5] of all extra nodal NHL and 0.7% of all NHL. [6] Histologically, primary breast lymphoma is predominantly of B-cell origin with most common subtype being diffuse large B-cell type, [7] as in our case. ...
Eight cases of primary non-Hodgkin's lymphoma of the breast found in the pathology files of the Institute of Oncology, Ljubljana, Yugoslavia, for a period of 25 years (from 1961 to 1985) were analyzed. During the same period 5711 cases of breast carcinoma were seen. Seven cases were diffuse lymphomas, and one case was nodular. Five cases were high-grade large cell lymphomas and three cases were of low-grade type. One case of the latter group was associated with elevated IgA in the serum and showed monoclonal reaction of plasmacytic lymphoma cells for kappa light chain and IgA. In this case amyloid deposits were seen in the breast tumor. In six cases, focal infiltration of ductal/Iobular epithelium by lymphoma cells was found. This so-called lymphoepithelial lesion appears to be an important characteristic of various mucosa-associated lymphoid tissue lymphomas which have been described in different extranodal sites (e.g. gastrointestinal tract, and respiratory tract). They may show different behavior from nodal counterparts, especially in terms of their spread to other mucosal sites which may appear before or without nodal dissemination. The breast appears to be yet another location for these lymphomas.
Review of our surgical experience with 10 cases of "primary" lymphoma initially confined to the breast and of previous published reports indicates that radical surgery is to be avoided. Radiation therapy with limited surgery provides excellent local-regional control. The addition of systemic combination chemotherapy is warranted in the more aggressive histologic subtypes because death is generally due to subsequent disseminated disease.
Patients with HIV infection, like immunosuppressed transplant recipients, are at high risk for the development of non-Hodgkin's lymphoma. These are high-grade lymphomas of B cell origin. Most patients present with advanced extralymphatic disease, and primary lymphoma of the central nervous system has frequently been reported. The cause of the non-Hodgkin's lymphomas in the setting of HIV infection remains unclear. In contrast to those lymphomas observed in transplant recipients, Epstein-Barr virus DNA sequences have been identified in a minority of AIDS-associated lymphomas. Response to therapy in these patients has been disappointing. Response rates to chemotherapy have been lower than those observed in other lymphoma patients, and treatment has been complicated by lack of adequate bone marrow reserve and the occurrence of frequent opportunistic infections. Survivals have been short. Good performance status and absence of a prior AIDS diagnosis are important predictors of response and survival. Although Hodgkin's disease has been observed in HIV-infected patients, epidemiologic data are not suggestive of a direct causal relationship. Hodgkin's disease in this setting is characterized by poor prognosis histologic pattern, advanced disease, and median survivals of less than 1 year.
The development of malignant lymphoma following breast cancer has not been described before. Here we report the development of malignant lymphoma at the ipsilateral chest wall subsequent to the surgical treatment of breast cancer. A 48-year-old woman underwent modified radical mastectomy due to breast carcinoma. Tamoxifen (10 mg twice daily) was given 3 years after the operation and continued for about 3 years. The patient was well until she recently (17 years after the initial operation) noted a small lump at her left anterior chest wall near the axilla. The local tumour mass was initially assumed to be a local recurrent lesion of breast cancer. Excisional biopsy was performed and eventually was histologically diagnosed to be malignant lymphoma. In view of the therapeutic implication, the development of second malignancy should not be mistaken as a progression of the known primary malignancy. Only with the awareness of such entity, can the prompt diagnosis and proper treatment be achieved.
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