Article

Rare lymphoid malignancies of the breast: A report of two cases illustrating potential diagnostic pitfalls

Journal of Hematopathology 11/2009; 2(4):237-44. DOI: 10.1007/s12308-009-0043-y
Source: PubMed

ABSTRACT

Breast involvement by lymphoma is uncommon and poses challenges in diagnosis. Lymphomas may clinically, radiologically, and morphologically mimic both benign and neoplastic conditions. We describe two cases of lymphoid malignancies predominantly involving the breast, both presenting diagnostic dilemmas. The first case, ALK-negative anaplastic large-cell lymphoma involving a seroma associated with a breast implant, is an emerging clinicopathologic entity. Anaplastic large-cell lymphoma has been identified in association with breast implants and seroma formation relatively recently. The second case, hairy cell leukemia involving the breast and ipsilateral axillary sentinel lymph node, is, to our knowledge, the first reported case of hairy cell leukemia involving the breast at the time of diagnosis. While a localized bone lesion was present at time of diagnosis, bone marrow involvement was relatively mild in comparison to that seen in the breast and lymph node. In the first case, lymphoma occurred in a clinical setting where malignancy was unsuspected, highlighting the importance of careful morphologic evaluation of paucicellular samples, as well as awareness of rare clinicopathologic entities, in avoiding a misdiagnosis of a benign inflammatory infiltrate. In the second case, the lymphoid neoplasm exhibited classic morphologic and immunophenotypic features, but presented at an unusual site of involvement. Knowledge of the patient's concurrent diagnosis of hairy cell leukemia involving the bone marrow and bone helped avoid a misdiagnosis of carcinoma rather than lymphoma.

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Available from: Judith A Ferry, Apr 21, 2015
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    • "Our patient had rare circulating hairy cells and limited bone marrow involvement but no cytopenia or splenomegaly. HCL involving the breast is exceedingly rare and only one prior case report has been published to date by Farkash et al. which was a case of breast HCL concurrent with ductal carcinoma in situ (DCIS) [9]. This published case represented an advanced HCL disease given the fact that HCL involved the lymph nodes and extensively bone marrow with patient reporting bone pain. "
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    ABSTRACT: Hairy cell leukemia/lymphoma (HCL) is a rare B-cell neoplasm primarily involving spleen, bone marrow, and blood. However, other sites of primary involvement do occur and can present a diagnostic and therapeutic challenge. We present an unusual case of HCL involving predominantly the breast that was diagnosed as an incidental finding during an elective reduction mammoplasty in an otherwise healthy asymptomatic woman. Bone marrow performed for staging revealed limited involvement by HCL. Notably, there was no splenomegaly and/or involvement of other extramedullary sites. The peripheral blood revealed minimal involvement detected by flow cytometry. Extensive immunohistochemical studies supported by positive BRAF V600E mutational status confirmed the diagnosis of HCL. The patient remains asymptomatic without treatment one year following the diagnosis. This is the first case of a well-documented HCL presenting primarily in the breast in an asymptomatic patient. We review the literature on extramedullary, extrasplenic involvement by HCL and discuss the diagnostic challenges as well as the utility of immunohistochemistry and molecular studies in the diagnosis of atypical presentations of HCL.
    Full-text · Article · Jul 2014
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    • "66 RM Sein 84 — — Sérum physiologique Capsulectomie ablation prothèse Chirurgie Radiothérapie Chimiothérapie De Jong et al. [36] 43 Esthétique Non 156 — — Silicone texturée Mc Ghan — — De Jong et al. [36] 53 Esthétique Non 12 — — Sérum physiologique ; Rofil PIP — — De Jong [36] 38 Esthétique Non 156 — — — — — De Jong et al. [36] 29 Esthétique Non 36 — — Silicone texturée Mc Ghan — — De Jong et al. [36] 49 Esthétique Non 276 — — Silicone texturée Mc Ghan — — Farkash et al. [37] 54 RM Sein 204 Oui — Sérum physiologique Capsulectomie ablation prothèse Chirurgie Chimiothérapie Fritzsche et al. [14] "
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    ABSTRACT: There is a new concern about a possible association between anaplastic large cell lymphoma (ALCL) and breast implants. The purpose of this review was to identify and analyze all reported cases of ALCL occurring in patients with breast implants. Therefore, we reviewed all articles published concerning this subject between 1991 and 2011. We found 41 cases of ALCL. The mean age of the patients was 51 years old with an average of 108 months between the implantation and the diagnosis. Over 60 % of the reported cases were aesthetic augmentations. However, none of the published study managed to highlight a correlation between the prosthesis and this lymphoma. Therefore, we believe that for the moment, we can reassure our patients, but we must be aware of this association if a late seroma or a tumefaction occur on prosthesis. The surgical management seems to be essential for the diagnosis and the treatment, especially by the negative ALK and CD 30 expression of this lymphoma.
    Full-text · Article · Feb 2012 · Annales de chirurgie plastique et esthetique
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    • "66 RM Sein 84 — — Sérum physiologique Capsulectomie ablation prothèse Chirurgie Radiothérapie Chimiothérapie De Jong et al. [36] 43 Esthétique Non 156 — — Silicone texturée Mc Ghan — — De Jong et al. [36] 53 Esthétique Non 12 — — Sérum physiologique ; Rofil PIP — — De Jong [36] 38 Esthétique Non 156 — — — — — De Jong et al. [36] 29 Esthétique Non 36 — — Silicone texturée Mc Ghan — — De Jong et al. [36] 49 Esthétique Non 276 — — Silicone texturée Mc Ghan — — Farkash et al. [37] 54 RM Sein 204 Oui — Sérum physiologique Capsulectomie ablation prothèse Chirurgie Chimiothérapie Fritzsche et al. [14] "
    [Show abstract] [Hide abstract]
    ABSTRACT: There is a new concern about a possible association between anaplastic large cell lymphoma (ALCL) and breast implants. The purpose of this review was to identify and analyze all reported cases of ALCL occurring in patients with breast implants. Therefore, we reviewed all articles published concerning this subject between 1991 and 2011. We found 41 cases of ALCL. The mean age of the patients was 51 years old with an average of 108 months between the implantation and the diagnosis. Over 60 % of the reported cases were aesthetic augmentations. However, none of the published study managed to highlight a correlation between the prosthesis and this lymphoma. Therefore, we believe that for the moment, we can reassure our patients, but we must be aware of this association if a late seroma or a tumefaction occur on prosthesis. The surgical management seems to be essential for the diagnosis and the treatment, especially by the negative ALK and CD 30 expression of this lymphoma.
    Full-text · Article · Feb 2012 · Annales de Chirurgie Plastique Esthétique
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