Clinicopathologic features of the nine patients with primary diffuse large B cell lymphoma of the breast

Department of Medical Oncology, Dr. Lutfi Kirdar Education and Research Hospital, Istanbul, Turkey.
Archives of Gynecology (Impact Factor: 1.36). 08/2011; 284(2):405-9. DOI: 10.1007/s00404-010-1683-y
Source: PubMed


Non-Hodgkin lymphomas of the breast are uncommon cancers that occur as either primary extranodal diseases or secondary localizations of a systemic disease. The term "primary breast lymphoma" (PBL) is used to define malignant lymphomas primarily occurring in the breast in the absence of previously detected lymphoma localizations. In this report, we analyzed nine patients with primary diffuse large B cell lymphoma (DLBCL) of breast.
Patients with newly diagnosed PBLs treated between 1997 and 2009 in five institutions were retrospectively evaluated.
The median age of the patients with PBL was 49 years (range 30-82 years), and four patients had left-sided and five had right-sided disease. All of the nine patients were classified as DLBCL. Five patients with DLBCL received chemotherapy followed by involved-field or elective-field radiotherapy and four received chemotherapy alone. Complete remission (CR) following primary treatment for all patients with PBL except for two cases was obtained. In two patients, recurrence occurred. At the median follow-up of 24.2 months, the 5-year OS rate was 76.2%. Univariate analysis indicated that age, ECOG PS, clinical stage, international prognostic index score, lactate dehydrogenase levels and the presence of B symptoms were not important prognostic factors in our study.
Our series contained a small sample size, but it is interesting because it included only DLBCL cases. However, definitive conclusions about treatment and follow-up options of patients cannot be made in such a small series of patients. There are very few reports of patients with PBL treated with R-CHOP rather than CHOP alone. The followup is probably still too short and sample size very few to know how R-CHOP compares with CHOP-treated patients in other series, but this is definitely worth looking at in more detail when reasonable median follow-up has been achieved and sample size are sufficient.

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    • "With the exception of the recently published prospective Mexican trial (Aviles) and the large study of the International Extranodal Lymphoma Study Group (IELSG) with genuine PBLs and sufficient follow-up, which identified 204 patients [6], in the literature there were only retrospective studies with a relatively limited number of patients that have provided some interesting information [7-11]. "
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    ABSTRACT: Introduction Primary breast lymphoma is an uncommon disease with poor clinical outcome. Breast lymphomas present less than 0.5% of malignant breast neoplasms and 2.2% of extranodal lymphomas. This study investigated the clinicopathological features and optimal treatment of PBL. Case presentations Clinical records of seven Moroccan PBL patients, treated at the National Institute of Oncology, Rabat, Morocco, from 2002 to 2010, were reviewed. Six of the patients were women and one a man, with ages ranging from 32 to 76. Five patients had stage IE and two stage IIE. All of the patients were classified with DLBCL. Of seven patients, one received a mastectomy and three excision of the breast lesion. Axillary dissection was performed in three patients. Two patients received chemotherapy followed by radiotherapy, while four received chemotherapy alone. Complete remission (CR) following primary treatment for all patients with PBL except in two cases was obtained. In one patient, recurrence occurred. Conclusions There is no consensus on the question of how to best treat PBL: Mastectomy offers no benefit in the treatment of PBL. The combined therapy approach, with chemotherapy and radiotherapy, is the most successful treatment. PBL is poorly represented in rituximab-containing trials in DLBCL patients; there is not much experience with this agent in breast DLBCL. Because of the high incidence of central nervous system (CNS) involvement in PBL patients, many authors strongly believe that patients with aggressive forms of PBL should receive CNS infiltration prophylaxis.
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    ABSTRACT: Patients with diffuse large B-cell lymphoma (DLBCL) can be divided into germinal center B-cell-like subtype (GCB-DLBCL) and activated B-cell-like type (ie non-GCB-DLBCL) and with a prognostic value based on the cell of origin of the tumor as determined by microarray analysis, as well as by immunostain algorithms. To stratify primary breast DLBCL, according to immunostain algorithms of Hans, Choi, and Meyer (Tally), the reason why primary breast DLBCL possesses a poor clinical outcome was further elucidated. Twenty-two cases of primary breast DLBCL, diagnosed according to the 2008 World Health Organization classification of tumors of hematopoietic and lymphoid tissues, were retrospectively studied. Immunochemical study was performed, and follow-up information was analyzed. The histopathologic and immunophenotypic features of all cases were summarized. Among these 22 cases, most (17, 16, and 17, respectively) were assigned to the activated B-cell-like subtypes, few (5, 6, and 5, respectively) were classified as GCB-DLBCL subtype. Fourteen of these 22 cases expressed high proliferative activity (≥40% Ki-67 labeling). Most primary breast DLBCLs have activated B-cell-like subtype characteristics and high proliferative activity; these features might be a significant factor.
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    ABSTRACT: After publication of this work (Mouna et al, 2012), we noted that we had inadvertently included Bodmer Alexandre, Castiglione-Gertsch Monica and Pierre Yves Dietrich as authors of the study. The list of authors has now been corrected and the Authors' contributions and Competing interests section modified accordingly.
    Full-text · Article · Oct 2012 · World Journal of Surgical Oncology
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