Breast lymphoma
Breast lymphoma refers to the involvement of the breast with lymphoma and may be primary or secondary.
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Epidemiology
Both primary and secondary breast lymphomas are rare. Breast lymphoma accounts for <1% of all breast malignancies and <2% of all extranodal non-Hodgkin lymphoma 11. Secondary lymphoma is the most common type of secondary malignancy/metastasis involving the breast (17%) 12.
Secondary breast lymphoma more common than primary lymphoma 13.
The median age of presentation is 60-70 years 11.
Clinical presentation
Breast lymphoma may present either as a palpable mass or as diffuse thickening of the breast. Axillary lymph nodes are enlarged in a substantial minority 11.
Pathology
Primary breast lymphoma
Primary breast lymphoma is typically a B cell type of non-Hodgkin lymphoma (NHL), with the most common histologic type being diffuse large B cell lymphoma 11. A minority of cases are follicular lymphoma, mucosa-associated lymphoid tissue lymphoma, or Burkitt lymphoma 11. A rare subtype associated with breast implants is anaplastic large cell lymphoma.
For a tumor to be labeled as a primary breast lymphoma, it must fulfill the following criteria 5:
- the disease should be in the breast or in close proximity to breast tissue
- no previous history of extramammary lymphoma
- no evidence of widespread disease, except ipsilateral axillary lymph nodes may be involved if developing simultaneously with primary breast tumor
Secondary breast lymphoma
Secondary lymphoma of the breast is also more frequently non-Hodgkin lymphoma than Hodgkin lymphoma.
Radiographic features
There is no single imaging finding diagnostic of lymphoma. A biopsy is typically required for diagnosis. Enlarged intramammary lymph nodes may be seen, but these can be seen also in other breast malignancies.
Mammography
Breast lymphoma most commonly appears as a solitary mass, and less commonly as an asymmetry 11. Calcifications are absent 11. The particular mammographic features of lymphoma presenting as a breast mass are nonspecific: it is usually oval or round in shape, with circumscribed or indistinct margins. Less common features are skin thickening and lymphedema manifest as a diffuse increase in parenchymal density.
Ultrasound
Breast lymphoma most commonly appears as a hypoechoic mass. The particular sonographic features are nonspecific: shape can be oval or irregular, margins can be circumscribed or indistinct, and orientation is usually parallel 11. Lymphomas are usually hypervascular 11.
MRI
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T1 C+:
- mass with homogeneous or heterogeneous enhancement
- enhancement curve usually type II or less commonly type III 10,11
- skin thickening associated with diffuse infiltration in a minority of cases 11
Differential diagnosis
Both radiologic and clinical appearances are similar to carcinoma and therefore the differential diagnosis is difficult. Mammographic findings are nonspecific and the following should be considered 9:
- primary epithelial breast cancer
- fibroadenoma
- phyllodes tumor
- metastases to the breast
Related Radiopaedia articles
Lymphoma
- overview of lymphoma
- WHO classification of tumors of hematopoietic and lymphoid tissues
- location-specific lymphomas
- central nervous system
- head and neck lymphoma
- thoracic lymphoma
- gastrointestinal lymphoma
- hepatobiliary lymphoma
- genitourinary lymphoma
- musculoskeletal lymphoma
- cutaneous lymphoma
- multi-regional
- lymphoma staging
Breast imaging and pathology
- breast screening
-
mammography
- breast imaging and the technologist
- forbidden (check) areas in mammography
-
mammography views
- craniocaudal view
- mediolateral oblique view
- additional (supplementary) views
- true lateral view
- lateromedial oblique view
- late mediolateral view
- step oblique views
- spot view
- double spot compression view
- magnification view
- exaggerated craniocaudal (axillary) view
- cleavage view
- tangential views
- caudocranial view
- bullseye CC view
- rolled CC view
- elevated craniocaudal projection
- caudal cranial projection
- 20° oblique projection
- inferomedial superolateral oblique projection
- Eklund technique
- normal breast imaging examples
- digital breast tomosynthesis
- breast ultrasound
- breast ductography
- breast MRI
- breast morphology
- breast intervention
- breast pathology
- malignant lesions
-
breast cancer
- breast adenocarcinoma
- ductal breast carcinoma
- ductal carcinoma in situ (DCIS)
- invasive ductal carcinoma
- lobular breast carcinoma
- ductal breast carcinoma
- adenoid cystic carcinoma of the breast
- apocrine carcinoma of the breast
- breast cancer metastases
- breast lymphoma
- breast sarcoma
- inflammatory carcinoma of breast
- intracystic breast cancer
- male breast cancer
- malignant phyllodes tumor
- metastases to the breast
- metaplastic carcinoma the breast
- gamuts
- breast adenocarcinoma
-
breast cancer
- borderline breast disease / high risk breast lesion
- benign lesions
- adenosis of the breast
- benign papillary lesions of the breast
- breast cyst
- breast hematoma
- breast hamartoma
- breast lipoma
- ductal adenoma of the breast
- epidermal inclusion cysts of the breast
- fat necrosis of the breast
- fibroadenoma
- granular cell tumor of the breast
- gynecomastia
- lymphocytic mastitis
- mammary fibromatosis
- oil cyst
- phyllodes tumor
- post-surgical breast scar
- post-radiation breast changes
- post-traumatic fibrosis
- pseudoangiomatous stromal hyperplasia (PASH)
- pseudogynecomastia
- tubular adenoma
-
breast calcifications (approach)
- morphology
- distribution
- location
- lobular calcification within breast tissue
- intraductal calcification within breast tissue
- milk of calcium within a breast cyst
- vascular calcification in breast tissue
- skin (dermal) calcification in / around breast tissue
- suture calcification within breast tissue
- stromal calcification within breast tissue
- artifactual calcification from outside the breast
- suspicious breast calcifications
- infection/inflammation
- vascular lesions
- systemic disease
- gamuts
- classification systems
- malignant lesions
- breast cancer staging