Diffuse large B-cell lymphoma of the breast

Case contributed by Dr Giorgio M Baratelli

Presentation

Painless, rapidly growing lump in the left breast, discovered two months before the consultation. She had no history of trauma.

Patient Data

Age: 83 years
Gender: Female
Modality: Photo

On examination, there was a 10 x 6 cm firm mass in the upper quadrants of the left breast. The mass was mobile but appeared to be fixed to the skin which was stretched and discoloured. No oedema or "peau d'orange" changes. The nipple was not retracted.

Modality: Mammography

Mammographic imaging of the left breast shows a high-density dishomogenous lobulated mass, with well-circumscribed margins and no microcalcifications

Modality: Ultrasound

Ultrasonography shows a heterogeneous, irregular, mixed hyper- and hypo-echoic mass with a lobulated margin. The overlying skin appears normal.

Colour Doppler imaging shows internal vascularity; i.e. vessels are detected within the mass.

The axillary lymph nodes were enlarged, with the largest measuring 2 cm in diameter and showed a cortical thickness greater than 3 mm.

Modality: Pathology

A radical mastectomy and a complete axillary dissection were performed. The section of the specimen shows the lobulated pattern of the mass.

Case Discussion

The pathologic diagnosis was a primary non-Hodgkin's lymphoma of the breast and of the 27 axillary lymph nodes removed (diffuse large B-cell lymphoma or DLBCL).

Key learning points:

  1. Primary lymphomas represent 0.5% of the all breast malignancies.
  2. The most frequent subtype is diffuse large B-cell non-Hodgkin's lymphoma (NHL) accounting for approximately 25% of NHL cases, followed by follicular lymphoma. 
  3. They have a typical bimodal distribution of age-specific incidence rates with two peaks in the 4th and the 7th decades of life.
  4. The pushing margins of the lesion (see clinical, mammographic and pathological pictures) are related to its rapid grow.

 

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Case Information

rID: 38565
Case created: 25th Jul 2015
Last edited: 11th Dec 2016
System: Breast
Inclusion in quiz mode: Included

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