A Bleeding Breast Nodule: Lymphomatoid Papulosis- An Unusual Pathology

Abstract

This case report elucidates the presentation of a 17-year-old female who sought medical intervention due to an emergent, bleeding, nodular lesion on her left breast. This erythematous, exophytic manifestation, devoid of other accompanying symptoms or abnormalities in either the ipsilateral or contralateral breast and axilla, necessitated an excisional biopsy following unsuccessful conservative management. Histopathological evaluation identified the lesion as lymphomatoid papulosis (LP), a rare dermatological condition that, while benign, mimics the histological characteristics of malignant lymphomas. The distinctiveness of this case lies in the uncharacteristic de-novo presentation of LP, which traditionally manifests as a recurrent crop of pruritic papules predominantly in middle-aged females. The pathophysiology and spontaneous regression of LP remain largely enigmatic, though the interplay between CD30 and its ligand, leading to apoptosis of neoplastic T cells, is postulated. The therapeutic arsenal for LP is diverse, ranging from conservative management to chemotherapy and phototherapy. In circumstances where spontaneous resolution remains elusive within a period of 4-12 weeks, surgical excision is a viable consideration. For this case, given the intractable bleeding and the lesion's location, excision was carried out with a 1 cm margin, serving both symptomatic and aesthetic purposes. The absence of recurrence after a 2-year follow-up suggests that a 1 cm surgical margin may be adequate in analogous situations. However, further research is required to ascertain the most effective therapeutic approach for managing LP.