A case of orbital malt lymphoma with breast involvement detected by 18FDG‐positron emission tomography

Abstract

A diagnosis of right lacrimal gland mucosa-associated lymphoid tissue (MALT) lymphoma was made in a 71-year-old woman. Histological examination showed dense atypical lymphocytic infiltration. The tumour cells had small dark nuclei with abundant clear cytoplasm (top left, haematoxylin and eosin, ·200) and there was strong immunoreactivity for CD20 (·200; top right). The patient was referred for staging with 2-(F) fluorodeoxyglucose positron emission tomography (F-FDGPET) after surgery of the orbital lesion. Head/neck, thorax and abdomen computerised tomography had been performed previously, with no significant findings. Head and neck magnetic resonance imaging showed diffuse high signals in both, especially in the right inferior palpebral area, with no discrete mass, and with cervical lymphadenopathy, particularly on the right side; all nodes were <1 cm in diameter. An FDG-PET scan showed an area (2 · 3AE4 cm) of moderate hypermetabolism, in the left breast (bottom), but a mammogram did not show any significant abnormality. The breast lesion was evaluated by fine needle aspiration, which showed low-grade non-Hodgkin lymphoma, consistent with MALT lymphoma. Gastric involvement was ruled out by gastric biopsy, which showed no metaplasia or dysplasia, although there was atrophic gastritis, and Helicobacter pylori was present. The co-existence of orbital and breast MALT-type lymphoma has been previously reported (Chopra et al, 2005) but is rare. Although PET scanning is often used for staging lymphoma, its role in MALT-type lymphoma is uncertain, as this technique produces negative results in many patients with extranodal-marginal zone lymphoma. Further evaluation of its role is indicated.