A Case of Synchronous Primary of CA Breast and Non-Hodgkins Lymphoma

Abstract

A 66 years old female with diabetes and hypertension was evaluated for a lump in the left breast of six months duration, the lump was gradually increasing in size. On clinical examination it was found that the lump measured 4x4cm and was present in the left upper outer quadrant and was non tender. As a part of metastatic work up a PET CT was done which showed metabolically active lobulated soft tissue density mass lesion with multiple satellite nodules in left breast upper and outer quadrant measuring 3.2x2.1x4.4cms with max SUV 4.4, the lesion maintained fat planes with skin anteriorly and muscles posteriorly. Multiple non FDG avid to mildly FDG avid sub cm to cm size soft tissue density lesion in left breast around the main lesion was noted. Non FDG avid multiple sub cm left axillary lymph nodes were also present. Imageologically Stage II disease. Biopsy from the breast lesion was invasive carcinoma of nos type. Patient underwent left sided MRM. The final pathological staging was pT2N1a.Section from one lymph node showed partially effaced lymph node architecture with sheets of medium to large sized atypical lymphoid cells with fine chromatin prominent nucleolus and scant cytoplasm. IHC done showed the tumor cells to be positive for CD20, CD45, CD15, CD30(40%), MUM1, cmyc (30%) and negative for CK, CD3, EBV, ALK, BCL-2CD10, SOX11, Ki67-60%. The final diagnosis was Diffuse Large B Cell Lymphoma, non-germinal center type.