Abstract
IntroductionBreast involvement by non-Hodgkin lymphoma is particularly rare in men. We describe the case of a patient with a rapidly growing, painless gynecomastia-like nodule in the left breast. On ultrasonography, the nodule was suspicious for breast carcinoma.Case presentationA breast biopsy from a 54-year-old Caucasian man showed the morphoimmunophenotypical features of grade 3 follicular lymphoma. Moreover, fluorescence in situ hybridization analysis showed a t(14,18) translocation suggesting breast involvement by a systemic lymphoma rather than a primary breast lymphoma. The histological diagnosis was subsequently confirmed after nodule excision. Mediastinal and abdominal node involvement was then identified on computed tomography and positron emission tomography scans during staging examinations. Our patient was treated with chemotherapy. After three years our patient experienced a right retro-areolar relapse. He then received two further cycles of chemotherapy but developed a myeloid acute leukemia and, as a result of this, he subsequently died.ConclusionsThe rarity of breast lymphomas, especially in men, and the problems related to the therapeutic choices with these tumors require molecular techniques in association with classical histological diagnosis.
Highlights
Breast involvement by non-Hodgkin lymphoma is rare in men
The rarity of breast lymphomas, especially in men, and the problems related to the therapeutic choices with these tumors require molecular techniques in association with classical histological diagnosis
Breast involvement could be the expression of a systemic lymphoma or could be the only site of the disease (primary breast lymphoma (PBL)) [3]
Summary
Breast lymphoma is a rare clinicopathological entity that affects both sexes. Approximately one-third of patients with non-Hodgkin lymphoma (NHL) present with extranodal disease [1,2,3]. Case presentation A 54-year-old Caucasian man presented to our facility with a left breast gynecomastia-like nodule. It was mobile, non-tender and not fixed to the skin or. The morphology and immunohistochemistry results of a new biopsy were superimposable to the previous samples After another six cycles of R-CHOP chemotherapy our patient developed acute myeloid leukemia, from which he died some months later. The tru-cut biopsy showed proliferation of atypical lymphoid cells with a nodular pattern of growth, with small lymphoid cells (centrocyte type) and centroblast-like cells. FISH analysis again showed the presence of t(14;18) translocation on the surgical sample from the left breast and the biopsy of the right relapse (Figure 2). DNA purified from the paraffin sample was of good quality as shown by the presence of discrete bands for both FR1, FR2 and FR3 rearrangements, indicative of a B monoclonal pattern (Figure 3)
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