Case report of surgically treated primary breast lymphoma in a very elderly patient

Abstract

Abstract Introduction: Primary malignant lymphoma of the breast (PBL) is a rare disease, and few cases have been reported in very elderly patients. Generally, first-line therapies for primary PBL are chemotherapy and radiation therapy. However, these invasive therapies may not always be the best choice, especially for very elderly patients who desire a better quality of life rather than improved prognosis over a long period of time. In addition, no studies have reported whether findings from preoperative imaging can be used to distinguish PBL from normal breast cancer and other malignant diseases. Patient concerns: A 91-year-old woman presented with an elastic, hard tumor in the upper lateral part of the right breast. The right axillary lymph node was palpable as an elastic hard mass of approximately 30 × 20 mm. Diagnoses: Needle biopsy of the breast strongly suggested malignant lymphoma. Ultrasonographic analysis revealed a maximal 90-mm hypoechoic area with hyperechoic margins. Thoracoabdominal computed tomography scanning revealed lesions only in the mammary gland and ipsilateral axillary lymph nodes. No other lymph node swelling was observed. Therefore, the patient was preoperatively diagnosed with PBL, stage II as per the Ann Arbor staging classification. After histopathological and immunohistochemical examinations, the patient was finally diagnosed with non-germinal center B-cell-like diffuse large B-cell lymphoma. Interventions: Right radical mastectomy and axillary lymph node dissection were performed in September 2019. Thereafter, the patient only received follow-up observation. Outcomes: Her postoperative progress was uneventful, and she was discharged 9 days post-surgery. She was followed-up for 1 year and there was no relapse. Conclusion: PBL should always be considered among other breast cancer diagnoses, although its incidence is very low. This is because PBL is highly malignant and frequently spreads to systemic lymph nodes, and its treatment differs from that of other breast cancers. Therefore, it should be definitively diagnosed preoperatively via histological analysis using adequate tissue obtained from either needle or open biopsies. Thus, surgical resection is a good choice, even for very elderly patients who wish to have a better quality of life.