Lymphoid and Hematopoietic Tumors of the Breast

Abstract

Hematopoietic tumors of the breast are very rare. Non-Hodgkin lymphoma is the most frequently encountered disease subtype and accounts for less than 1 % of all non-Hodgkin lymphomas. Primary lymphoma of the breast is less common than secondary breast involvement by disseminated lymphoma and constitutes approximately 0.5 % of all malignant breast lesions. The majority of both primary and secondary breast lymphomas correspond to diffuse large B-cell lymphoma, followed by low-grade B-cell lymphomas, such as extranodal marginal zone lymphoma and follicular lymphoma. Chronic lymphocytic leukemia, mantle cell lymphoma, peripheral T-cell lymphoma, and lymphoblastic lymphoma are very rare and typically present in patients with evidence of systemic disease. Burkitt lymphoma of the breast is significantly associated with African ethnicity, young age and pregnancy or lactation. Classical Hodgkin lymphoma of the breast virtually always represents either direct extension from axillary or mediastinal lymph nodes or is a manifestation of systemic disease. Primary breast lymphoma usually presents as a large painless breast mass, which is clinically and radiographically indistinguishable from breast carcinoma. The diagnostic yield of a core needle biopsy is approximately 50 % and is higher for high-grade lymphoma, compared to low-grade lymphoma. Immunophenotypic evaluation is mandatory in order to correctly diagnose and subtype lymphoma. Polymerase chain reaction (PCR) analysis demonstration of clonal immunoglobulin and T-cell receptor gene rearrangements have been successfully used to determine the lineage and clonality of lymphoma in challenging cases.