Mammographic, Sonographic, and Pathologic Characteristics of Burkitt's Lymphoma in a Patient Referred for Diagnostic Mammography

Abstract

Case Report A 56-year-old HIV-seropositive woman was referred for mammographic evaluation of a rapidly enlarging, palpable, and tender mass in the axillary tail of the right breast. Physical examination revealed a visible right axillary tail mass with peau d’orange skin changes of the right breast (Figs. 1A and 1B). Mammography (Figs. 1C and 1D) showed a subtle band of increased density overlying the pectoralis muscle at the axillary tail. No calcifications were identified. There were no other mammographic findings. Sonography (Figs. 1E and 1F) showed a diffuse hypoechoic mass seen posterior to branching tubular structures, which corresponded to the mammographic and clinical findings. The branching tubular channels, which represent dilated lymphatic channels, are seen anterior to the mass. CT (Fig. 1G) showed involvement of the right axilla and chest wall. Sonographically guided fine-needle aspiration and core biopsy (Fig. 1H) specimens were obtained from the inferior axillary tail. Histology (Figs. 1I–1L) revealed Burkitt’s lymphoma, which is characterized by a diffuse lymphocytic infiltrate with a “starry sky” pattern. The cells were medium-sized with slightly irregular nuclei. The nucleus contained clumped chromatin and multiple prominent basophilic nucleoli. The tumor showed increased mitoses and numerous pyknotic nuclei and nuclear fragments, free or engulfed in the actively phagocytic histioA