Abstract

Primary breast lymphoma (PBL) in males is a rare clinical entity and has been reported in anecdotal case reports up until now. We report two cases of PBL from a tertiary care centre in Southern India. A 46-year-old male presented with a lump in the right breast with right axillary lymphadenopathy; a biopsy with immunohistochemistry showed neoplastic cells positive for CD 20 and negative for CD 30, epithelial membrane antigen, anaplastic lymphoma kinase, suggestive of diffuse large B cell lymphoma stage IIEA. He received three cycles of CHOP (cyclophosphamide, adriamycin, vincristine, and prednisolone) chemotherapy, then developed a cerebrovascular accident, and died. The other patient was a 60-year-old male with a left breast lump with left axillary lymphadenopathy. The biopsy with immunohistochemistry showed neoplastic cells positive for CD 23 and CD 5, suggestive of small lymphocytic lymphoma stage IIEA. Initially he received three cycles of cyclophosphamide, vincristine, and prednisolone (COP) and defaulted. One year later, he received six cycles of COP chemotherapy, developed progressive disease, and was lost to follow-up. The literature on PBL in males was reviewed. To conclude, PBL in males is an extremely rare disease and can mimic breast cancer. A strong index of suspicion with early diagnosis by biopsy with immunohistochemistry and treatment with rituximab- and anthracycline-based chemotherapy followed by radiotherapy will improve overall survival.

Highlights

  • Around 1% of all malignant breast tumours occur in males, and primary breast lymphoma (PBL) in males is an extremely rare clinical entity and can masquerade as breast cancer in its clinical presentation

  • We describe two cases of PBL in males from Kidwai Memorial Institute of Oncology, a tertiary care oncology centre in Southern India

  • The breast lump and axillary lymph node biopsy with immunohistochemistry revealed large B cells positive for CD 20 and negative for CD 30, epithelial membrane antigen (EMA), and anaplastic lymphoma kinase (ALK), suggestive of diffuse large B cell lymphoma (DLBCL) of right breast (Ann-Arbor stage IIEA). He was not able to afford rituximab and received three cycles of chemotherapy with cyclophosphamide 750 mg/m2, adriamycin 50 mg/m2, vincristine 1.4 mg/m2, and prednisolone 100 mg/day for five days (CHOP), following which he developed a cerebrovascular accident with right hemiparesis and died

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Summary

Introduction

Around 1% of all malignant breast tumours occur in males, and primary breast lymphoma (PBL) in males is an extremely rare clinical entity and can masquerade as breast cancer in its clinical presentation. The breast lump and axillary lymph node biopsy with immunohistochemistry revealed large B cells positive for CD 20 and negative for CD 30, epithelial membrane antigen (EMA), and anaplastic lymphoma kinase (ALK), suggestive of diffuse large B cell lymphoma (DLBCL) of right breast (Ann-Arbor stage IIEA) He was not able to afford rituximab and received three cycles of chemotherapy with cyclophosphamide 750 mg/m2, adriamycin 50 mg/m2, vincristine 1.4 mg/m2, and prednisolone 100 mg/day for five days (CHOP), following which he developed a cerebrovascular accident with right hemiparesis and died. The breast lump and axillary lymph node biopsy with immunohistochemistry revealed neoplastic cells positive for CD 23 and CD 5, suggestive of a small lymphocytic lymphoma (SLL) of the left breast (Ann-Arbor stage IIEA) He received chemotherapy with cyclophosphamide, vincristine, prednisolone (COP) for two cycles and defaulted for one year.

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