Breast systemic follicular lymphoma in a man: a case report

Abstract

Introduction: Breast 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 presentation: A 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.

Conclusions: 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.

Figure 1

Immunohistochemistry: follicular lymphoma grade 3, with a diffuse and follicular pattern. Positive expression of CD10 in tumoral cells. (a) EE (Ematossilin/Eosin) (10x); (b) CD20 (Magnification 10x); (c) EE (Magnification 40x); (d) Bcl6 (Magnification 40x).

Figure 2

Representative fluorescence in situ hybridization (FISH) patterns with LSI IGH/BCL2 DualColor, Dual Fusion Translocation Probe (Vysis). This probe set is a mixture of locus-specific immunoglobulin heavy chain (IgH) probe labeled with SpectrumGreen (Vysis) and a locus-specific probe for B cell leukemia/lymphoma 2 (Bcl2) labeled with SpectrumOrange (Vysis). 1R1G2F classic dual-fusion (D-FISH) pattern in a balanced t(14;18)(q32;q21)-IgH/Bcl2+ case. (A) Translocated signal; (B) non-translocated signal.

Figure 3

Representative gel photo of polymerase chain reaction (PCR) for immunoglobulin heavy chain rearrangements. Lane 1 represents the 100-bp DNA ladder (Invitrogen, Carlsbad, CA, USA); lane 2 represents FR1 rearrangement on monoclonal control; lane 3 represents FR1 rearrangement on internal sample; lane 4 represents FR1 rearrangement on follicular lymphoma sample; lane 5 represents FR1 rearrangement on polyclonal control; lanes 6 to 9 represent FR2 rearrangement on the same set of samples; monoclonal control; lanes 10 to 13 represent FR3 rearrangement on the same set of samples. The last four lanes represent β globin gene amplification.