Synchronous invasive ductal carcinoma and intravascular large B-cell lymphoma of the breast: a case report and review of the literature

Abstract

Primary breast lymphomas (PBLs) represent less than 1% of all breast malignancies. Intravascular large B-cell lymphoma (ILBCL) is a rare, aggressive form of extranodal lymphoma. Breast involvement has only been described in the literature once previously. ILBCL is characterized by the proliferation of tumour cells within the lumen of small vessels of involved organs, resulting in their eventual occlusion. Clinical features are often vague, diagnosis is difficult and delayed, and prognosis is usually poor. We report the first ever case of synchronous ILBCL and invasive ductal carcinoma (IDC) of the breast in a patient presenting with pyrexia of unknown origin and altered mental status who underwent modified radical mastectomy and subsequent chemotherapy, and review the literature regarding intravascular large B-cell lymphoma, PBLs and synchronous carcinomas and lymphomas of the breast.

Figure 1

Mammogram. (A) Craniocaudal and (B) mediolateral oblique views of the patient’s right breast. There is a 19 mm spiculated mass with associated architectural distortion in the lower central breast highly suspicious for malignancy. There is also a partially calcified fibroadenoma in the lower inner quadrant and a few calcified oil cysts in the upper outer quadrant.

Figure 2

PET-CT. A 1.8 × 1.4 cm spiculated mildly FDG-avid right breast nodule just below the level of the nipple is demonstrated (maximum standardized uptake value 3.9). FDG, fluorodeoxyglucose; PET-CT, positron emission tomography-computed tomography.

Figure 3

Histological analysis. (A) IDC (top right) with ILBCL (bottom centre) 130× magnification. (B) ILBCL in the surrounding breast tissue away from the IDC. Most of the blood vessels show darkly stained atypical lymphoid cells within their lumen 40× magnification. (C) Atypical lymphoid cells within the blood vessels 200× magnification. (D) CD20 reactive atypical large cells within the blood vessels 400× magnification. IDC, invasive ductal carcinoma; ILBCL, intravascular large B-cell lymphoma.