Synchronous presentation of invasive ductal carcinoma and mantle cell lymphoma: a diagnostic challenge in menopausal patients

Abstract

Synchronous presentation of breast carcinoma and non-Hodgkin lymphoma (NHL) is a rare occurrence (Bradford PT, Freedman DM, Goldstein AM, Tucker MA. Increased risk of second primary cancers after a diagnosis of melanoma. Arch Dermatol 2010; 146: :265-72; Dutta Roy S, Stafford JA, Scally J, Selvachandran SN. A rare case of breast carcinoma co-existing with axillary mantle cell lymphoma. World J Surg Oncol 2003; 1: :27; Suresh Attili VS, Dadhich HK, Rao CR, Bapsy PP, Batra U, Anupama G et al. A case of breast cancer coexisting with B-cell follicular lymphoma. Austral Asian J Cancer 2007; 6: :155-6). In particular, only two reported cases on synchronous presentation of invasive ductal carcinoma (IDC) and mantle cell lymphoma (MCL) exist in the English literature. Owing to the rarity, there is a lack of consensus about underlying mechanism as well as optimal treatment strategy, and diagnosing both malignancies together without a delay remains a complex clinical challenge. We report a case of synchronous presentation of IDC and MCL in a 67-year-old female patient whose MCL diagnosis was delayed due to a misinterpretation of her B symptoms as postmenopausal, with a review of the literature on concurrently occurring breast carcinoma and NHL.

Figure 1:

Cranio-caudal view of mammogram showing a 2.4 cm × 1.4 cm × 1.8 cm lobulated mass with an indistinct margin in the left breast at 1 o'clock, 5.8 cm from the nipple.

Figure 2:

Histologic images of the IDC. Magnification ×100. (a) Hematoxylin and eosin (H&E) staining photomicrograph of left breast cancer showing proliferative growth of malignant ductal epithelial cells and (b) invasion under basement membrane.

Figure 3:

Histologic images of MCL. Magnification ×100. (a) H&E staining showing effaced nodal architecture due to closely packed neoplastic growth of mantle zone B-cells of lymphoid follicles, (b) singly scattered epitheliod histocytes making a starry-sky appearance at a lower magnification and (c) cyclin D1+ immunostaining.

Figure 4:

PET demonstrating ¹⁸F-fluorodeoxyglucose-avid lymphadenopathy of the neck, axilla and mediastinum consistent with the patient's MCL. (a) The largest lymph nodes in the left neck level II measured 16 × 13 mm with a maximal SUV of 4.8. (b) The largest left axillary lymph node measured 26 × 18 mm with an associated maximal SUV of 3.7.