Primary breast lymphoma

Abstract

We report a case of primary breast lymphoma in a 75-year-old woman who noticed a lump in her right breast after trauma. Mammographic, ultrasonographic, and pathologic correlations are provided. The typical appearance of primary breast lymphoma on mammography is a solitary, uncalcified, circumscribed, or indistinctly marginated mass with adjacent lymphadenopathy. On ultrasound, primary breast lymphoma is usually hypoechoic with circumscribed or microlobulated margins demonstrating increased vascularity. The differential diagnosis for a mass with this appearance is discussed in detail and includes hematoma, abscess, primary breast lymphoma, invasive ductal carcinoma, phyllodes tumor, and metastatic disease.

Keywords: BI-RADS, American College of Radiology Breast Imaging Reporting and Data System; MRI, magnetic resonance imaging.

Figure 1A

75-year-old woman with primary breast lymphoma. Mammogram of the right breast, CC view. Note a large oval isodense mass (arrows) with indistinct margins at 1 o’clock extending from anterior to posterior depth without associated calcifications. A BB marks the site of palpable abnormality.

Figure 1B

75-year-old woman with primary breast lymphoma. Mammogram of the right breast, ML view. Note a large oval isodense mass (arrows) with indistinct margins at 1 o’clock extending from anterior to posterior depth without associated calcifications. A BB marks the site of palpable abnormality.

Figure 1C

75-year-old woman with primary breast lymphoma. Mammogram of the right breast, spot magnification, CC view. Note a large oval isodense mass (arrows) with indistinct margins at 1 o’clock extending from anterior to posterior depth without associated calcifications. A BB marks the site of palpable abnormality.

Figure 1D

75-year-old woman with primary breast lymphoma. Mammogram of the right breast, spot magnification, ML view. Note a large oval isodense mass (arrows) with indistinct margins at 1 o’clock extending from anterior to posterior depth without associated calcifications. A BB marks the site of palpable abnormality.

Figure 2A

75-year-old woman with primary breast lymphoma. Ultrasound image of the palpable area demonstrates a 44 × 20 × 44 mm heterogeneous, hypoechoic oval mass parallel to the chest wall with circumscribed and microlobulated margins and increased vascularity.

Figure 2B

75-year-old woman with primary breast lymphoma. Ultrasound image of the palpable area demonstrates a 44 × 20 × 44 mm heterogeneous, hypoechoic oval mass parallel to the chest wall with circumscribed and microlobulated margins and increased vascularity at 1 o'clock 3 cm to the nipple.

Figure 3A

75-year-old woman with primary breast lymphoma. Ultrasound image of an axillary lymph node reveals loss of the normal reniform appearance with eccentric, bulbous cortical thickening with slitlike configuration of the hilum.

Figure 3B

75-year-old woman with primary breast lymphoma. Ultrasound image of an axillary lymph node reveals loss of the normal reniform appearance with eccentric, bulbous cortical thickening with slitlike configuration of the hilum.

Figure 3C

75-year-old woman with primary breast lymphoma. Color Doppler image of the same axillary lymph node demonstrates increased vascularity with increased cortical flow.

Figure 4

Medium power view of the breast biopsy contains a diffuse infiltrate of malignant cells, invading in a sheet-like growth pattern (H&E stain, 200X). The cytologic features of the malignant cells are apparent at higher power. The cells have scant to inapparent cytoplasm with large atypical nuclei containing prominent nucleoli, vesicular chromatin, and irregular nuclear membranes (arrowheads). A normal lymphocyte is bracketed (asterisks) for comparison.