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. 2022 May 19;8(1):99.
doi: 10.1186/s40792-022-01456-z.

A rare case of synchronous multiple primary malignancies of breast cancer and diffuse large B-cell lymphoma that responded to multidisciplinary treatment: a case report

Yuichi Ueda  1 , Yuko Makino  2 , Taro Tochigi  3 , Yoshikazu Ota  4 , Hideki Hidaka  2 , Takeshi Nakamura  2 , Kiichiro Beppu  2 , Jiro Ohuchida  2 , Seiichi Odate  2 , Soshi Terasaka  2 , Takahiro Nishida  2   5 , Masaki Yoshida  2 , Ryuichiro Kimura  2 , Kousuke Marutsuka  6 , Naoki Otomo  2
Affiliations

A rare case of synchronous multiple primary malignancies of breast cancer and diffuse large B-cell lymphoma that responded to multidisciplinary treatment: a case report

Yuichi Ueda et al. Surg Case Rep. .

Abstract

Background: Multiple primary malignancies of breast cancer and diffuse large B-cell lymphoma (DLBCL) are rare. Here, we report a case of advanced breast cancer and DLBCL managed with multidisciplinary therapy preceded by surgery with a successful outcome.

Case presentation: During a medical examination, a 71-year-old woman was diagnosed with a right breast mass, enlarged lymph nodes throughout the body, and a splenic tumor. The results of the clinical examination and imaging were suggestive of widely spread breast cancer with lymph node metastasis and malignant lymphoma with systemic metastasis. The histological evaluation of the biopsied breast tissue revealed human epidermal growth factor receptor 2 (HER2)-positive breast cancer, whereas the histological evaluation of the excised inguinal lymph node revealed DLBCL. 18F-FDG PET/computed tomography was performed, and it was determined that both breast cancer and DLBCL were in an advanced stage. Thus, mastectomy was performed, and the axillary lymph nodes showed mixed metastasis of breast cancer and DLBCL. Soon after, the R-CHOP therapy was initiated (375-mg/m2 rituximab, 2-mg/m2 vincristine, 50-mg/m2 doxorubicin, 750-mg/m2 cyclophosphamide, and 125-mg methylprednisolone). After irradiation of the spleen, trastuzumab was administered for 1 year.

Conclusions: We experienced a case of combined breast cancer and DLBCL, which was difficult to treat because both were in advanced stages. Thorough staging of the malignancy and discussion by a multidisciplinary team are necessary to determine the optimal treatment strategy.

Keywords: Breast cancer; DLBCL; Double cancer; Multiple primary malignancies; Synchronous.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Histopathological examination of the breast tumor. a HE staining revealed invasive ductal carcinoma of the breast, histological grade III (×10 magnification). b ER negative (×10 magnification). c PgR negative (×10 magnification). d HER2 score3 (× 10 magnification)
Fig. 2
Fig. 2
Histopathological examination of the inguinal lymph nodes. HE staining revealed the loss of the native lymph node architecture and diffused proliferation of large lymphocytes against a background of numerous small lymphocytes and histiocytes (a ×4 magnification; b ×20 magnification). Immunostaining for c CD3; d CD20. The large lymphoid cells are selectively positive for CD20, and numerous CD3-positive small T-lymphocytes are observed in background, supporting the diagnosis of diffuse large B-cell lymphoma (×20 magnification)
Fig. 3
Fig. 3
Pre-treatment PET/CT findings. PET demonstrated an accumulation of 18F fluorodeoxyglucose in the right breast, bilateral axillary, right cervical, intra-abdominal lymph nodes, spleen, and bilateral inguinal lymph nodes. The findings of the a whole body, b right breast, and c spleen are shown
Fig. 4
Fig. 4
Macroscopic and microscopic findings of the resected specimen. a Surgical specimen of the right breast. b Pathological examination of a specimen from the breast showed invasive carcinoma (×4 magnification). c Pathological examination of the right axillary lymph node showed metastatic cells from the breast cancer (×10 magnification). d Pathological examination of the left axillary lymph node showed diffuse large B-cell lymphoma (×10 magnification)
Fig. 5
Fig. 5
Treatment progress chart. After the completion of six courses of R-CHOP, PET–CT showed no lymphoma lesions or new lesions
See this image and copyright information in PMC

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