Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2023 Mar 31;12(3):651-657.
doi: 10.21037/tcr-22-1893. Epub 2023 Mar 7.

B-cell non-Hodgkin lymphoma of the breast in Waldenström's macroglobulinemia: a case report

Emanuela Esposito  1 , Valeria Varone  2 , Claudio Siani  1 , Maurizio Di Bonito  2 , Maria Teresa Melucci  1 , Ivana Donzelli  1 , Raimondo di Giacomo  1 , Ugo Marone  1 , Ruggero Saponara  1 , Francesca Collina  2 , Alfredo Fucito  1 , Franca Avino  1
Affiliations
Case Reports

B-cell non-Hodgkin lymphoma of the breast in Waldenström's macroglobulinemia: a case report

Emanuela Esposito et al. Transl Cancer Res. .

Abstract

Background: Non-Hodgkin lymphoma (NHL) of the breast is a rare disease and can occur amongst patients affected by Waldenström's Macroglobulinemia (WM). WM is an indolent B-cell lymphoproliferative disorder with an overall incidence of about 1/100,000 in Europe. Breast imaging is not specific to breast lymphoma that often mimics benign lesions. The diagnosis is based on breast biopsy, the presence of MYD88L265P somatic mutation and immunoglobulin M (IgM) paraprotein detectable in the setting of lymphoplasmacytic infiltration by bone marrow (BM) biopsy.

Case description: A 60-year-old woman with personal and familial history of monoclonal gammopathy of undetermined significance (MGUS) and a lump in her right breast was referred to our hospital. Standard imaging showed round mass with smooth edges. The lump was biopsied and the pathology examination showed lymphoplasmacytic lymphoma (LPL) of the breast which led to final the diagnosis of WM.

Conclusions: Lymphoma of the breast is a rare disease, often misdiagnosed because of the lack of specific features at mammogram and ultrasound. Core biopsy is crucial to make diagnosis of breast lymphoma and early diagnosis of WM has been shown to improve overall survival (OS). A comprehensive approach is required in order to assess patients affected by blood disorders presenting with a new breast mass that can lead to diagnosis of breast lymphoma.

Keywords: Breast; MYD88 mutation; Waldenström’s macroglobulinemia (WM); case report; immunoglobulin M monoclonal gammopathy (IgM monoclonal gammopathy); lymphoma.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tcr.amegroups.com/article/view/10.21037/tcr-22-1893/coif). EE serves as an unpaid editorial board member of Translational Cancer Research from May 2018 to April 2024. The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Ultrasound scan showing 24.6 mm smooth margins and heterogeneously echogenic mass in the right breast.
Figure 2
Figure 2
Ultrasound showing weakly vascularized breast mass at color Doppler.
Figure 3
Figure 3
Shear-wave elastography showing high elasticity level in the periphery of the lesion (green) whereas lower elasticity levels are in centre of the lesion (blue).
Figure 4
Figure 4
Ultrasound guided core needle biopsy procedure. 2D ultrasound image showing 14 Gauge needle inserted through the breast lesion.
Figure 5
Figure 5
Breast parenchyma with amyloid deposition and monomorphous infiltrate of small lymphocytes, plasmacytoid lymphocytes and plasma cells. (A) 2× H&E. (B) 10× H&E. H&E, hematoxylin and eosin.
Figure 6
Figure 6
CD20 antibody immunostaining highlights a diffuse infiltration of neoplastic B cells. (A) 2× IHC. (B) 10× IHC. IHC, immunohistochemistry.
Figure 7
Figure 7
CD138 antibody immunostaining highlights plasma cells isolated and forming clusters. (A) 2× IHC. (B) 10× IHC. IHC, IHC, immunohistochemistry.
Figure 8
Figure 8
ISH shows clonal lambda light chain expression. (A) 2× ISH. (B) 10× ISH. ISH, in situ hybridization.
See this image and copyright information in PMC

References

    1. Kastritis E, Leblond V, Dimopoulos MA, et al. Waldenstro¨m’s macroglobulinaemia: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2018;29:iv41-50. 10.1093/annonc/mdy146 - DOI - PubMed
    1. Waldenstrom macroglobulinemia | Genetic and Rare Diseases Information Center (GARD) – an NCATS Program. Available online: https://rarediseases.info.nih.gov/diseases/7872/waldenstrom-macroglobuli...
    1. Frampas E. Lymphomas: Basic points that radiologists should know. Diagnostic and Interventional Imaging 2013;94:131-44. 10.1016/j.diii.2012.11.006 - DOI - PubMed
    1. Owen RG, Treon SP, Al-Katib A, et al. Clinicopathological definition of Waldenstrom's macroglobulinemia: consensus panel recommendations from the Second International Workshop on Waldenstrom's Macroglobulinemia. Semin Oncol 2003;30:110-5. 10.1053/sonc.2003.50082 - DOI - PubMed
    1. WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues. Vol. 2 (Ed Revised 4th Edition). Geneva: WHO Press 2017.

Publication types

LinkOut - more resources