A rare case of primary breast lymphoma presenting as calcifications on screening mammography

Abstract

Extranodal marginal zone lymphoma (EMZL) is a low-grade subtype of B-cell non-Hodgkin lymphoma that can affect any mucosal tissue, most commonly the GI tract. Primary involvement of the breast, known as primary breast lymphoma (PBL), is a very rare manifestation. We report an unusual case of a 65-year-old woman with primary breast EMZL presenting as calcifications discovered during screening mammography. This represents an exceedingly atypical appearance of primary breast lymphoma that is rarely described in the literature.

Keywords: Breast calcifications; Extranodal marginal zone lymphoma; MALT lymphoma; Primary breast lymphoma.

Fig. 1

Left breast medial lateral oblique (left) and craniocaudal (right) images demonstrate new calcifications in the left breast at middle depth. The breast density is almost entirely fatty.

Fig. 2

Magnification craniocaudal (left) and medial-lateral (right) and cropped magnified images show grouped coarse heterogeneous calcifications in the central breast. Calcifications measure 3 mm.

Fig. 3

Craniocaudal prefire (left) and postfire (right) images obtained during tomosynthesis-guided left breast biopsy demonstrate satisfactory targeting of calcifications. On the postfire image, the calcifications are immediately adjacent to the biopsy needle trough.

Fig. 4

Specimen radiograph from left breast tomosynthesis-guided biopsy shows the targeted calcifications in one core specimen.

Fig. 5

PET/CT 3D MIP image demonstrates no pathologic hypermetabolic activity. Normal metabolic activity is noted most prominently in the brain, heart, and urinary collecting system.