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PRIMARY NON-HODGKINS LYMPHOMA OF BREAST

ARSHAD S KHAN*, GIRISH D BAKHSHI**, KUNDAN K PATIL***, HEMANT G BORSE***, PRASHANT B SANKAYE***, LATA D BHANDARKAR+
*Associate Professor and Unit Head; **Lecturer; ***Resident; +Professor, *Department of Surgery and +Department of Pathology, Grant Medical College and Sir JJ Group of Hospitals, Mumbai 400 008.

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The female breast is a rare location of extra-nodal Non-Hodgkins lymphoma. We present a case of 60 year old post-menopausal female who presented with painless lump in left breast. Fine needle aspiration cytology (FNAC) suggested malignancy. Investigations ruled out metastasis, hence modified radical mastectomy (MRM) was done. Histopathology of specimen revealed Non-Hodgkins lymphoma of breast. Investigations to rule out any other site of lymphoma proved it to be primary Non-Hodgkins lymphoma of breast with no metastasis. Patient post-operatively was given chemotherapy. Patient is clinically disease free in post-operative follow-up of one year.

INTRODUCTION

Primary Non-Hodgkins lymphoma of Breast is a rare disease. It is estimated that the number of published cases in Western literature is approximately 250 cases. Even better insight into the frequency of this disease is achieved by determining the ratio of primary malignant lymphomas of the breast to total number of the breast malignancies in a given institution or geographic region. This number does not differ very much from publication to publication and puts the proportion of lymphomas in the range of 0.04%-0.52% of all the malignant tumours of the breast.[1]

CASE REPORT

A 60-year-old post-menopausal female presented with painless lump in the left breast since 4 months with no other symptoms. Clinical examination revealed lump in the upper outer quadrant of left breast measuring 5 cm X 5 cm fixed within the breast tissue, both axillae and right breast were normal. Fine Needle Aspiration Cytology (FNAC) revealed malignancy. Investigations ruled out any metastasis, hence Modified Radical Mastectomy (MRM) was done. Histopathology of the specimen revealed it to be Non-Hodgkins lymphoma of breast of diffuse large cell high grade type with presence of cleaved and uncleaved cells infiltrating ductal lining epithelium (Fig. 1). Resection margins were free of tumour cells. Patient was investigated to rule out other sites of lymphoma which were negative and proved it to be the primary site. Patient was given chemotherapy with Cyclophosmamide, Doxorubicin, Vincristine and Prednisone. Post-operative follow up of 1 year has shown her to be locoregionally controlled and asymptomatic.

Fig.1: Histology of the legion showing large cleaved and uncleaved lymphoma cells infiltrating ductal lining epithelium. (H and E stain, 40 X).

DISCUSSION

Non-Hodgkins lymphoma(NHL) involving the breast either as a primary site or as a site of recurrance from lymphoma previously diagnosed elsewhere is rare. Several series have reported varying incidences of primary and secondary cases. Primary breast lymphoma constitute 0.04%-0.50% of malignant breast neoplasms,[1] 1.7% of all extranodal NHL and 0.7% of all NHL.[2]

The rarity of the primary breast lymphoma as suggested by Ferguson is related to the relatively small amount of lymphoid tissue in the breast as compared to the gut or lung in which primary lymphomas are much more frequent.[3]

These patients typically have a painless breast mass detected on self examination as was seen in our case. In one series 93% of symptomatic patients complained of painless mass as compared with a painful mass in 4% and breast swelling in 2%.[4]

The histologic grade of the tumour is the most significant prognostic factor for patients with primary lymphoma of the breast.[4] In most series diffuse lymphomas of the breast are more frequent than nodular lymphomas.[5] Our case was also of diffuse variety.

Various treatment modalities have been advocated which include surgery with radiotherapy or chemotherapy or radiotherapy with chemotherapy or radiotherapy alone.[6] Current literature recommends combined therapy for intermediate and high grade lymphoma. In our case we used combination of surgery with chemotherapy as it was high grade malignancy. This case demonstrates that lymphoma should be considered as a differential diagnosis of breast lump.

ACKNOWLEDGEMENT

We would like to thank Dean and Dr. GB Daver Head of the Department of Surgery, Grant Medical College and JJ Group of Hospitals for granting us permission to publish this case report.

REFERENCES

1.Fischer MG, Chideckel NJ. "Primary" lymphoma of the breast. Breast 1984; 10 : 7-12.

2.Mattia AR, Ferry JA, Harris NL. Breast lymphoma a B-cell lymphoma of mucosa associated lymphoid tissue. Am J Surg Pathol 1993; 17 : 574-87.

3.Ferguson DJP. Intraepithelial lymphocytes and macrophages in the normal breast. Virchow Arch (A) 1985; 405 : 369-78.

4.Brustein S, Kimmel M, Lieberman PH, et al. Malignant lymphoma of the breast, a study of 53 patients. Ann Surg 1987; 205 : 144-50.

5.Schouten JT, Weese JL, Carbone PP. Lymphoma of the breast. Ann Surg 1981; 194 : 749-59.

6.Giardini R, Piccolo C, Rilke F. Primary Non-Hodgkins Lymphomas of the female breast. Cancer 1992; 69 : 725-35.

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