The use of staging imaging modalities with increased sensitivity has led to an increase in the incidence of detection of simultaneous malignancies. These cases require careful evaluation and discussion in a multidisciplinary setting to establish a treatment plan that optimizes the outcome with respect to each malignancy, particularly when treatment modalities overlap. We report a case of a patient diagnosed with axillary nodal diffuse large B-cell lymphoma (DLBCL) in a community hospital where staging workup also revealed synchronous bilateral breast carcinomas. To our knowledge, this is only the second case report of a patient with three synchronous primary malignancies: bilateral breast carcinomas and axillary DLBCL. The only other similar case report had no role for radiation or chemotherapy in the management of the indolent follicular lymphoma. 1. Introduction Breast cancer constitutes approximately 14% of all primary cancers in women, accounting for more than 207,000 cases per year , but only a small fraction (2.2–4.3% in retrospective reviews) of these presented as bilateral breast cancer [2–4]. For early-stage disease, primary treatment involves surgical resection via modified radical mastectomy or breast conservation therapy with lumpectomy and sentinel lymph node biopsy. Adjuvant chemotherapy and hormonal therapy are often considered as well as completion of breast conservation therapy with radiation therapy to the involved breast and, if indicated, the regional lymph nodes . Conversely, non-Hodgkin lymphoma constitutes only 4% of all primary cancers in women. Primary treatment for limited stage diffuse large B-cell lymphoma (DLBCL) involves systemic chemotherapy with or without consolidative radiation therapy, while late stage is treated primarily with systemic chemotherapy alone with radiation therapy considered for areas of original bulky disease . Herein, we report a case of a patient diagnosed with axillary nodal DLBCL in a community hospital where staging workup also revealed synchronous bilateral breast carcinomas. A review of the relevant literature is also discussed. 2. Case Report The patient was a 64-year-old woman who presented to her local community hospital emergency department with a complaint of rapidly increasing edema to the right arm. She was noted to have significant right axillary adenopathy and although she denied fevers or night sweats, she had lost over 25 pounds (>10% of her body weight) in the three months prior to presentation. A computed tomography (CT) scan of the chest demonstrated multiple right axillary
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