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PRIMARY LYMPHOMA OF BREAST - UNUSUAL TYPE - CASE REPORT  [PDF]
N. Panda,Manju Banerjee,Ruchira Das
Jurnalul de Chirurgie , 2011,
Abstract: Introduction: Primary Lymphoma of the breast (PBL) is a rare entity, while secondary involvement of the breast with diffuse disease is more common. While Non Hodgkin Lymphoma type is the usual variant in PBL. We report a case primary Hodgkins lymphoma of the breast. Case Presentation: A 50 yr old woman presented three years ago with multiple lump in her left breast. Core biopsy revealed lymphoma like features. Excision biopsy of the upper outer quadrant lump revealed nodular lymphocytic predominant Hodgkin’s lymphoma (HL). Stage was II A. Chemotherapy resulted in complete remission. Patient was lost in follow up only to return with multiple local recurrences three years after primary treatment. Discussion: Primary NHL breast is rare but primary breast HL is rarer still. Nodular lymphocyte-predominant type of Hodgkin's disease is recognized as an entity distinct from classical Hodgkin's disease with a number of characteristics that suggest its relationship to non-Hodgkin's lymphoma. In histological terms, the differentiation of breast lymphoma cases from breast carcinomas and pseudo lymphoma is important. In our case, though no immunohistochemistry was available, the histological diagnosis was straightforward. Primary breast lymphomas behave similarly to lymphomas of similar histologic types. Treatment wise, the optimal sequence recommended is lumpectomy followed by Radiotherapy or radiotherapy alone for local control and standard anthracycline-based regimens. PBL tends to relapse to CNS; therefore, Computerized Tomography (CT) or Magnetic Resonance (M R) image of CNS is necessary during follow-up. Conclusion: PBL should be treated as lymphoma elsewhere with proper staging. While immunocytochemistry helps, when not available, treatment as per histological type should suffice. Proper staging and post treatment follow up is crucial.
Synchronous Bilateral Breast Carcinoma and Axillary Non-Hodgkin Lymphoma: A Case Report and Review of the Literature
Edward F. Miles,Laura L. Jacimore
Case Reports in Oncological Medicine , 2012, DOI: 10.1155/2012/685919
Abstract: 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.
Synchronous Bilateral Breast Carcinoma and Axillary Non-Hodgkin Lymphoma: A Case Report and Review of the Literature  [PDF]
Edward F. Miles,Laura L. Jacimore
Case Reports in Oncological Medicine , 2012, DOI: 10.1155/2012/685919
Abstract: 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 [1], 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 [5]. 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 [6]. 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
Primary lymphoma of the breast involving both axillae with bilateral breast carcinoma
Neeraj K Garg, Nitin B Bagul, Gary Rubin, Elizabeth F Shah
World Journal of Surgical Oncology , 2008, DOI: 10.1186/1477-7819-6-52
Abstract: A 57-year-old woman was recalled because her screening mammograms revealed three separate lesions in her right breast and one in the left. Histology of the lesions confirmed lymphoma in one breast with ductal carcinoma in the other.Most of reported cases in literature have been involving the right breast, and almost all the patients were females. NHLs of the breast typically present as unilateral mass; the frequency of bilateral disease at first presentation ranges from 5–25%. Our objective is to report a case of primary lymphoma of the breast involving both axillae with concomitant bilateral primary breast cancer which has not been reported yet to our best of knowledge in literature.About 50% of lymphomas are primary extranodal non-Hodgkin's lymphomas (NHL) [1]. Primary non-Hodgkin's lymphoma (PNHL) of the breast is a rare entity, while secondary involvement of the breast with diffuse disease of NHL is more common [2]. However, PNHL is the most frequent haematopoietic tumour of the breast [3]. Diagnostic criteria for PNHL of the breast are [4]: 1) presence of technically adequate pathologic specimens, 2) close association of mammary tissue and lymphomatous infiltrate, 3) no prior diagnosis of an extarammamary lymphoma, and 4) no evidence of concurrent widespread disease, except for ipsilateral axillary lymph nodes if concomitant with the primary lesion.The number of cases of PNHL of the breast reported to date is around 250 [5]. Most of these cases have involved the right breast, and almost all the patients were females. NHLs of the breast typically present as unilateral mass; the frequency of bilateral disease at first presentation ranges from 5–25% [6]. To the best of our knowledge a case of primary lymphoma of the breast involving both axillae with concomitant bilateral primary breast cancer has not been reported yet.A 57-year-old woman attended for routine mammography screening. She was recalled because her screening mammograms revealed three separate lesions i
Stage IAE Follicular Lymphoma of the Breast: Case Report and Review of the Literature  [PDF]
Raymon Patron,Edward F. Miles
Case Reports in Oncological Medicine , 2013, DOI: 10.1155/2013/597527
Abstract: Primary lymphoma of the breast is a rare entity in the field of oncological medicine and represents <0.5% of all breast malignancies. A definitive diagnosis is obtained by excisional biopsy as the clinical and radiographical presentation is similar to the more common primary breast carcinoma. Unlike primary breast carcinoma, localized radiation therapy is the mainstay of treatment. We report on a case of primary follicular lymphoma of the breast in a 67-year-old Caucasian woman treated with localized radiation as well as coinciding literature review regarding outcomes of different treatment modalities. 1. Introduction Follicular lymphoma is the second most common lymphoma diagnosed in the United States, comprising 20% of all non-Hodgkin lymphomas and 70% of all indolent lymphomas [1]. Median age at diagnosis is 60 years with a slight female predominance [2, 3]. Most patients present with asymptomatic lymphadenopathy, and more than 90% present with Stage III or IV disease [4]. Primary breast lymphoma is much less common and represents 1% of all non-Hodgkin lymphomas [5] and <0.5% of all breast malignancies [6]. Management of follicular lymphoma depends on the stage; for early stage disease (I and II), current guidelines recommend the consideration of 2,400–3,000 centiGray (cGy) involved-field radiation therapy for nodal sites and involved-organ radiation therapy for extranodal sites [7]. We report a case of successful local control of an incidental follicular lymphoma of the breast diagnosed at excisional biopsy. 2. Case Report The patient was a 67-year-old Caucasian female who self-palpated a 1?cm firm nodule in the midsuperior portion of the right breast. Her screening mammogram was normal eight months before. Ultrasound evaluation demonstrated a mixed density lesion measuring 1?cm in greatest dimension, directly overlying the pectoralis muscle. She underwent excisional biopsy which demonstrated Grade 2 follicular lymphoma (Figures 1 and 2). Due to the unusual diagnosis, her case was reviewed at a multidisciplinary tumor board and discussed in detail with radiology, pathology, general surgery, radiation oncology, and medical oncology specialists. Figure 1: Follicular lymphoma of the breast at 4x magnification in hematoxylin and eosin stain. Figure 2: Follicular lymphoma of the breast at 40x magnification in hematoxylin and eosin stain. She subsequently underwent a complete workup per the national comprehensive cancer network (NCCN) guidelines, [8] including a bone marrow biopsy which was normal and a positron emission tomography/computed tomography
CASE REPORT: Primary Bilateral Non Hodgkin s Ovarian Lymphoma A Case Report
Sunita S. Dantkale,Gopal A. Pandit,Supriya D. Joshi,Smita S. Pudale
Journal of Krishna Institute of Medical Sciences University , 2012,
Abstract: Background: Involvement of the ovary by malignant lymphoma is a well known late manifestation of disseminated nodal disease. Primary ovarian lymphoma is rare. Case History: We report an autopsy case of primary ovarian non Hodgkin’s lymphoma with bilateral involvement. A 30 years old woman was admitted with signs and symptoms suggestive of an ovarian cancer. Computed tomography revealed two abdominal masses measuring 10cm in diameter, without enlarged lymph nodes. Patient died on second day of treatment, so her autopsy was performed. Diagnosis of malignant lymphoma was made on histopathology. Tumour was classified as a diffuse large B cell lymphoma with the help of immunohistochemistry. Absence of disease in blood and bone marrow, no lymphadenopathy favours the diagnosis of primary lymphoma.
Development of non-Hodgkin’s lymphoma in a patient with primary biliary cirrhosis: A case report and review of the literature  [cached]
Theoni Kanellopoulou,Alexandra Alexopoulou,Flora N. Kontopidou,Anna Filiotou
Annals of Gastroenterology , 2011,
Abstract: Patients with autoimmune disorders seem to have an elevated risk of lymphoma, especially non-Hodgkin’s lymphoma (NHL). The increased risk has been attributed to the disturbance of immune function found in these patients or to the immunosuppressive therapy used to treat the autoimmune disorders. However, little information exists about the estimated baseline risk for lymphoma in patients with primary biliary cirrhosis (PBC). In this case report, we describe a female patient who developed nodal diffuse large B-cell lymphoma ten years following PBC diagnosis. Twenty five additional case reports (19 NHL and 4 Hodgkin’s disease (HD), 2 without data about NHL or Hodgkin’s disease) predominantly females were identified in the English literature. B-cell lymphoma was the most common NHL type reported but beyond that no clear predisposition for any specific lymphoma subtype was documented. PBC usually preceded lymphoma diagnosis. Fifteen cases had extranodal localization and the most common site was the liver. Keywords PBC, non-Hodgkin’s lymphoma, autoimmune disorders Ann Gastroenterol 2011; 24 (2): 125-128
Primary bony non-Hodgkin lymphoma of the cervical spine: a case report
Zachary A Smith, Mark F Sedrak, Larry T Khoo
Journal of Medical Case Reports , 2010, DOI: 10.1186/1752-1947-4-35
Abstract: We report on a 23-year-old Caucasian-American man who presented with two months of night sweats, fatigue, parasthesias, and progressive weakness that had progressed to near quadriplegia. Magnetic resonance (MR) imaging demonstrated significant cord compression seen primarily at C7. Surgical management, with corpectomy and dorsal segmental fusion, in combination with adjuvant chemotherapy and radiation therapy, halted the progression of the primary disease and preserved neurological function. Histological analysis demonstrated an aggressive anaplastic large cell lymphoma.Isolated primary bony lymphoma of the spine is exceedingly rare. As in our case, the initial symptoms may be the result of progressive cervical cord compression. Anterior corpectomy with posterolateral decompression and fusion succeeded in preventing progressive neurologic decline and maintaining quality of life. The reader should be aware of the unique presentation of this disease and that surgical management is a successful treatment strategy.Primary vertebral lymphoma presenting without sites of systemic involvement is exceedingly rare. Bone is the primary origin of the disease in only 1% of non-Hodgkin lymphomas [1]. Further, primary vertebral locations account for only 1.7% of all primary bone lymphomas, and the vast majority occur in short bones, with a predilection for the scapula, ileum, femur, and tibia [1,2]. Bony and epidural non-Hodgkin lymphoma has been described in small case series when it has involved the thoracic and lumbar spine [3,4]. However, to our knowledge, the presentation of primary bone lymphoma of the cervical spine is unique to the clinical literature.Moreover, when it occurs in a primary vertebral location, the tumor can often grow insidiously and reach considerable size and clinical consequence prior to diagnosis. When this occurs, the symptoms may be rapidly progressive, and surgical decompression and stabilization may be required to preserve function and maintain quali
Primary breast lymphoma; disease recurrence
Hüseyin KADIO?LU,Serap YüCEL,Zeynep GüRAL,Nurhan G?ZüBüYüKO?LU
Turkish Journal of Oncology , 2012,
Abstract: Primary breast lymphoma (PBL) accounts 0.4-0.5% of all breast cancers. The aim is to present the patient diagnosed with recurrency of primary breast lymphoma treated six year ago without radiotherapy. A 63-years-old woman patient admitted to our hospital with a palpabl mass in her left breast. Six years ago she was treated with chemoterapy after local excision for primary left breast lymphoma. Imaging modalities showed multiple lesion in breast and confirmed with biopsy. Pathologic results were similar with first one and the case was accepted as PBL recurrence. Multipl metastases has been determined with staging modalities. Patient started to chemotherapy treatment. PBL is a rare cancer of breast and there is no consensus at the treatment of disease. In the literature addition of radiotherapy to the treatment prevents local recurrence. There were occured recurrence without radiotherapy, mimicked that radiotherapy is an essential modality in PBL treatment.
Primary Bilateral Non-Hodgkin's Lymphoma of the Adrenal Gland: A Case Report  [PDF]
Ahmed Amine Bouchikhi,Mohamed fadl Tazi,Driss Amiroune,Soufiane Mellas,Jalaledine El Ammari,Abdelhak Khallouk,Mohammed Jamal El fassi,Moulay Hassan Farih
Case Reports in Urology , 2012, DOI: 10.1155/2012/325675
Abstract: Primary bilateral non-Hodgkin's lymphoma (NHL) of the adrenal gland is a very rare entity. Indeed less than 60 cases have been reported in the literature. Hence, we report a case of high-grade lymphoma of both adrenal glands that was found in a young patient of 32 years of age. The patient was admitted in the emergency department of our hospital with a profile of hemorrhagic shock. After stabilization, the imaging investigations demonstrated large bilateral adrenal masses. The CT-scan guided biopsy of both adrenal glands allowed the diagnosis of primary bilateral adrenal NHL. The patient died after the first chemotherapy session. The presence of bilateral adrenal masses associated with a rapid increase of volume should raise the diagnosis of primary adrenal non-Hodgkin's lymphoma. 1. Introduction The adrenal mass has a significant etiological diagnosis problem. Thus, primary lymphoma of the adrenal gland is a rare origin of adrenal tumors; it has to be evoked specifically whenever bilateral adrenal affections are revealed. We report a case of a primary bilateral adrenal lymphoma. We discuss the clinical feature and paraclinical and therapeutic issues with literature review [1–4]. 2. Case Report The patient is a 32-year-old married lady. The patient was admitted in the emergency department of our hospital with a profile a hemorrhagic shock. The interview revealed a patient with bilateral back pain of 5 months history without irradiation. The general examination found a patient of poor general state with difficulties to measure blood pressure and showing a frank discolored connective. The patient followed an urgent blood filling. The abdominal examination found painful masses in both sides which were difficult to delineate without any hepatomegaly or splenomegaly. Neither signs of hyperadrenocorticism nor lymphadenopathy were found. The clinical examination of a primary neoplasm was negative. The biological assessment of the adrenal hormones was normal. The chest radiography was without abnormality. The abdominal ultrasound revealed bilateral adrenal masses, while the abdominal CT scan objectified bilateral adrenal masses of hypodense tissue measuring 7?cm and 10?cm diameter in the right and left sides, respectively (Figure 1). Poly-retro-peritoneal lymph nodes measuring 10 to 20?cm diameter meters were also found. A second CT scan was achieved with contrast enhancement and demonstrated an increased size of the adrenal masses (Figures 2 and 3). A CT-scan guided biopsy was performed for diagnostic purposes. The histological examination showed a
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