A case of primary small lymphocytic lymphoma of breast

Introduction/Background/Significance: Non-Hodgkin lymphoma (NHL) can be either indolent or aggressive. Breast involvement by NHL, either primary or secondary is rare, with an incidence of 1% among all breast malignancies, SLL breast involvement is exceedingly rare. Here, we presented a case of primary small lymphocytic lymphoma of the breast in a 66-year-old female who was noted to have a suspicious mass on a routine screening mammogram consistent with BI-RADS 4.

Materials and Methods/Case Presentation/Objective: 66 year old female who had a routine screening mammogram showing suspicious left breast mass BI-RADS Category 4. Patient underwent biopsy of the left breast mass suspected for B-cell chronic lymphocytic leukemia/small lymphocytic lymphoma (SLL/CLL). Lymphocytes are composed of B cells positive for CD79a and CD20 with a variant expression of CD5. T cells are positive for CD3. Ki-67 shows a proliferative index of up to 20% focally. In the absence of a t(11;14) translocation, the findings were consistent with B-CLL/SLL. That led to a staging workup with PET/CT scan and bone marrow biopsy that showed that her disease is confined to the breast. Bone marrow biopsy showed normocellular at 30-40% with normal trilineage hematopoiesis, no evidence of lymphomatous involvement. Patient then underwent seed localization lumpectomy and Pathology showed multifocal aggregates of SLL. On her next follow up visit, there was no evidence of disease recurrence

Results/Description/Main Outcome Measures: SLL consists of monomorphic small round B lymphocytes involving the lymph nodes, peripheral blood, and bone marrow. In this patient, the histopathologic report of the mass showed small lymphocytes positive for CD20, CD3, and CD5 markers. The presence of the neoplastic lymphocytes primarily in the breast tissue rather than circulating in peripheral blood was diagnostic of SLL [1-3]. The management of SLL ranges from watchful waiting to surgery, active therapy with systemic treatment including chemotherapy, radiotherapy, and anti CD-20 monoclonal antibody which can be done alone or in different combinations.

Conclusions: Primary breast lymphoma is a rare malignancy of the breast which could be misdiagnosed with breast carcinoma and other breast malignancies. It is crucial to do careful assessment for accurate diagnosis and treatment. Here we discussed the case of primary breast SLL successfully treated with surgical excision thereby avoiding the side effects and associated risks of chemotherapy and radiation.

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References

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