J Korean Soc Magn Reson Med.  2014 Jun;18(2):176-181. 10.13104/jksmrm.2014.18.2.176.

MR Spectroscopy and Diffusion Weighted Imaging Findings of Primary Non-Hodgkin Lymphoma of the Breast: Two Case Reports

• Nam SY
• Yoo EY
• Choi HY

• KMID: 2099895
• DOI: http://doi.org/10.13104/jksmrm.2014.18.2.176

Abstract

Primary non-Hodgkin lymphoma (NHL) of the breast is a very rare disease, and the mammographic and ultrasonographic findings of breast lymphoma are variable. There are several reports of magnetic resonance (MR) imaging findings in patients with breast lymphomas; however, few reports have described the findings observed on MR spectroscopy or the features of diffusion weighted (DW) imaging. The authors report the findings of classical MR imaging, MR spectroscopy and DW imaging of a 48-year-old woman and a 40-year-old woman with primary non-Hodgkin's lymphoma of breasts. Mammography and breast ultrasonography revealed a mass with circumscribed margin. The mass showed strong enhancement after contrast injection on MR imaging. DW imaging showed reduced diffusion and high-amplitude choline (Cho) peak at 3.22 ppm was detected by single voxel MR spectroscopy which was consistent with malignancy.

Keyword

Non-Hodgkin's lymphoma; Breast; MR Spectroscopy; Diffusion weighted imaging

MeSH Terms

Adult
Breast*
Choline
Diffusion*
Female
Humans
Lymphoma
Lymphoma, Non-Hodgkin*
Magnetic Resonance Imaging
Magnetic Resonance Spectroscopy*
Mammography
Middle Aged
Rare Diseases
Ultrasonography, Mammary
Choline

Figure

• 

  Fig. 1 A 48-year-old woman with primary non-Hodgkin lymphoma of the right breast. a. Craniocaudal mammogram of her right breast shows an 8 cm sized, oval shaped, circumscribed, hyperdense mass at palpable site of the right breast (arrow). b. Ultrasonography shows an oval shaped, circumscribed, heterogeneous echoic mass. c. Axial dynamic contrast-enhanced fat-suppressed T1-weighted MR imaging shows strong enhancement. d. Graph of kinetic enhancement shows a fast initial uptake of contrast material and a washout pattern of delayed-phase enhancement. e. Axial DW imaging showed diffuse hyperintensity within the mass compatible with diffusion restriction. f. The lesion was hypointense on the ADC map. The lesion gave a mean ADC value of 0.75 × 10-3 mm2/s at b=1000 s/mm2. g. MR spectroscopy shows a prominent Cho peak at 3.22 ppm.

• 

  Fig. 2 A 40-year-old woman with primary non-Hodgkin lymphoma of the left breast. a. Mediolateral mammogram of her left breast show a 4 cm sized, oval shaped, circumscribed, equal dense mass at palpable site of the left breast (arrow). b. Ultrasonography shows an oval shaped, circumscribed, heterogeneous echoic mass. c. Axial dynamic contrast-enhanced fat-suppressed T1-weighted MR imaging shows strong enhancement. d. Graph of kinetic enhancement shows a fast uptake of contrast material and a persistent pattern of delayed-phase. e. The mass showed restriction in diffusion on DW imaging. f. ADC map shows hyposignal intensity of the mass, with a mean ADC value of 0.82 × 10-3 mm2/s (arrow). g. There was a Cho peak detected at 3.22 ppm on MR spectroscopy.

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