J Breast Cancer.  2015 Sep;18(3):296-300. 10.4048/jbc.2015.18.3.296.

Multifocal Bilateral Breast Cancer and Breast Follicular Lymphoma: A Simple Coincidence?

• Michalinos A
• Vassilakopoulos T
• Levidou G
• Korkolopoulou P
• Kontos M

• KMID: 2407579
• DOI: http://doi.org/10.4048/jbc.2015.18.3.296

Abstract

Breast cancer coexisting with lymphoma is a rare condition with various diagnostic and therapeutic implications. In this report, we describe the case of a 55-year-old Caucasian woman who presented with simultaneous ductal carcinoma in situ of the right breast, and follicular lymphoma involving an inguinal lymph node and the left breast. The patient underwent local excision and radiotherapy for the ductal carcinoma in situ, while a watch and wait strategy was adopted for the lymphoma. Two years later, the patient presented with multifocal ductal carcinoma of the left breast and reappearance of the lymphoma in the left axillary lymph nodes. She underwent bilateral mastectomy, left sentinel node biopsy, and chemotherapy. Synchronous follicular lymphoma and bilateral metachronous breast carcinoma has not been described previously. Diagnosis is based on tissue histology after excision or a needle biopsy. Treatment for these two diseases is distinct, and a multidisciplinary approach should be adopted.

Keyword

Breast neoplasms; Follicular lymphoma; Multiple primary neoplasms; Noninfiltrating intraductal carcinoma

MeSH Terms

Biopsy
Biopsy, Needle
Breast Neoplasms*
Breast*
Carcinoma, Ductal
Carcinoma, Intraductal, Noninfiltrating
Diagnosis
Drug Therapy
Female
Humans
Lymph Nodes
Lymphoma
Lymphoma, Follicular*
Mastectomy
Middle Aged
Neoplasms, Multiple Primary
Radiotherapy

Figure

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  Figure 1 Bilateral mammography of the patient. Both breasts are heterogeneously dense. (A) Right: There is a high-density irregular mass in the upper outer quadrant of the breast. It has indistinct margins, possibly spiculated at places but without significant architectural distortion. The mammogram was graded as Breast Imaging Reporting and Data System (BI-RADS) category 4. (B) Left: There is an asymmetric density with microcalcifications in the upper outer quadrant of the breast corresponding to the palpable lump. The finding has ill-defined or microlobulated margins at places and is not associated with architectural distortion. The mammogram was graded as BI-RADS category 4.

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  Figure 2 Microscopic finding of secondary follicular lymphoma involving left breast. Neoplastic lymphoid cells, mainly centrocytes with a few scattered centroblasts, diffusely infiltrating breast parenchyma (H&E stain, × 200).

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  Figure 3 Microscopic findings of right breast ductal carcinoma in situ (DCIS). Low grade DCIS of cribriform pattern with the presence comedo necrosis involving two ducts (H&E stain, ×200).

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  Figure 4 Microscopic findings of inguinal lymph node specimen. Neoplastic lymphoid cells consisting of centrocytes and some few centroblasts (<15/high-power field) infiltrated the inguinal lymph node, thus disturbing the lymph node normal architecture. The neoplastic populating is arranges in a predominantly nodular pattern (H&E stain, ×200).

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  Figure 5 Histological specimen of sentinel lymph node after second excision. (A) Histological examination of in situ follicular lymphoma in sentinel lymph node after second excision (H&E stain, ×100). (B) CD20 immunopositivity showing the nodules corresponding to infiltrated germinal centers (×100). (C) CD3 immunohistochemical staining showing the reactive T cells arranged mainly outside the nodules (×100). (D) Bcl-2 immunopositivity in the lymphoma B cells inside the germinal centers (×100). (E) CD10 immunopositivity in the neoplastic nodules excluding the probability of being primary follicles, the latter being CD10 negative (×100). (F) Ki-67 index in the neoplastic nodules which is rather low, compared to the expected increased one in reactive germinal centers (×100).

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