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8 December 2010 Case of the Week #192

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Case of the Week #192

Clinical History

A 37 year old woman presented with a palpable left breast mass. Mammogram and ultrasound showed a 4.5 cm mass without calcifications, characterized as ACR-BIRADS category IV-suspicious. A needle core biopsy was obtained.

Micro images:

   

Immunostains:
   
Left: negative for keratin; Right: negative for CD20 (B cell marker) and CD30

   
Left: strongly positive for CD3 (T cell marker); Right: strongly positive for Ki-67

What is your diagnosis?































Diagnosis:

High-grade malignant lymphoma, peripheral T-cell, type not further specified.

Discussion:

The diagnosis was confirmed by molecular probes which demonstrated a clonal T-cell population using primers for the T-gamma region.

Primary breast lymphomas are rare, constituting less than 1% of all breast malignancies. Patients tend to be either ages 30-35 years (diffuse large B cell) or 55-60 years (diffuse large B cell or MALT-type). Screening mammography may be increasing the detection of low-grade lymphoma.

The criteria for primary breast lymphoma are: (a) sufficient tissue for diagnosis; (b) close interaction between the lymphoma infiltrate and breast tissue; (c) no evidence of widespread lymphoma at time of diagnosis; (d) no prior diagnosis of nonbreast lymphoma (Cancer 1972;29:1705). Secondary breast lymphoma has a similar incidence as primary breast lymphoma, and is the most common metastatic disease to the breast.

T cell lymphomas of the breast are extremely rare (Mod Pathol 2000;13:599). As in this case, these tumors are often considered to be diffuse large B cell lymphomas until immunostains are performed for T and B cell markers.

T cell lymphomas of the breast often have aggressive behavior. In this case, the patient responded only briefly to therapy. She subsequently developed jaundice with increased liver function tests. A liver biopsy showed involvement by T-cell lymphoma, and she subsequently died of her disease.

Additional references: PathologyOutlines.com - Breast Malignant Chapter - Lymphoma


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