Primary bilateral breast lymphoma in an elder male patient

Abstract

An 82‐year‐old man was admitted to our outpatient clinic with a 2‐ month‐history of bilateral painless breast masses. The patient had no complaints of fever, weight loss or night sweats. On examination, bi‐ lateral painless masses were palpated in the mid‐outer quadrant with 8 × 6 cm and upper‐inner quadrant with 5 × 3 cm of the right breast and in the upper inner quadrant with 4 × 3 cm of the left breast (Figure 1). Laboratory evaluation revealed an erythrocyte sedimen‐ tation rate level of 46 mm/h, and a lactate dehydrogenase level of 370 U/L (referance range, 122 to 222 U/L). Bilateral breast ultra‐ sound and magnetic resounance imaging showed bilateral multiple lesions, with the largest mass of 85 × 65 mm in the right breast with axillary lymph nodes. Tru‐cut biopsies revealed neoplastic lymphoid proliferation in the breast. Pancytokeratin immunostaining showed entrapped ductus of the breast, whereas CD20 and CD79a immu‐ nostaining showed neoplastic pleomorphic lymphoid infiltration between the fibrous bands of the underlying stroma. Reactive lym‐ phocytes were positive for CD3. Ki67 proliferation index was high. Ig G immunostaining was also seen on the neoplastic cells which is a sign of plasmocytic differentiation of the lymphoma. High grade B cell lymphoma with plasmocytic differentiation was diagnosed (Figure 2). 18F‐FDG PET/CT imaging revealed an intense bilateral breast uptake (SUVmax:47.5) and hypermetabolic millimetrıc medias‐ tinal (SUVmax:6.1) and intra‐abdominal lymph nodes (SUVmax:10.1) (Figure 3). Primary breast lymphoma is a very rare type that accounts for about 2% of patients with extranodal non‐Hodgkin lymphoma. F I G U R E 1 Clinical imaging of primary breast lymphoma