A Rare Case of Asynchronous Bilateral B-cell Lymphoma of the Breast

We report an asynchronous bilateral malignant lymphoma of thebreast, in a 56-year-old woman, presenting unusual clinicalsigns and histological features. The patient, who had a familyhistory of breast cancer, had undergone a standard right radicalmastectomy four years previously for a non-epithelial malignanttumor. At that time, the tumor was thought to be a stromal sarcoma,because some of the neoplastic cells were elongated or vacuolated.The patient recently became aware of a rapidly growing tumorof the left nipple without erosion or pain. This tumor underwentbiopsy, and the histological examination showed a non-Hodgkin'slymphoma of diffuse mixed type. Staging procedures demonstratedno sign of generalized disease. Following a modified left radicalmastectomy for optimal local control and accurate staging, adjuvantchemotherapy consisting of vincristine, cyclophosphamide, prednisoloneand doxorubicin was initiated. Immunohistochemical stainingfor PAN-B and leucocyte common antigen revealed both tumorsto be malignant lymphomas of B-cell type, and the first lymphomaof the right breast was thought to be showing ‘signetring’ cell change. Since the two tumors were morphologicallyquite different from each other, h was suggested that they wereasynchronous bilateral primary malignant lymphomas; however,the possibility remains that the recent left breast tumor isa recurrence of the malignant lymphoma of the right breast.The patient is currently disease-free, 10 months after surgery