Primary malignant lymphoma of the breast: clinicopathological study of nine cases

Primary lymphoma of the breast is rare, accounting for 1.7-2.2% of extranodal lymphomas and 0.38-0.7% of non-Hodgkin's lymphomas (NHL). The aim of this study was to evaluate the clinicopathological features and treatment outcomes of patients with primary breast lymphomas (PBL). We conducted a retrospective review of the NHL cases diagnosed at Korea Cancer Center Hospital between 1989 and 2002. Nine (0.9%) of the 1,050 cases fulfilled the criteria for PBL. All patients were women (median age, 45 years) and usually presented with breast masses that had recently become enlarged. Six cases involved the breast alone (stage IE), whereas 3 cases also involved the ipsilateral axillary lymph nodes (stage IIE). Histopathologic studies revealed a diffuse large B cell lymphoma in 7 cases, marginal zone B cell lymphoma in 1 case, and small lymphocytic lymphoma in 1 case. Immunohistochemical analysis revealed a B-cell phenotype in all cases. There was no uniform approach to the treatment of PBL. Modified radical mastectomy and chemotherapy was performed in 4 cases, modified radical mastectomy and chemoradiotherapy was performed in 1 case, chemoradiotherapy alone, modified radical mastectomy alone, chemotherapy alone, and radiotherapy alone were performed in 1 case each. All cases achieved complete remission, but median overall survival was 12 months, showing very poor prognosis irrespective of the type of treatment modality.     

Primary breast lymphoma. An immunohistologic study of 20 new cases

Primary malignant lymphomas of the breast (PBL) are uncommon. The authors report the clinical, histologic, and immunoperoxidase findings on 20 cases recorded at the Alberta Cancer Registry over the last 23 years. These cases were then added to material on 257 cases abstracted from the literature and analyzed. It was found that there are two clinicopathologic types of PBL. The first affects pregnant or lactating women with bilateral, diffuse disease, is rapidly fatal, and corresponds histologically to a Burkitt's-type lymphoma. The second is unilateral at presentation and afflicts a broad age range, but primarily older women. This has a variable course only part of which is predicted by histologic grade and stage. Tumor size, treatment, and side of presentation were not found to be significant prognostic factors. Histologically, these tumors can be grouped into large cell B-cell lymphomas, monocytoid B-cell lymphomas (MBCL), and undifferentiated, some of which may be T-cell. Evidence suggesting that the MBCL of breast are the equivalent of the malignant lymphomas of the mucosa-associated lymphoid tissues (MALT) is reviewed. The breast is a hormone-dependent member of the MALT and therefore it is interesting that two of these tumors were strongly positive for estrogen receptors.     

Primary breast lymphoma.

Primary breast lymphoma (PBL) is a rare tumor of the breast. Three cases of PBL are being described. All three cases achieved remission following biopsy, chemotherapy, and/or radiotherapy. The literature is extensively reviewed with emphasis on true incidence of PBL and survival rates.     

乳腺原发性非霍奇金淋巴瘤临床病理分析

目的：报道5例乳腺原发性非霍奇金淋巴瘤（PBNHL）探讨其临床病理特点、诊断和鉴别诊断。方法：对5例乳腺原发性非霍奇金淋巴瘤进行光镜、免疫组化和基因重排检测。结果：镜下肿瘤细胞均弥漫分布，2例瘤细胞中等大，圆形、卵圆形，胞质中等量，核大，染色质细，核仁不明显；2例瘤细胞呈空泡状，核仁明显；2例瘤细胞内可见浆细胞样淋巴细胞，5例核分裂均多见。免疫表型：4例肿瘤细胞均CD20、CD79a和LCA弥漫阳性，CD3和CD45RO灶性阳性。1例仅LCA阳性，而CD20、CD79a、CD3和CD45RO均阴性。结论：乳腺原发性非霍奇金淋巴瘤是一种较罕见的结外恶性淋巴瘤，诊断和鉴别诊断主要依赖其病理形态学特点并结合免疫表型。     

Cellular angiomas of infancy: an ultrastructural study of two cases.

Vascular tumors in infants may be clinically disfiguring, requiring surgical intervention. Some of these lesions are histopathologically worrisome, due to increased cellularity and mitotic activity. The interpretation of these lesions is hampered by a surfeit of terminology, although, regardless of the diagnostic name, they are clinically benign. Two such cellular angiomas are reported, one typical and one unusual case. Electron microscopy of both cases demonstrated a heterogeneous cellular composition, primarily endothelial cells and pericytes. In those light microscopic areas of diffuse growth, primitive vascular structures were resolved. Electron microscopy may be diagnostically useful in supporting the light microscopic impression of a vascular tumor.     

Primary Malignant Lymphoma of the Breast： a Study of 15 Cases and Review of the Chinese Literature

OBJECTIVE To study the clinical features and significant prognostic factors for primary breast lymphoma (PBL).METHODS A retrospective clinical analysis of 15 patients with PBL and a statistical analysis of 134 cases with PBL were performed.RESULTS All 15 patients, but one, were female with a median age of 42years. None were diagnosed with PBL preoperatively. Pathological studyshowed that all cases were non-Hodgkin‘s lymphoma with the DLCL type(53.3%). The right breast was affected in 10 patients, the left in 4 and both inone. A statistical analysis showed that the size of tumors and treatmentpattern (single or multi-modality) were significant prognostic factors inpredicting the survival time, but the location of the tumor at initialpresentation and the age of the patients were not.CONCLUSION Most PBLs are NHL. The right breast is more frequently involved. The correct diagnosis depends mostly on postoperative pathology. The size of the tumor and the modality of treatment are significant prognostic factors.     

Primary malignant melanoma of the vagina: study of four autopsy cases with ultrastructural findings.

Four cases of primary malignant melanoma of the vagina in women aged 23, 44, 51 and 65 years are presented. In these 4 cases, thorough clinical and postmortem examinations ruled out the possibility of a primary melanoma elsewhere. The primary tumors showed exophytic growth with superficial ulceration. Three of the melanomas arose from the middle third of the vagina and one from the upper third. Melanin was visible in sections stained with hematoxylin and eosin in 3 of the tumors. In the other one, the first biopsy failed to reveal melanin. However, the second biopsy performed following irradiation showed abundant melanin pigment. Electron microscopic examination of 3 tumors revealed premelanosomes and melanosomes in the tumor cells, thus confirming the diagnosis. Two neoplasms showed atypical histologic features, and only the presence of melanin enabled us to make diagnosis of malignant melanoma. One melanoma was associated with an adjacent widespread intraepithelial component of superficial spreading type indicating its probable mode of origin. All 4 patients died of widespread metastases within 13 months after initial treatment. These 4 cases, in which clinical diagnosis was confirmed by thorough autopsy, strongly indicate that malignant melanoma can arise directly from the vagina.     

Primary ovarian lymphoma: report of two cases and review of the literature

Ovarian lymphoma is a rare entity. Clinicians should be aware of its clinical manifestations and management since surgery alone often is not adequate treatment. Here, we present two cases of ovarian lymphoma and discuss what is known about ovarian lymphoma.     

Primary Testicular NK/T-Cell Lymphoma：A Study of Two Cases and Review of Literature

Primary testicular NK/T-cell lymphoma is an extremely rare entity progressed rapidly. The aim of this study was to examine clinical and pathological features of primary testicular NK/T-cell lymphoma and to investigate the effective diagnosis and prognosis. In this paper, the two cases of primary testicular NK/T-cell lymphoma were observed by light microscopy, immunohistochemistry and examined by in situ hybridization for Epstein-Barr Virus (EBV) DNA and the literatures were reviewed. The two patients respectively present with bilateral and right-side painless testicular enlargement. The morphology of neoplastic cells of case 1 were small to medium, tumor cells of case 2 were small, medium and large mixed. The tumor cells grew diffusely with irregular and distort nuclear, destructed the organizational structure of the normal testis, and damaged blood vessels, meanwhile, coagulation necrosis was exist. Immunohistochemical staining of neoplastic cells showed positive for CD45, CD2, CD56, CD3ɛ (cytoplasm staining pattern), CD45RO and Granzyme B, and negative for CD57, CD20, CD79α, CD30, CK, MPO, TdT, Bcl-2 and PLAP were negative. In addition, the EBV DNA was detected in the lymphoma by In situ hybridization. In conclusion, the expression of CD56, CD3ɛ, and Granzyme B associated proteins and EBV examination by in situ hybridization play a vital role in diagnosis and differential diagnosis of primary testicular NK/T-cell lymphoma.     

21例原发乳腺弥漫大B细胞淋巴瘤的临床分析

  目的  探讨原发乳腺弥漫大B细胞淋巴瘤（primary breast diffuse large B cell lymphoma,PB-DLBCL）的临床特征、治疗方案及预后因素。  方法  回顾性分析2010年1月至2018年1月郑州大学第一附属医院收治的21例PB-DLBCL患者的临床病理资料。所有患者均为女性,中位年龄为49（21~77）岁,均接受化疗,其中17例接受CHOP方案,4例接受EPOCH方案。8例接受化疗序贯放疗,13例接受单纯化疗。采用Kaplan-Meier法及Cox回归模型进行多因素分析。  结果  21例患者无痛性肿块为主要表现。5年总生存率（overall survival,OS）和无进展生存率（progressione-free survival,PFS）分别为74%和66%。EPOCH方案与CHOP方案之间在复发或进展上的差异无统计学意义（P=0.603）。行预防性鞘内注射的患者无中枢神经系统复发,未行鞘内注射患者有2例中枢神经系统复发,差异无统计学意义（P=0.232）。单因素及多因素分析结果均显示,β2微球蛋白（HR=0.431,95%CI为0.432~ 0.967,P=0.044）和放疗（HR=0.495,95%CI为1.073~2.508,P=0.002）与PB-DLBCL的OS均相关。  结论  PB-DLBCL好发于女性,多累及单侧乳腺,主要表现为无痛性肿块。β2微球蛋白水平为不良的预后因素。化疗联合放疗可显著提高患者的生存期。鞘内注射对于预防中枢神经系统淋巴瘤的复发可能具有意义。      

原发性乳腺非霍奇金淋巴瘤

原发性乳腺非霍奇金淋巴瘤（PNHLB）临床少见,占所有乳腺恶性肿瘤的0．04％～1．10％,占所有非霍奇金淋巴瘤（NHL）的0．39％。好发于中年女性,无特征性临床表现,诊断依赖病理。弥漫性大B细胞淋巴瘤是最常见的病理类型。以化疗为主的综合治疗疗效较好。手术的主要目的在于取得组织标本以明确诊断。预后可能与分期及年龄有关。     

原发性乳腺淋巴瘤

恶性淋巴瘤为一全身性疾病,好发于淋巴结。结外器官发病率低,其中以消化道、肺等部位相对多见。乳腺恶性淋巴瘤临床少见,且以转移性肿瘤（Secondly breast lymphoma,SBL）为主。原发性乳腺恶性淋巴瘤（Primary breast lymphoma,PBL）极少见,仅占乳腺恶性肿瘤的0．04％-0．53％,占恶性淋巴瘤的0．38％-0．70％。PBL多见于50岁以上妇女,以B细胞来源为主,右侧多见,少数为双侧发病。病因尚不明确。与乳腺癌相比,临床表现和影像学检查均无特异性。确诊主要依靠细针穿刺或术后病理检查。预后差,易早期局部复发或远处转移。现有研究趋向于以CHOP方案化疗为主的综合治疗方案,避免采用扩大的手术治疗。很多学者建议早期鞘内注射化疗。     

Primary lymphoma of the breast: breast mass as an initial symptom.

Seven patients with lymphoma presenting as a breast mass are described. Four of them fulfilled the criteria for primary lymphoma of the breast, and three had evidence of secondary lymphoma of the breast. Two patients were diagnosed with stage IAE disease, and both did well with local treatment with or without chemotherapy. Two patients were diagnosed with stage IIAE disease; both had distant failure without systemic chemotherapy. Although local treatment is curative in a subset of stage IAE disease, combination chemotherapy followed by local radiation is a safer approach. For stage IIAE disease, combination chemotherapy and local radiation therapy should be considered.     

Primary lymphoma of the breast

Primary lymphoma of the breast is a rare finding. Two cases and a review of the literature are presented.     

乳腺原发性恶性淋巴瘤

目的 分析10例乳腺原发性淋巴瘤的临床病理特点、治疗方法及治疗效果。方法 10例乳腺原发恶性淋巴瘤,其中ⅠE期6例,ⅡE期3例,Ⅳ期1例。低度恶性3例,中度恶性6例 ,高度恶性1例。其中4例行乳腺肿块切除加化疗或不加放疗,4例行乳腺单纯切除加腋淋巴结清扫术加或不加化疗,2例行乳腺癌根治术加或不加化疗。结果 全组5年生存率为60．0％,5年无瘤生存率为50．0％,远处转移发生率为40．0％。低度恶性组5年生存为3／3,中度恶性组5年生存为3／6,高度恶性组5年生存为0／1。ⅠE 期5年生存为5／6,ⅡE期5年生存为1／3,Ⅳ期5年生存为0／1。手术联合化疗组5年生存为6／7,手术未联合化疗组5年生存为0／3。乳腺肿块直径＜5cm者5年生存为4／6,乳腺肿块直径≥5cm者5年 生存为2／4。结论 Ann-Arobr分期、病理类型、治疗方式及原发肿块大小为原发性乳腺恶性淋巴瘤的预后因素。治疗应强调手术、化疗及放疗的综合治疗。     

Primary breast lymphoma

Primary breast lymphoma is a rare form of extranodal lymphoma, defined by the presence of a primary lesion within the breast with or without regional nodal involvement but no other extra-mammary sites of involvement. It comprises diverse histologic subtypes, but diffuse large B-cell lymphoma is the most common. In this review, we describe in detail the clinical features, diagnosis and staging, pathogenesis, risk factors and therapy of primary breast diffuse large B-cell lymphoma. We consider choice and number of cycles of chemotherapy, the indications for radiotherapy and discuss the need for central nervous system prophylaxis. We also provide a brief overview of the less commonly encountered histologic subtypes including marginal zone, follicular, Burkitt and breast implant associated anaplastic large cell lymphoma. We conclude with a suggested treatment approach and potential areas of future research.     

Primary breast lymphoma

Primary breast lymphoma (PBL) is a rare form of localized extranodal lymphoma. Few reports are available in the literature concerning its treatment and outcome. Of the 34 cases of PBL seen at our institution over a 25-year period, 20 consecutive cases were treated with CHOP or CHOP-like chemotherapy regimen and had adequate biopsy specimens for histological review. All these 20 PBL were of B-cell origin including one case of Burkitt lymphoma, and 2 cases of low-grade histologic type. Sixteen of the 20 patients achieved a complete remission (CR) and 2 achieved a partial remission (PR) (>75% tumor regression). Two patients had progressive disease while on therapy. With a median follow-up period of 80 months, 6 patients relapsed. Median time to relapse from diagnosis was 23 months (range, 3-41 months). Two of the relapses involved the central nervous system (CNS): isolated CNS relapse in one case and associated with other relapse sites in 1 case. The two patients who achieved a PR after chemotherapy also had disease progression to the CNS, 4 and 8 months after the end of CHOP chemotherapy. All 4 patients died of their disease 3, 6, 10 and 13 months after CNS involvement. Of the 16 centroblastic diffuse large B-cell lymphoma (DLCL), 3 had CNS disease at relapse. Three (15%) of our study patients developed a controlateral breast relapse. Twelve of the initial 20 patients were alive, including 11 with a persistent CR, 6 patients died of their lymphoma and 2 of unrelated diseases. In conclusion, we observed a high incidence of CNS relapse in this group of localized extranodal lymphoma, strongly suggesting that CNS prophylaxis should be associated with systemic chemotherapy in localized PLB.     

原发性乳腺淋巴瘤

恶性淋巴瘤为一全身性疾病,好发于淋巴结.结外器官发病率低,其中以消化道、肺等部位相对多见.乳腺恶性淋巴瘤临床少见,且以转移性肿瘤(Secondly breast lymphoma,SBL)为主.原发性乳腺恶性淋巴瘤(Primary breast lymphoma,PBL )极少见,仅占乳腺恶性肿瘤的0.04%-0.53%,占恶性淋巴瘤的0.38%-0.70%.PBL多见于50岁以上妇女,以B细胞来源为主,右侧多见,少数为双侧发病.病因尚不明确.与乳腺癌相比,临床表现和影像学检查均无特异性.确诊主要依靠细针穿刺或术后病理检查.预后差,易早期局部复发或远处转移.现有研究趋向于以CHOP方案化疗为主的综合治疗方案,避免采用扩大的手术治疗.很多学者建议早期鞘内注射化疗.     

乳腺原发性淋巴瘤的临床病理及预后

目的 对乳腺原发性淋巴瘤的临床病理诊断、免疫表型进行分析.方法 对1998年1月至2007年5月诊治的乳腺原发性淋巴瘤8例,回顾性分析其临床表现、病理特征及免疫组织化学标记分型.结果 8例乳腺原发性淋巴瘤中,弥漫性大B细胞淋巴瘤5例,黏膜相关淋巴组织淋巴瘤2例,淋巴浆细胞性淋巴瘤1例.免疫组织化学标记,LCA、CD20、CD79a肿瘤细胞膜阳性;CD45RO、CD3、CD23、CD10、CD5肿瘤细胞阴性.临床分期,5例为ⅠE期,3例为ⅡE期.采用CHOP方案化疗,随访2～110个月,其中1例随访108个月后,另一侧乳腺肿瘤复发.结论乳腺原发性淋巴瘤主要为B细胞淋巴瘤,以弥漫性大B细胞淋巴瘤和黏膜相关淋巴组织淋巴瘤较多见,而淋巴浆细胞性淋巴瘤少见.对于临床ⅠE期和ⅡE期的早期患者,采用CHOP方案化疗有较好的治疗效果.