Hematolymphoid Neoplasms of Breast – A Case Series with Review of Lymphoid Cell Rich Lesions of Breast

Abha Thakur; Ruchika K Goel; Rashi Sharma

doi:10.21276/apalm.3168

Abha Thakur Department of Pathology and Laboratory medicine Medanta The Medicity, Gurgaon
Ruchika K Goel Department of Pathology and Laboratory medicine Medanta The Medicity, Gurgaon
Rashi Sharma Department of Pathology and Laboratory medicine Medanta The Medicity, Gurgaon

DOI: https://doi.org/10.21276/apalm.3168

Keywords: Breast, lymphoma, myeloid sarcoma, plasmacytoma, hematolymphoid neoplasm

Abstract

Objective: Hematolymphoid neoplasms involving breast (HLNB) are rare with majority of lesions in breast being epithelial in nature. There are no characteristic clinical and radiologic features to distinguish breast carcinomas from HLNB. However, it is essential to recognise lesion as hematolymphoid in nature for appropriate patient management. This case series highlights clinical, radiologic, and pathologic features of HLNB of breast. Methods: Clinical data (age, sex, laterality, site and size of breast tumor, interval of secondary breast involvement, stage, treatment and clinical follow up), radiologic and pathologic features of patients with HLNB over a period of 6 years (2014-20) were recorded. Pathologic differential diagnosis of lymphoid cell rich lesions of breast are also discussed. Results: Six cases of HLNB were identified during this period. This constitutes 0.22 % of malignancies of breast, 0.4% of non-Hodgkin lymphoma (NHL), 1.2% of extra nodal NHL and one case each of myeloid sarcoma and plasmacytoma. Conclusion: HLNB are extremely rare and histologically mimics numerous other entities, which may be misdiagnosed without immunohistochemical evaluation. Thus, it is critical for a pathologist to be aware of the diagnostic features and pitfalls to avoid misinterpretation.

References

Harris NL, Jaffe ES. Lymphoid and haematopoietic tumours. In: Lakhani SR, Ellis IO, Schnitt SJ, Tan PH, Vijver MJ, editors. WHO classification of tumours of the breast. 4th ed. Lyon: IARC; 2012.p.155-60.

Topalovski M, Crisan D, Mattson JC. Lymphoma of the breast. A clinicopathologic study of primary and secondary cases. Arch Pathol Lab Med 1999; 123(12):1208-18.

Hoffman J, Ohgami RS. Hematolymphoid lesions of the breast. Semin diagn Pathol 2017; 34(5):462-9.

Wiseman C, Liao KT. Primary lymphoma of the breast. Cancer 1972; 29(6):1705–12.

Surov A, Holzhausen HJ, Wienke A, Schmidt J, Thomssen C, Arnold D et al. Primary and secondary breast lymphoma: prevalence, clinical signs and radiological features Br J Radiol. 2012; 85(1014):195–205.

Maurya V, Singh G, Ram B, Ganguli P. Multimodality imaging features of primary breast lymphoma - A rare entity. Indian J Radiol Imaging 2019; 29(1):85-8.

Domchek SM, Hecht JL, Fleming MD, Pinkus GS, Canellos GP. Lymphomas of the breast: primary and secondary involvement. Cancer 2002; 94(1):6-13.

Guilbert MC, Hornick JL, Chikarmane SA, Lester SC. Hematologic malignancies of the breast: A contemporary series Investigating Incidence, presentation, accuracy of diagnosis on core needle biopsy, and hormone receptor expression. Breast Cancer: Basic and Clinical Research 2019; 13:1-11.

Ishikawa MK, Pinsky RW, Smith LB, Jorns JM. Morphologic mimics of invasive lobular carcinoma. Arch Pathol Lab Med 2015;139(10):1253-7

Valbuena JR, Admirand JH, Gualco G, Medeiros LJ. Myeloid sarcoma involving the breast. Arch Pathol Lab Med 2005; 129(1):32-8.

Pileri SA, Orazi A, Falini B. Myeloid sarcoma. In: Swerdlow SH, CampoE, Harris NL, Jaffe ES, Pileri SA, Stein H, et al, editors. WHO classification of tumors of haematopoietic and lymphoid tissues. Revised 4thed.Lyon: IARC; 2017.p.167-8.