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Primary MALT lymphoma of the breast. Case presentation

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Primary MALT lymphoma of the breast. Case presentation.

 

C.Sofoudis1   L.Lekakos1     O.Tzaida2   K.Megalakaki3   N.Vlachakos4  

  P.Kalogerakos6  J.Nomikos5    K.Kalogerakos1

1. Breast Unit Metaxa Cancer  Hospital, Piraeus, Greece.

2. Department of Histopathology, Metaxa Cancer  Hospital, Piraeus, Greece.

3.Department of Hematology, Metaxa Cancer  Hospital, Piraeus, Greece.

4. 2nd Department of Surgery,Tzanion General Hospital, Piraeus, Greece.

5.2nd Department of Surgery, Metaxa Cancer  Hospital, Piraeus, Greece.

6. Medical School of Athens

 

Introduction

Primary breast lymphoma (PBL) represents a rare entity accounting for 0.5% of all breast malignancies. The most common histologic type is diffuse large B-cell lymphoma. The definition of PBL requires lymphomatous infiltration of breast parenchyma, absence of previous diagnosis of lymphoma and no extramammary disease other than ipsilateral axillary nodes.

 

Aim of the study

We present a case of primary mucosa-associated lymphoid tissue (MALT) breast lymphoma that was successfully treated.

 

Case

A 63 year old female patient (gravida 8, para 2) presented with a painless, irregular, firm mass, 6X5 cm in dimension, located in the upper outer quadrant of the right breast. The lesion was classified by ultrasound and mammography as BIRADS 4. She underwent a breast FNA that revealed lymphocytes in all stages of maturation. Due to clinical suspicion an FNB was performed, which demonstrated diffuse non-Hodgkin B cell lymphoma. Staging investigations were undertaken in our Hematology Clinic, where whole body PET-CT scan and bone marrow biopsy, did not demonstrate any signs of metastasis or extramammary disease. The breast lump did not respond to her chemotherapy regimen and the patient was referred to the Breast unit where a right wide local excision was performed. Histology confirmed the diagnosis of a non-Hodgkin low grade B cell lymphoma, with MALT morphology. Her postoperative course was unremarkable and the patient was discharged on the 5th pod. She received adjuvant breast RT and her follow up has been uneventful for the past 3 years.

 

 

Discussion

PBL is a rare subtype of extranodal lymphoma that can mimic both clinically and histologically breast carcinoma. The median age of presentation varies from 60 to 65 years. The breast lymphoid cells derive from the breast MALT, namely lymphocytes adjacent to ducts and lobules or the intramammary lymph nodes. The most common clinical presentation consists of a painless mass. Surgery has a limited therapeutic role, with excisional biopsy performed in cases of equivocal core biopsy results. Treatment options include chemotherapy and immunotherapy followed by radiotherapy. Currently, the optimal treatment remains controversial.

 

Conclusion

Although rare, the incidence of PBL is constantly increasing due to improvement in diagnostic techniques and disease awareness. Multidisciplinary team cooperation is of paramount importance in the proper diagnosis and successful management.

 

 

 

 

 

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