Case of the month - December 2007
Discussion
Diagnosis - Diffuse large B cell non-Hodgkin's lymphoma
The thumbnail images alongside remind you of the main features in this biopsy - click on each thumbnail to return to the original images.
The following features are seen:
- Diffuse infiltration by sheets of large malignant cells
- Lack of convincing 'epithelial' architecture
- Large nuclei with prominent nucleoli
- Negative pan CK immunostain
- Positive CD45 and CD20 immunostains
Background information:
- The history was helpful in this case - the tumour was very large and the surgeon had expressed surprise that there was no skin tethering
- The mammogram is often unusual in lymphoma - and may also show bulky axillary nodes
- In this case there was no history of previously diagnosed lymphoma so this seems to be arising de novo in the breast
- This case came very close to being misdiagnosed as a grade 3 carcinoma - the misdiagnosis was averted by a rather unusual cytoplasmic pattern of
ER staining which prompted a review of the original sections and the requesting of supplementary immuno studies
- Consideration will be given to using chemotherapy and/or radiotherapy - they often respond well to standard lymphoma chemotherapy
Additional information:
- Primary lymphomas of the breast are very uncommon
- Usually non-Hodgkin's type; Hodgkin's disease very rare
- Any of the recognised subtypes of non-Hodgin's lymphoma may occur in the breast
