Igarashi Tetsuyuki, Ishiguro Kazuya, Takagi Yoshitake, Fujino Michihiro, Tsujisaki Masayuki
Department of Hematology, Tenshi Hospital.
Department of Gastrointestinal medicine, Tenshi Hospital.
Rinsho Ketsueki. 2020;61(11):1584-1589. doi: 10.11406/rinketsu.61.1584.
When a 74-year-old male patient visited our hospital for the treatment of herpes zoster, his computed tomography (CT) revealed a mass in his right breast, axillary lymph node enlargement, and multiple lung nodules. A histological examination of the breast and lymph node biopsies revealed diffuse large B-cell lymphoma (DLBCL) while the bronchial and salivary gland biopsies showed secondary amyloidosis and Sjögren's syndrome (SjS). According to the Ann Arbor staging, the clinical stage of the lymphoma was evaluated as IIE. The patient achieved a complete remission after six cycles of rituximab, pirarubicin, cyclophosphamide, vincristine, and prednisolone (R-THP-COP) combined with intrathecal chemotherapy to prevent meningeal infiltration and irradiation after chemotherapy. Primary breast lymphoma was diagnosed within 2% of the breast tumor. Only sixteen male cases of breast lymphoma have been previously reported. In those reports, gynecomastia and hormonal therapy accounted for nine cases, but none of the cases coexisted with SjS. The present case is suggestive of the need to investigate possible autoimmune involvement in the development of lymphoma.
一名74岁男性患者因带状疱疹来我院就诊时，其计算机断层扫描（CT）显示右乳有肿块、腋窝淋巴结肿大及多个肺结节。乳腺及淋巴结活检的组织学检查显示为弥漫性大B细胞淋巴瘤（DLBCL），而支气管及唾液腺活检显示继发性淀粉样变性和干燥综合征（SjS）。根据Ann Arbor分期，淋巴瘤的临床分期评估为IIE期。该患者在接受6个周期的利妥昔单抗、吡柔比星、环磷酰胺、长春新碱和泼尼松龙（R-THP-COP）联合鞘内化疗以预防脑膜浸润及化疗后放疗后实现了完全缓解。原发性乳腺淋巴瘤占乳腺肿瘤的比例不到2%。此前仅报道过16例男性乳腺淋巴瘤病例。在那些报道中，男性乳房发育症和激素治疗占9例，但无一例与SjS共存。本病例提示有必要研究自身免疫在淋巴瘤发生中的可能作用。
