Yadav Kusum, Gupta Nidhi, Sharma Akanksha, Kumar Manish
Pathology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, IND.
Pathology, Dr. KNS Memorial Institute of Medical Sciences, Lucknow, IND.
Cureus. 2024 Aug 29;16(8):e68152. doi: 10.7759/cureus.68152. eCollection 2024 Aug.
Background Breast carcinoma is the most common cause of death in women arising primarily from either epithelial or stromal components. Primary breast lymphoma (PBL) is a less common type of neoplasm arising from the lymphoid tissue and is classified as non-Hodgkin's lymphoma (NHL). PBL is a rare tumor that accounts for less than 1% of total primary malignant neoplasms of the breast. The majority of PBLs are of B-cell origin; the most common histological type is diffuse large B-cell lymphoma (DLBCL) followed by follicular lymphoma (FL) and other T-cell and B-cell lymphomas. Material and methods We conducted this five-year retrospective descriptive PBL study from July 2019 to May 2024 at a tertiary care center in North India. We included 11 cases of diagnosed PBL based on morphology and confirmation by at least one lymphoid differentiation marker, that is, leukocyte common antigen (LCA) We retrieved paraffin-embedded blocks from the archive and conducted routine hematoxylin and eosin (H&E) staining and Leishman's stain. We applied an extended immunohistochemistry (IHC) panel to confirm the microscopic findings We used the Dako (Agilent Diagnostics & Genomics Group) antibody with a dilution of 1:100. Results In this study, patients' mean age was 46.8 years (32 to 84 years). Radiological findings indicated that the tumor was indistinguishable from carcinoma. Microscopic findings showed that cells were medium to large lymphoid cells displaying moderate pleomorphism, centrally placed nuclei, vesicular to coarsely clumped chromatin, and scant cytoplasm. IHC showed one case of T-cell origin (ALCL) and 10 of B-cell origin. Among the B-cell cases, four were DLBCL, four were high-grade NHL likely DLBCL and two were high-grade lymphoma. Conclusion Primary breast lymphoma is a rare tumor that closely resembles breast carcinoma clinically as well as radiologically. This study is an effort to highlight the importance of clinical, radiological, and histopathological parameters as well as immunohistochemical features in confirming diagnosis. We also emphasize a treatment protocol and survival outcome in hopes that this knowledge will provide an understanding of early diagnosis and proper management of disease.
背景 乳腺癌是女性最常见的死亡原因，主要起源于上皮或基质成分。原发性乳腺淋巴瘤（PBL）是一种较少见的起源于淋巴组织的肿瘤，被归类为非霍奇金淋巴瘤（NHL）。PBL是一种罕见肿瘤，占乳腺原发性恶性肿瘤总数的不到1%。大多数PBL起源于B细胞；最常见的组织学类型是弥漫性大B细胞淋巴瘤（DLBCL），其次是滤泡性淋巴瘤（FL）以及其他T细胞和B细胞淋巴瘤。
材料与方法 我们于2019年7月至2024年5月在印度北部的一家三级医疗中心开展了这项为期五年的回顾性描述性PBL研究。我们纳入了11例经形态学诊断并经至少一种淋巴样分化标志物（即白细胞共同抗原（LCA））证实的PBL病例。我们从档案中检索石蜡包埋块，并进行常规苏木精和伊红（H&E）染色及利什曼染色。我们应用扩展免疫组织化学（IHC）检测组来确认显微镜检查结果。我们使用稀释度为1:100的达科（安捷伦诊断与基因组学集团）抗体。
结果 在本研究中，患者的平均年龄为46.8岁（32至84岁）。影像学检查结果表明该肿瘤与癌难以区分。显微镜检查结果显示细胞为中等至大的淋巴样细胞，表现出中度多形性、核位于中央、核染色质呈泡状至粗块状，且胞质稀少。免疫组化显示1例起源于T细胞（间变性大细胞淋巴瘤（ALCL）），10例起源于B细胞。在B细胞病例中，4例为DLBCL，4例为可能是DLBCL的高级别NHL，2例为高级别淋巴瘤。
结论 原发性乳腺淋巴瘤是一种罕见肿瘤，在临床和影像学上与乳腺癌极为相似。本研究旨在强调临床、影像学和组织病理学参数以及免疫组化特征在确诊中的重要性。我们还强调了治疗方案和生存结果，希望这些知识能有助于对疾病的早期诊断和正确管理。
