Sawano Toyoaki, Wada Masahiro, Ozaki Akihiko, Hashiguchi Akinori, Hirooka Shinichi, Tanimoto Tetsuya
Department of Surgery, Jyoban Hospital of Tokiwa Foundation, 57 Kaminodai, Jyoban-Kami-Yunagayamachi, Iwaki, Fukushima, Japan.
Breast and Thyroid Center, Jyoban Hospital of Tokiwa Foundation, Iwaki, Fukushima, Japan.
Surg Case Rep. 2024 Oct 8;10(1):234. doi: 10.1186/s40792-024-02032-3.
Primary breast lymphoma (PBL) is a rare type of extranodal lymphoma, the diagnostic process for which presents significant challenges owing to an overlap in clinical and pathological features with those observed in triple-negative breast cancer (TNBC). However, the current literature reveals a paucity of information regarding the ramifications of potential diagnostic errors, particularly in the context of emergent therapeutic strategies for TNBC. Thus, we present a unique report of a case of PBL.
A 76-year-old female with no past medical or family history presented to the hospital with the chief complaint of a mass in the right breast. Two masses were palpated in the right breast: one 56 mm mass (No. 1) located at 10 o'clock, and a 21 mm large, elastic, hard mass (No. 2) at 4 o'clock. Needle biopsy was performed only on the larger 56 mm mass (No. 1). The results showed invasive carcinoma that was negative for estrogen receptor, progesterone receptor, and human epidermal growth factor receptor-2. The preoperative diagnosis was right breast cancer (T3N0M0 Stage IIB) of the TNBC subtype. The patient refused the preoperative chemotherapy recommended by the treatment team; therefore, right breast mastectomy and sentinel lymph-node biopsy were performed instead. The histopathological diagnosis of the first mass was diffuse large B-cell lymphoma (DLBCL); that of the second mass (No. 2) was an invasive breast carcinoma of no special type. Postoperative treatment consisted of endocrine therapy (letrozole) for breast cancer, while the DLBCL was treated with chemotherapy and three courses of intrathecal chemotherapy. At the time of this report, the patient is still living, and neither tumor had recurred in the 2 years following surgery.
On rare occasions, PBL can preoperatively mimic TNBC. While this case did not lead to serious consequences, because surgery was eventually selected as the first therapy, clinicians should be aware that the diagnosis of PBL is challenging using only a core-needle biopsy and can often be misdiagnosed as TNBC.
原发性乳腺淋巴瘤（PBL）是一种罕见的结外淋巴瘤，由于其临床和病理特征与三阴性乳腺癌（TNBC）存在重叠，其诊断过程面临重大挑战。然而，目前的文献显示，关于潜在诊断错误的后果，特别是在TNBC紧急治疗策略背景下的相关信息匮乏。因此，我们报告一例独特的PBL病例。
一名76岁女性，无既往病史及家族病史，因右乳肿块为主诉入院。右乳可触及两个肿块：一个56mm的肿块（1号）位于10点位置，另一个21mm大、有弹性、质地硬的肿块（2号）位于4点位置。仅对较大的56mm肿块（1号）进行了针吸活检。结果显示为浸润性癌，雌激素受体、孕激素受体及人表皮生长因子受体-2均为阴性。术前诊断为TNBC亚型的右乳腺癌（T3N0M0 ⅡB期）。患者拒绝了治疗团队推荐的术前化疗；因此，改为行右乳乳房切除术及前哨淋巴结活检。第一个肿块的组织病理学诊断为弥漫性大B细胞淋巴瘤（DLBCL）；第二个肿块（2号）的诊断为非特殊类型浸润性乳腺癌。术后治疗包括针对乳腺癌的内分泌治疗（来曲唑），而DLBCL采用化疗及三个疗程的鞘内化疗。在撰写本报告时，患者仍在世，术后2年两个肿瘤均未复发。
在极少数情况下，PBL术前可表现类似TNBC。虽然该病例未导致严重后果，因为最终选择手术作为首要治疗方法，但临床医生应意识到，仅通过粗针活检诊断PBL具有挑战性，且常易误诊为TNBC。
