Login Register Cart 0
Generic placeholder image

Current Medical Imaging

Editor-in-Chief

ISSN (Print): 1573-4056
ISSN (Online): 1875-6603

Back
Journal Home About Journal Editorial Board Journal Insight Current Issue Volumes/Issues
Subscribe
Research Article

Sonographic Features of Primary Breast Lymphoma: An Analysis of 10 Cases

Author(s): Xinying Liu, Jingyun Liu* and Shuangxi Chen

Volume 19, Issue 6, 2023

Published on: 05 September, 2022

Article ID: e160822207521 Pages: 8

DOI: 10.2174/1573405618666220816105051

Price: $65

Abstract

Background: Primary breast lymphoma (PBL) is a rare malignant breast tumor. The literature concerning PBL ultrasound is based primarily on case reports, with only a few cases reported to date.

Purpose: This study aimed to elucidate the sonographic characteristics of PBL and explore the value of ultrasonography in the preoperative diagnosis of PBL using the Breast Imaging Reporting and Data System (BI-RADS).

Methods: A retrospective review of files involving a diagnosis of PBL (2013–2020) was conducted in the Department of Pathology, Zhejiang Provincial People’s Hospital, Hangzhou, and the First Affiliated Hospital of Wenzhou Medical University, Wenzhou. The clinical characteristics and sonographic features of 12 lesions in 10 patients were analyzed and discussed in light of the literature.

Results: All patients, aged 50.40 ± 14.31 years (range 30–66 years), had clinically palpable lumps. Most cases were on the right breast and were unilateral. Only one patient had mucosa-associated lymphoma. The histological type of the other patients was diffuse large B-cell lymphoma (DLBCL). Ultrasonography revealed nodular and diffuse PBL lesions without internal calcification. The nodular PBL was hypoechoic or mixed hypo- to hyperechoic, with a differential lobulated shape and horizontal growth. Although color Doppler flow imaging (CDFI) showed no significant features, the ultrasound findings were categorized as BI-RADS 4 in 10 of the 12 lesions and BI-RADS 5 in two lesions. All patients were suspected of having malignancies (BI-RADS 4 or 5).

Conclusion: PBL was mostly found in middle-aged and elderly women, and the right breast was more prone to the development of malignancies. PBL lesions were classified as either nodular or diffuse based on the boundaries of the tumors in the ultrasound images. Typical PBL was characterized by hypoechoic or heterogeneous lesions with circumscribed or microlobulated margins and horizontal growth. The sonographic features of the PBL lesions and the BI-RADS categorizations of the lesions analyzed suggested malignancy.

Keywords: Primary breast lymphoma, PBL, ultrasound, the breast imaging reporting and data system, BI-RADS, diffuse large B-cell lymphoma, DLBCL, color Doppler flow imaging, CDFI.

Graphical Abstract

[1]
Wiseman C, Liao KT. Primary lymphoma of the breast. Cancer 1972; 29(6): 1705-12.
[http://dx.doi.org/10.1002/1097-0142(197206)29:6<1705:AID-CNCR2820290640>3.0.CO;2-I] [PMID: 4555557]
[2]
El Khoury M, Maietta A, Tran A, Trop I, Lalonde L, Mesurolle B. Case 285: Primary breast lymphoma. Radiology 2021; 298(1): 231-6.
[http://dx.doi.org/10.1148/radiol.2020191329] [PMID: 33347397]
[3]
Avenia N, Sanguinetti A, Cirocchi R, et al. Primary breast lymphomas: A multicentric experience. World J Surg Oncol 2010; 28: 53.
[http://dx.doi.org/10.1186/1477-7819-8-53]
[4]
Jonckheere S, Depypere H, Standaert C. Breast Lymphoma: Teaching point: Primary breast lymphoma is a rare disease, especially in males, but should be considered in the differential diagnosis of a breast mass because of the different treatment and prognosis. J Belg Soc Radiol 2019; 103(1): 26.
[http://dx.doi.org/10.5334/jbsr.1769] [PMID: 30993257]
[5]
Herráez-Albendea MM, Jarilla-Fernández MC, Jiménez-Burgos FJ. Primary breast lymphoma: A case report. Rev Bras Hematol Hemoter 2017; 39(1): 89-90.
[http://dx.doi.org/10.1016/j.bjhh.2016.09.011] [PMID: 28270358]
[6]
Cheah CY, Campbell BA, Seymour JF. Primary breast lymphoma. Cancer Treat Rev 2014; 40(8): 900-8.
[http://dx.doi.org/10.1016/j.ctrv.2014.05.010] [PMID: 24953564]
[7]
Peng F, Li J, Mu S, et al. Epidemiological features of primary breast lymphoma patients and development of a nomogram to predict survival. Breast 2021; 57: 49-61.
[http://dx.doi.org/10.1016/j.breast.2021.03.006] [PMID: 33774459]
[8]
Yang WT, Lane DL, Le-Petross HT, Abruzzo LV, Macapinlac HA. Breast lymphoma: Imaging findings of 32 tumors in 27 patients. Radiology 2007; 245(3): 692-702.
[http://dx.doi.org/10.1148/radiol.2452061726] [PMID: 17911538]
[9]
Zhang XH, Xiao C. Diagnostic value of nineteen different imaging methods for patients with breast cancer: A network meta-analysis. Cell Physiol Biochem 2018; 46(5): 2041-55.
[http://dx.doi.org/10.1159/000489443] [PMID: 29723846]
[10]
Bevers TB, Anderson BO, Bonaccio E, et al. NCCN clinical practice guidelines in oncology: Breast cancer screening and diagnosis. J Natl Compr Canc Netw 2009; 7(10): 1060.
[http://dx.doi.org/10.6004/jnccn.2009.0070] [PMID: 19930975]
[11]
Davis J, Liang J, Roh A, et al. Use of breast imaging-reporting and data system (BI-RADS) ultrasound classification in pediatric and adolescent patients overestimates likelihood of malignancy. J Pediatr Surg 2021; 56(5): 1000-3.
[http://dx.doi.org/10.1016/j.jpedsurg.2020.12.025] [PMID: 33494944]
[12]
Mouna B, Saber B. Primary malignant non-Hodgkin’s lymphoma of the breast: A study of seven cases and literature review. World J Surg Oncol 2012; 151.
[http://dx.doi.org/10.1186/1477-7819-10-151]
[13]
Lyou CY, Yang SK, Choe DH, Lee BH, Kim KH. Mammographic and sonographic findings of primary breast lymphoma. Clin Imaging 2007; 31(4): 234-8.
[http://dx.doi.org/10.1016/j.clinimag.2007.02.028] [PMID: 17599616]
[14]
National Center for Ultrasonic Medical Quality Control, Chinese Medical Association Medical Ultrasond Branch. Expert consensus on quality control of ultrasound examination of breast diseases(2019). Chinese Journal of Ultrasonography 2020; 29(1): 1-5.
[http://dx.doi.org/10.3760/cma.j.issn.1004-4477.2020.01.001]
[15]
Gluskin J, D’Alessio D, Kim AC, Morris EA, Chiu A, Noy A. Primary lymphoma of the breast: A report of two cases. Clin Imaging 2020; 68: 295-9.
[http://dx.doi.org/10.1016/j.clinimag.2020.08.008] [PMID: 32961512]
[16]
Mason HS, Johari V, March DE, Crisi GM. Primary breast lymphoma: Radiologic and pathologic findings. Breast J 2005; 11(6): 495-6.
[http://dx.doi.org/10.1111/j.1075-122X.2005.00167.x] [PMID: 16297110]
[17]
Sabaté JM, Gómez A, Torrubia S, et al. Lymphoma of the breast: Clinical and radiologic features with pathologic correlation in 28 patients. Breast J 2002; 8(5): 294-304.
[http://dx.doi.org/10.1046/j.1524-4741.2002.08509.x] [PMID: 12199758]
[18]
Franco F, González-Rincón J, Lavernia J, et al. Mutational profile of primary breast diffuse large B-cell lymphoma. Oncotarget 2017; 8(61): 102888-97.
[http://dx.doi.org/10.18632/oncotarget.21986] [PMID: 29262531]
[19]
Jia Y, Sun C, Liu Z, Wang W, Zhou X. Primary breast diffuse large B-cell lymphoma: A population-based study from 1975 to 2014. Oncotarget 2017; 9(3): 3956-67.
[http://dx.doi.org/10.18632/oncotarget.23285] [PMID: 29423097]
[20]
Seker M, Bilici A, Ustaalioglu BO, et al. Clinicopathologic features of the nine patients with primary diffuse large B cell lymphoma of the breast. Arch Gynecol Obstet 2011; 284(2): 405-9.
[http://dx.doi.org/10.1007/s00404-010-1683-y] [PMID: 20872226]
[21]
Stasi R, Evangelista ML, Brunetti M, et al. Analysis of differential therapeutic strategies for primary breast lymphoma: Two case reports. Med Oncol 2009; 26(1): 22-6.
[http://dx.doi.org/10.1007/s12032-008-9073-z] [PMID: 18461288]
[22]
Radkani P, Joshi D, Paramo JC, Mesko TW. Primary breast lymphoma: 30 years of experience with diagnosis and treatment at a single medical center. JAMA Surg 2014; 149(1): 91-3.
[http://dx.doi.org/10.1001/jamasurg.2013.2283] [PMID: 24257833]
[23]
Hosein PJ, Maragulia JC, Salzberg MP, et al. A multicentre study of primary breast diffuse large B-cell lymphoma in the rituximab era. Br J Haematol 2014; 165(3): 358-63.
[http://dx.doi.org/10.1111/bjh.12753] [PMID: 24467658]
[24]
Chen Y, Zhou JH, Fan HX, Luo Y, Peng YL, Ma BY. Ultrasound diagnosis of breast lymphoma and the identification of breast infiltrating ductal carcinoma. J Ultrasound Med 2020; 39(6): 1203-11.
[http://dx.doi.org/10.1002/jum.15209] [PMID: 31891216]
[25]
Jennings WC, Baker RS, Murray SS, et al. Primary breast lymphoma: The role of mastectomy and the importance of lymph node status. Ann Surg 2007; 245(5): 784-9.
[http://dx.doi.org/10.1097/01.sla.0000254418.90192.59] [PMID: 17457172]
[26]
Surov A, Holzhausen HJ, Wienke A, et al. Primary and secondary breast lymphoma: Prevalence, clinical signs and radiological features. Br J Radiol 2012; 85(1014): e195-205.
[http://dx.doi.org/10.1259/bjr/78413721] [PMID: 22665932]
[27]
Wadhwa A, Senebouttarath K. Primary lymphoma of the breast: A case series. Radiol Case Rep 2018; 13(4): 815-21.
[http://dx.doi.org/10.1016/j.radcr.2018.04.009] [PMID: 29988973]
[28]
Picasso R, Tagliafico A, Calabrese M, et al. Primary and secondary breast lymphoma: Focus on epidemiology and imaging features. Pathol Oncol Res 2020; 26(3): 1483-8.
[http://dx.doi.org/10.1007/s12253-019-00730-0] [PMID: 31428995]
[29]
Yoneyama K, Nakagawa M, Hara A. Primary lymphoma of the breast: A case report and review of the literature. Radiol Case Rep 2020; 16(1): 55-61.
[http://dx.doi.org/10.1016/j.radcr.2020.10.039] [PMID: 33193929]
[30]
Abeywardhana DY, Nascimento VC, Dissanayake D, et al. Review of ultrasound appearance in inflammatory breast cancer: A pictorial essay. J Med Imaging Radiat Oncol 2016; 60(1): 83-7.
[http://dx.doi.org/10.1111/1754-9485.12418] [PMID: 26631841]

Rights & Permissions Print Cite
Article Metrics
3
© 2024 Bentham Science Publishers | Privacy Policy