Primary breast lymphoma cytologic diagnosis

Lymphoepithelioma-like Carcinoma of the Breast: A Case Report

Lymphoepithelioma-like carcinoma carries similar histopathological features with lymphoepithelioma typically located in the nasopharynx. Lymphoepithelioma-like carcinoma of the breast can be mistaken for breast lymphoma or medullary carcinoma due to the undifferentiated appearance of tumor cells and presence of prominent lymphoid component. Lymphoepithelioma-like carcinoma is rare, and the similarity between medullary carcinoma of the breast makes it difficult to distinguish these two tumors. In the presented case, neither lymph node nor distant metastases were detected. Breast lymphoepithelioma-like carcinoma is extremely rare with only 21 reported cases in the literature. Herein we present a 59-year-old woman with lymphoepithelioma-like carcinoma of the breast along with the cases previously published in the literature.

A primary nipple lymphoma diagnosed by a modified fine-needle aspiration method

Primary breast lymphomas are uncommon. All reported primary breast lymphomas were in the breast parenchyma. Here we reported the first case of primary nipple lymphoma in a 76-year-old woman initially diagnosed using a modified fine-needle aspiration method. The aspirated material by this method had yielded adequate material for both cytomorphologic and flowcytometric analysis, as well as for molecular analysis of light chain rearrangement. In smears the atypical lymphocytes were predominantly middle-sized with irregular nuclei. Scattered large centroblast or immunoblast-like cells, a few reactive lymphocytes,histocytes, and few plasma cells were also observed. These findings suggested a low-grade lymphoma that was further confirmed by flow cytometry (CD19+/CD3-, positive for cytoplasmic kappa light chain but negative for lambda light chain) and molecular analysis (monoclonal rearrangement of immunoglobulin kappa chain). Immunohistochemical stains performed on the excised specimen showed that the tumor cells were positive forCD20 and CD79a but negative for cytokeratin, CD3, CD5,CD10, CD23, CD43, CD45RO, bcl-6, and cyclin-D1. The Ki-67 proliferation index was less than 20%. Taking these together, the case was diagnosed as a primary MALT lymphoma of the nipple.FNA usually provides a better cell morphology than tissue sections, but pathologists have to face the sampling error and lack of immunophenotype information when subtyping lymphoma issues using FNA. With the help of flow cytometry and molecular analysis, more and more trials have proved the accuracy of FNA in diagnosis of lymphomas. Therefore, FNA could play an informative and diagnostic role in diagnosis of lymphoma

Primary breast lymphoma with sudden death

Primary breast lymphoma is a rare form of extranodal lymphoma. B cells constitute the most common type involving the breast. T cells represents only 3%. Even though lymphomas have a high predilection to metastasize to the heart, there are no specific clinical or radiological findings, and most of the cases are diagnosed at autopsy. We discuss the case of a 49-year-old woman with primary breast lymphoma who presented with sudden death. Autopsy revealed a primary T-cell lymphoma of the breast with tumoral infiltration of the atrioventricular node and transmural myocardial permeation with focal necrosis.

Synchronous carcinoma and lymphoma of the breast

Primary breast lymphoma is a rare entity. Furthermore, extranodal marginal zone B-cell lymphoma affecting the breast is exceedingly rare. We report a unique case of invasive lobular carcinoma diagnosed simultaneously with an extranodal marginal zone B-cell lymphoma of the breast. A literature review demonstrated 2 reports of synchronous invasive ductal carcinoma and mucosa-associated lymphoid tissue lymphoma affecting the breast; however, there is a paucity of cases demonstrating different malignancies affecting the same breast tissue in a particular patient, especially in the setting of lobular carcinoma. As such, there are no clear guidelines on the optimal management of such synchronous tumors. Herein, the diagnostic and management issues are explored.