Follicular Lymphoma

History: An 84-year-old female presents for asymptomatic screening mammogram.

Findings: 

Figure 1: Craniocaudal and MLO views of the right breast on demonstrate stable appearance of an intramammary lymph node in the upper outer quadrant.

Figure 2: Craniocaudal and MLO views of the right breast at subsequent one-year follow-up demonstrate increased size of the intramammary lymph node with irregular borders.

Figure 3: Ultrasound evaluation demonstrated that the lymph node was slightly irregular with increased cortical thickness and was hypervascular. The node was biopsied.

Diagnosis:

Pathology demonstrated lymphoid tissue proliferation around irregular germinal centers. Immunohistochemistry was performed demonstrating lymphoid follicles in which the germinal center cells were diffusely positive for CD10, BCL-2, and BCL-6 whereas the interfollicular regions were positive for CD20 and negative for CD5, CD43 or cyclin-D1. CD3 highlights the T-cell areas. MIB-1 proliferative index was high in the germinal centers. The results supported the diagnosis of follicular lymphoma.

Conclusion:

Mammography is used as a screening test for early detection of breast cancer, however occasionally other malignancies or disease processes can be detected and diagnosed as a result of screening mammography. Primary or secondary lymphoma in the breast is a rare entity.^1,2 The estimated incidence of primary breast lymphoma ranges from 0.4 percent to 0.5 percent of all breast malignancies while the incidence of secondary lymphoma is approximately 0.07 percent of all breast malignancies.^1,2,3,4

Thomas Cade Raggio, MD, and Erini Makariou, MD, Georgetown Hospital, Washington DC

References:

1. Duncan VE, Reddy VV, Jhala NC, Chhieng DC, Jhala DN. Non-Hodgkin's lymphoma of the breast: a review of 18 primary and secondary cases. Ann Diagn Pathol. 2006;10:144–148. doi: 10.1016/j.anndiagpath.2005.09.018.

2. Domchek SM, Hecht JL, Fleming MD, Pinkus GS, Canellos GP. Lymphomas of the breast: primary and secondary involvement. Cancer. 2002;94:6–13. doi: 10.1002/cncr.10163

3. Vignot S, Ledoussal V, Nodiot P, Bourguignat A, Janvier M, Mounier N, Cherel P, Floiras JL, Turpin F. Non-Hodgkin's lymphoma of the breast: a report of 19 cases and a review of the literature. Clin Lymphoma. 2005;6:37–42.

4. Anuradha Sinha A, Ramrakhiani D. Primary non-Hodgkin's lymphoma of the breast: a case report. Acta Cytol. 2005;49:661–665.