Primary Lymphoma of Breast - Unusual Type - Case Report

PRIMARY LYMPHOMA OF BREAST -UNUSUAL TYPE-A CASE REPORT (ABSTRACT): Introduction: Primary Lymphoma of the breast (PBL) is a rare entity, while secondary involvement of the breast with diffuse disease is more common. While Non Hodgkin Lymphoma type is the usual variant in PBL. We report a case primary Hodgkins lymphoma of the breast. Case Presentation: A 50 yr old woman presented three years ago with multiple lump in her left breast. Core biopsy revealed lymphoma like features. Excision biopsy of the upper outer quadrant lump revealed nodular lymphocytic predominant Hodgkin’s lymphoma (HL). Stage was II A. Chemotherapy resulted in complete remission. Patient was lost in follow up only to return with multiple local recurrences three years after primary treatment. Discussion: Primary NHL breast is rare but primary breast HL is rarer still. Nodular lymphocyte-predominant type of Hodgkin's disease is recognized as an entity distinct from classical Hodgkin's disease with a number of characteristics that suggest its relationship to non-Hodgkin's lymphoma. In histological terms, the differentiation of breast lymphoma cases from breast carcinomas and pseudo lymphoma is important. In our case, though no immunohistochemistry was available, the histological diagnosis was straightforward. Primary breast lymphomas behave similarly to lymphomas of similar histologic types. Treatment wise, the optimal sequence recommended is lumpectomy followed by Radiotherapy or radiotherapy alone for local control and standard anthracycline-based regimens. PBL tends to relapse to CNS; therefore, Computerized Tomography (CT) or Magnetic Resonance (M R) image of CNS is necessary during follow-up. Conclusion: PBL should be treated as lymphoma elsewhere with proper staging. While immunocytochemistry helps, when not available, treatment as per histological type should suffice. Proper staging and post treatment follow up is crucial.