12 November 2021: Articles
Concurrent Breast Carcinoma and Follicular Lymphoma: A Case Series
Challenging differential diagnosis, Rare coexistence of disease or pathology
Tabinda Saleem E , Kaihong Mi E , Rajan Pathak F , Kolsoum Yari E , Kit Lu A*DOI: 10.12659/AJCR.931772
Am J Case Rep 2021; 22:e931772
Table 1. Case descriptions.
| Case 1 | Case 2 | Case 3 | |
|---|---|---|---|
| Case description | 72-year-old female with self-noticed right breast lump | 60-year-old female with self-noticed right palpable breast mass | 74-year-old female with mammographically detected left breast mass |
| Examination/imaging findings | High density irregular mass with spiculated margins in right breast at 9 o clock position; BI-RADS 5 | Irregular mass in right breast at 10 o’clock position, 3.8×3.0×3.0 cm; BI-RADS 5 with multiple suspicious lymph nodes in the right axilla | 13×9×15 mm irregularly shaped, hypoechoic mass with angular margins in the left breast’s at 1 o’clock position. BI-RADS 4 |
| Breast pathology | Invasive lobular carcinoma of the right breast, ER/PR+ (95/95%) and HER2 - | Invasive ductal carcinoma, ER/PR+ (90/90%) and HER2-. Positive right axillary LN biopsy | Invasive ductal carcinoma, ER/PR+ (99/95%) and HER2- |
| Stage breast | Stage IIIA (pT2pN3cM0) 30 mm focus, 19/22 LN, +LVI, +PNI, no DLI, grade 2 invasive lobular carcinoma | Stage IIB (pT2pN2acM0 35 mm, 5/12 LN, LVI present, focal angiolymphatic invasion, grade 3 invasive ductal carcinoma metastasis to axillary LN | Multifocal Stage IB (pT1CpN2acM0--2 foci 12 mm & 6mm, grade 2, 5/6 LN (3 macro/2 micros), LVI present, no PNI, grade 2 invasive ductal carcinoma |
| CT/PET findings indicative of second primary malignancy | Bilateral inguinal lymph node with increased FDG activity more prominent on the right than left | FDG activity in the thoracic inlet, anterior mediastinum, throughout the root of the mesentery and retroperitoneum | Multiple non-specific uptakes |
| Lymph node biopsy | Right inguinal lymph node+follicular lymphoma. Immuno-stains - for AE1/3. + for CD3, CD5, CD20, CD23, BCL-6, CD10, and BCL-2, and negative for cyclin D1, with a low proliferation index (10~20% by Ki67 on average, with rare follicles showing 40%) | Abdominal mesenteric lymph node+follicular lymphoma, low grade (Gr1-2) with high proliferation index by KI67 (70%) | Follicular neoplasia in situ in two of her left dissected axillary LN. Immunoperoxidase staining within occasional follicles displayed BCL2 expression with co-expression of CD10. CD20 and CD3 reveal normal antigenic expression |
| FLIPI stage | Stage 2 (intermediate risk) | Stage 2 (intermediate risk) | Stage 1 (low risk) |
| Management | Right modified radical mastectomy followed by chemotherapy. Close surveillance for her grade 1 follicular lymphoma | Right mastectomy and right axillary LN dissection, followed by adjuvant chemotherapy and radiotherapy. Patient remained on close surveillance with aim to re-evaluate her grade 2 follicular in future for subsequent chemotherapy | Left mastectomy and complete left axillary dissection followed by chemotherapy and radiotherapy. 6 months surveillance for follicular carcinoma in situ |
| ER – estrogen receptor; PR – progesterone receptor; LVI – lymphovascular invasion; PNI – perineural invasion; DNI – dermal lymphatic invasion; LN – lymph node. | |||