Spontaneous Regression Of Primary Extranodal Marginal Zone Lymphoma Of Mucosa-associated Lymphoid Tissue (malt Lymphoma) Colliding With Invasive Ductal Carcinoma Of The Breast: A Case Report
Matsuda, I., Watanabe, T., Enomoto, Y., Takatsuka, Y., Miyoshi, Y., & Hirota, S. (2014). spontaneous regression of primary extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) colliding with invasive ductal carcinoma of the breast: a case report. International journal of clinical and experimental pathology, 7(10), 7020–7027. https://doi.org/10.1016/b978-0-323-47779-6.50067-3
View Original Source →Abstract
Malignant lymphomas of the breast, whether they are primary or secondary, are rare diseases, constituting only around 0.1 to 0.15% of the primary neoplasm of the breast. Although the most prevalent histological subtype is diffuse large B-cell lymphoma, primary extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) also occurs in the breast as in other extranodal sites, comprising about 15% of malignant lymphomas of the breast. In many cases, primary MALT lymphoma of the breast is low grade lymphoma, localized in the breast with indolent behavior and good prognosis. Here we report a case of spontaneous regression of primary MALT lymphoma of the breast. The lymphoma collided with invasive ductal carcinoma in the breast. Both tumors were identified in the Vacora biopsy specimen before the operation. However, the lymphoma disappeared, while the carcinoma remained, in the resected mass. To our knowledge, this is the first case report of spontaneous regression of MALT lymphoma of the breast colliding with breast cancer.
Case Details
Disease Location
Right breast
Personal Characteristics
47 -year-old female japanese history suggested no precedence of malignant lymphomas premenopausal
Clinical Characteristics
Admitted for an examination of a mass of her right breast mammography study showed a 3.5 cm sized sub-nipple mass together with dysplastic calcification scattered diffusely in the right breast cytological exam of the needle aspiration of the mass showed scattered epithelial cells with inflammatory infiltrate with necrotic debris vacora biopsy of the mass revealed that most of the tumor was composed of diffuse but vaguely nodular lymphoid infiltration by small to medium-sized lymphoid cells a tiny part of the tumor was occupied by invasive ductal carcinoma the carcinoma cells were inconspicuous by lymphoid infiltrate but they were clearly identified by ihc of cytokeratin ae1/ae3 ihc exam of the carcinoma cells showed that the carcinoma cells were strongly positive for her2 with around 20% positivity for ki-67, the vaguely nodular lymphoid tumor contained small aggregates composed of homogeneous centrocyte-like cells the rest of the tumor cells exhibited extensive differentiation into plasma cells and diffusely circumscribed the small aggregate ihc exam demonstrated that the proliferating lymphoid tumor cells were partly positive for CD20, extensively positive for positive for plasma marker CD138, 23, and cyclin d1. In situ hybridization of immunoglobulin light chains showed restricted expression of kappa compared with lambda light chains, confirming the diagnosis of low grade b-cell lymphoma with plasmacytic differentiation the lymphoma lesion was localized in the breast without apparent involvement of peripheral lymph nodes final diagnosis was primary extranodal marginal zone lymphoma of mucosa-associated tissue, colliding with invasive ductal carcinoma of the right breast right mastectomy with sentinel lymph node biopsy and axillary ln dissection was performed approx. 1.5 months later macroscopically, the resected mass was associated with scatteredly punctuated calcification the main portion of the tumor was composed of solid- or comedo-type ductal carcinoma in situ, presumably related to dystrophic calcification observed in the preoperative mammography, with invasive components the residual lymphoid lesion was a reactive lymphoid hyperplasia with occasional germinal centers, which partly surrounded clusters of invasive cancer cells
Remission Characteristics
Histological exam of the resected mass revealed a profoundly different view at low power, compared with that of the preoperative vacora biopsy diffuse albeit vaguely nodular infiltration of lymphoid cells present in the preoperative biopsy diminished or disappeared postop the lymphoid infiltrate postop was dramatically decreased, only remaining in the narrow vicinity of the flourishing cancerous lesion as a feathery cuff postop - plasmacytic differentiation was not evident as observed in the preop biopsy there was no observation in any histological evidence of the residual malt lymphoma in the vicinity of the carcinoma in the resected specimen sr of the malt lymphoma originally detected in the preop vacora biopsy was confirmed while the invasive ductal carcinoma remained exam of the sentinel lymph nodes showed no evidence of lymphoma cells as well as cancerous metastasis 6 months follow-up after the operation showed evidence of no recurrence of both lesions the interval between diagnostic biospy and confirmation of regression was approx. 1.5 months
Treatment & Mechanisms
Proposed Remission Mechanisms
Needle trauma with possibility of hormonal factors due to being pre-menopausal
Clinical Treatment
Mastectomy with ln biopsy and axillary ln dissection
Non-Clinical Treatment
None reported