Spontaneous Regression Of Malignant Lymphoma Of The Breast
Iihara, K., Yamaguchi, K., Nishimura, Y., Iwasaki, T., Suzuki, K., & Hirabayashi, Y. (2004). spontaneous regression of malignant lymphoma of the breast. Pathology international, 54(7), 537–542. https://doi.org/10.1111/j.1440-1827.2004.01652.x
View Original Source →Abstract
A complete spontaneous regression of diffuse large B cell lymphoma involving the right breast, confirmed by aspiration cytology, is reported. The patient visited a hospital due to the rapid growth of a tumor in the right breast. Five years previously she underwent a craniotomy for a brain tumor, diagnosed as B‐cell malignant lymphoma, and received several courses of irradiation to the brain. Analysis of the breast tumor cells obtained by aspiration revealed lymphoma cells morphologically, which were similar to the tumor cells in the brain expressing CD20. While waiting for further examination, the tumor regressed rapidly and was not palpable after 20 days. An excisional biopsy of the breast exhibited no definite malignant lymphoma cells among a diffuse population of CD45RO and CD8‐positive small lymphocytes. Nucleotide sequencing of HCDR3s of the brain tumor and breast tumor cells showed a completely matched sequence, revealing the breast mass to be a metastatic lesion from the tumor of the brain. Although there was no tumorous lesion, the patient received additional chemotherapy and has shown no sign of recurrence in the breast for 7 years. We were able to confirm that the breast lymphoma shown in the aspiration cytology was a metastatic one, which was not proven histologically prior to chemotherapy, and regard the present case as a malignant lymphoma of the breast showing spontaneous regression. The present case shows a rare occurrence of spontaneous regression of diffuse large B cell malignant lymphoma after aspiration and suggests that CD8‐positive T cells might be related to the regression.
Case Details
Disease Location
Breast (right)
Personal Characteristics
46 -year-old female 5 years prior to the visit had a brain tumor excised which was diagnosed as a diffuse large b-cell lymphoma, she received irradiation and there has been no recurrence
Clinical Characteristics
Admitted due to a rapid-growth breast tumor over a few weeks physical exam revealed an undefined elastic hard mass 2cm in diameter in the right breast. The ipsilateral axillary lymph nodes were not palpable. Mammography revealed a high-density mass with no clear borderline aspiration cytology of the breast had features of malignant lymphoma and cell morphology similar to that of the brain tumor cells the excisional biopsy specimen was 2.3x2.0x1.8cm in size, on sequel cross-section showed no particular nodular lesions wbc count, chemistry survey and erythrocyte sedimentation were not contributory serological tests for ebv, cytomegalovirus, HIV, human t-cell lymphotropic virus type, herpes viruses, and hepatitis a, b, & c were all negative. Chest radiography, abdomen CT, bone marrow aspirate and biopsy showed no evidence of lymphoma. All other tests performed after the excisional biopsy showed normal values and widespread disease was not present patient was discharged after receiving chemo, one course of chop. Irradiation was not performed due to difficulty confirming location of the tumor 3 years after her discharge, a mass around the left sciatic nerve was found and gallium scan showed abnormal uptake. The mass was considered to be a site of infiltration of malignant lymphoma cells, paralysis of the bilateral lower extremities occurred after irradiation, but the patient is well without recurrence 7 years after the breast tumor remissed brain tissue slides showed diffuse proliferation of large lymphoid cells with scanty cytoplasm, round or oval nuclei and multiple nucleoli. Based on morphology, this was classified as diffuse large-cell lymphoma aspiration cytology of the right breast revealed large lymphoid cells with a homogenous cell size (12-20 micrometers in diameter) and morphology similar to the brain cells, the excisional biopsy showed diffuse proliferation of small lymphoid cells without atypia and a few scattered large blastic lymphoid cells in the center of a massive lymphoid cell infiltrate immunophenotyping of t- and b-cell lineage, monoclonal antibodies including CD45, cd45ro, 20, 4, 8, and 56 were used. Paraffin-embedded tissue was stained with these antibody preparations, a specimen that was stored was used for anti-CD4 and anti-CD8 antibody staining. The lymphoma cells in the brain tumor and those in the breast aspirate showed membranous positivity for CD20. The small lymphoid cells in the breast tumor were CD45 positive, showing immunoreactivity for cd45ro and were negative for CD20. Most of the CD45-positive cells were positive for CD8 but negative for CD56 and scattered CD4-positive was observed a few large atypical cells in the center of a massive population of small lymphoid cells showed immunoreactivity with CD20 an indirect immunoperoxidase test for the presence of ebv capsular protein applied to the breast tissue was negative DNA samples from the breast after regression were analyzed by southern blot hybridization targeting b-cell lineage and t-cell lineage markers; the jh and tcr beta probes were shown to hybridize with one band in each germ line position, suggesting no rearrangement
Remission Characteristics
20 days before admission to the hospital for closer examination, the breast tumor regression rapidly, but a excisional biopsy was still performed no recurrence of the breast tumor 7 years after regression
Treatment & Mechanisms
Proposed Remission Mechanisms
Biopsy lead to immunological effector mechanisms
Clinical Treatment
Excisional biopsy chemo one one course of combination chemo (chop)
Non-Clinical Treatment
None reported