Hematolymphoid Neoplasms of the Breast: A Clinicopathologic Study of 58 Cases
MM Stoecker, E Wang. Duke University Medical Center, Durham, NC
Background: Nonepithelial neoplasms of the breast, including hematologic neoplasms, are rare. There are few recent case series defining the clinicopathologic spectrum of breast hematolymphoid neoplasms according to World Health Organization (WHO) 2008 criteria. We report our experience with the diagnosis of breast hematologic neoplasms and discuss their clinical associations and implications.
Design: 58 hematolymphoid neoplasms of the breast were identified in our databases from 1999-2009 and reviewed along with clinical and laboratory data. Primary breast hematolymphoid neoplasms were designated if the infiltrate was closely associated with breast tissue and there was no prior diagnosis of lymphoma/leukemia or concurrent extramammary disease.
Results: In 58 cases, patients ranged from 3 to 82-years-old (median 63 years) and were predominantly female (96%). Of the total cases, 49 (84%) were B-cell non-Hodgkin lymphoma (NHL), including 16 follicular lymphomas (FL), 12 diffuse large B-cell lymphomas (DLBL), 11 marginal zone lymphomas (MZL), 4 mantle cell lymphomas, 4 CLL/SLL, 1 B-lymphoblastic lymphoma, and 1 unclassified lymphoma. The remaining cases were 3 anaplastic large cell lymphomas (ALCL), 2 Hodgkin lymphomas (HL), 2 granulocytic sarcomas, 1 follicular dendritic cell sarcoma (FDCS), and 1 extramedullary plasmacytoma. Primary neoplasms comprised 31% of total cases, including DLBL (7), MZL (5), FL (1), ALCL (1), and FDCS (1). Additionally, 7% of cases were associated with prior or subsequent breast carcinoma in the same or opposite breast, and 16% were associated with a prior or subsequent diagnosis of NHL, HL, or both. In 4 of 58 cases (2 primary), patients had a connective tissue disease and developed NHL (3 DLBL, 1 MZL), and 2 of 3 patients with ALCL (ALK-) had a prior diagnosis of sarcoidosis.
Conclusions: Secondary hematolymphoid neoplasms of the breast predominated (69%), with the majority being small mature B-cell neoplasms. Of the primary breast hematologic neoplasms, the majority were DLBL, followed by MZL. 11 of 58 cases were associated with prior or subsequent breast carcinoma or lymphoma, raising the possibility of therapy causing the secondary neoplasms. One breast carcinoma was diagnosed 6 years after lumpectomy and radiation for primary MZL, highlighting the importance of histologic evaluation of new lesions. DLBL was the most common hematologic breast neoplam in patients with connective tissue disorders (7% of total). Two of three cases of ALCL (ALK-) occurred in patients with sarcoidosis, an association that may be further investigated.
Monday, March 22, 2010 1:00 PM
Poster Session II # 44, Monday Afternoon