Invasive breast carcinoma - IARC

Malignant lymphoma
and metastatic tumours
J. Lamovec
A. Wotherspoon
J. Jacquemier
Malignant lymphoma
D e f i n i t i o n
Malignant lymphoma of the breast may
p resent as a primary or secondary
tumour; both are rare. There is no morphological
criterion to diff e re n t i a t e
between the two {117,1792}.
The criteria for defining and documentation
of primary breast lymphoma, first
p roposed by Wiseman and Liao {3136}
and, with minor modifications, accepted
by others, are as follows:
1. Availability of adequate histological
material.
2. Presence of breast tissue in, or adjacent
to, the lymphoma infiltrate.
3. No concurrent nodal disease except
for the involvement of ipsilateral axillary
lymph nodes.
4. No previous history of lymphoma
involving other organs or tissues.
As such criteria seem too restrictive and
leave no room for primary breast lymphomas
of higher stages, some authors
include cases in which the breast is
the first or major site of pre s e n t a t i o n ,
even if, on subsequent staging proc
e d u res, involvement of distant nodal
sites or bone marrow is discovere d
{ 3 5 9 , 1 2 6 1 , 1 7 5 3 } .
Epidemiology
P r i m a ry breast lymphoma may appear at
any age, but the majority of patients are
postmenopausal women. A subset of
patients is re p resented by pregnant or lactating
women with massive bilateral bre a s t
swelling; most of these cases were re p o rted
from Africa {2643} although non-
African cases are also on re c o rd {1753}.
The disease is exceedingly rare in men
{ 2 5 4 0 } .
Clinical features
Clinical presentation of primary breast
lymphoma usually does not differ from
that of breast carcinoma. It usually presents
with a painless lump sometimes
multinodular, which is bilateral in approximately
10% of cases. Imaging usually
reveals no feature which helps to distinguish
primary from secondary lymphoma
{1657,2199}. The value of MR imaging in
breast lymphomas has not been clearly
determined {1952,1961}.
Macroscopy
P r i m a ry and secondary breast lymphomas
most commonly appear as a
well circumscribed tumour of vary i n g
size, up to 20 cm in largest diameter. On
cut surface, the neoplastic tissue is white
to white-grey, soft or firm, with occasional
haemorrhagic or necrotic foci {994,
1580,1753,3136}.
Histopathology
Microscopically, the majority of primary
breast lymphomas are diffuse large B
cell lymphomas, according to the most
recent WHO classification {352,1144}. In
older literature, cases designated as
reticulum cell sarcoma, histiocytic lymphoma
and at least some lymphosarcoma
cases would nowadays most probably
be included in the above category.
M o re re c e n t l y, such lymphomas were
diagnosed as centroblastic or immunoblastic
by the Kiel classification or diffuse
large cell cleaved or noncleaved
and immunoblastic lymphomas by the
Lukes-Collins classification and Working
F o rmulation {18,296,534,706,994,1261,
1346,1580,1665}.
A minor pro p o rtion of primary lymphomas
of the breast reflect Burkitt lymphoma,
extranodular marginal-zone B-
cell lymphoma of mucosa associated
lymphoid tissue (MALT) type, follicular
lymphoma, lymphoblastic lymphoma of
either B or T type, and, extremely rarely,
T-cell lymphomas of variable subtypes
by the current WHO classification.
A
Fig. 1.159 Diffuse large B-cell lymphoma. A Medullary carcinoma-like appearance. B Circumscribed mass, composed of large pleomorphic neoplastic lymphoid
cells.
B
Malignant lymphoma and metastatic tumours 107