Teaching point: Primary breast lymphoma is a rare disease, especially in males, but should be considered in the differential diagnosis of a breast mass because of the different treatment and prognosis

Chloë Standaert

Herman Depypere

Senne Jonckheere

Journal of the Belgian Society of Radiology

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CaseAn 80-year-old man was referred to the radiology depart-ment because of a persisting palpable mass in the left breast. Family history of breast cancer was negative. The mammography revealed a retro-areolar mass in the left breast (Figure 1). There were no microcalcifications. Ultra-sound of the left breast showed predominantly enlarged mammary ducts, apparently caused by an ill-defined hypo-echogenic retro-areolar mass of 2.8 cm in diameter (Figure 2). An ultrasound-guided needle core biopsy of the retro-areolar mass was performed. Histology revealed a primary diffuse large B-cell type lymphoma of the breast. The patient had no prior history of lymphoma. Additional PET–CT showed a metabolic active lesion in the left breast (Figure 3). Widespread disease was not present.CommentPrimary breast lymphoma is a rare neoplasm of the breast with an incidence of less than 0.6% of primary breast malignancies. It is most frequently seen in the sixth IMAGES IN CLINICAL RADIOLOGYBreast LymphomaTeaching point: Primary breast lymphoma is a rare disease, especially in males, but should be considered in the differential diagnosis of a breast mass because of the  different treatment and prognosis.Senne Jonckheere, Herman Depypere and Chloë StandaertKeywords: breast lymphoma; male; mammography; ultrasound; PET-CTJonckheere, S, et al. Breast Lymphoma. Journal of the Belgian Society of Radiology. 2019; 103(1): 26, 1–2. DOI: https://doi.org/10.5334/jbsr.1769UZ Gent, BECorresponding author: Senne Jonckheere  (jonckheeresenne@msn.com)Figure 1: Retro-areolar mass in the left breast on mam-mography (oblique view).Figure 2: Retro-areolar hypo-echogenic mass with  secondary mammary duct ectasia on ultrasound.Jonckheere et al: Breast LymphomaArt. 26, page 2 of 2  decade. Due to the relatively small amount of lymphoid tissue in the breast, it has a low incidence and is even rarer in the male breast.The clinical and histologic criteria for diagnosis of a  primary breast lymphoma are the following: 1) a close asso-ciation between breast tissue and infiltrating  lymphoma; 2) no evidence of widespread lymphoma and no history of previous extramammary lymphoma; and 3) documenta-tion of the breast as the principal organ involved and the primary site.The differential diagnosis consists of invasive ductal carcinoma and metastatic disease to the breast. Invasive ductal carcinoma usually presents as a mass on imaging with the following features: microcalcifications, architec-tural distortion and spiculated margin. These features are rare in breast lymphoma. Metastatic disease of the breast was in our case less likely because there was no prior history of malignancy and the mass was single and unilateral. It is important to distinguish a breast lymphoma from breast cancer because of the different therapy (radiochemotherapy instead of surgery). Patients with breast lymphoma generally have a better progno-sis than patients with breast cancer or extranodal lym-phoma [1].Breast lymphoma is a rare disease, especially in males, but it is important to differentiate it from breast cancer because of the different treatment and prognosis.Competing InterestsThe authors have no competing interests to declare.Reference 1. Rathod, J, Taori, K, Disawal, A, et al. A rare case of male breast lymphoma. J Breast Cancer. 2011; 14(4): 333–336. DOI: https://doi.org/10.4048/jbc.2011.14.4.333How to cite this article: Jonckheere, S, Depypere, H and Standaert, C. Breast Lymphoma. Journal of the Belgian Society of Radiology. 2019; 103(1): 26, 1–2. DOI: https://doi.org/10.5334/jbsr.1769Submitted: 06 February 2019        Accepted: 17 March 2019        Published: 09 April 2019Copyright: © 2019 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC-BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See http://creativecommons.org/licenses/by/4.0/.                           OPEN ACCESS Journal of the Belgian Society of Radiology is a peer-reviewed open access journal published by Ubiquity Press.Figure 3: Metabolic active mass in the left breast on PET-CT.

Breast Lymphoma

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