Article Text

  1. B. Persing1,
  2. V. Herrin1,
  3. S. Elkins1,
  4. J. Files1,
  5. C. Bigelow1
  1. 1Division of Hematology/Oncology, University of Mississippi Medical Center, Jackson, MS.


Introduction Diffuse large B-cell lymphoma (DLBCL) comprises 31% of non-Hodgkin's lymphomas (NHL), making DLBCL the most common form of NHL. DLBCL typically presents as a rapidly expanding abdominal or neck mass but can also present as extranodal disease. This case is an example of an unusual site for extranodal presentation of DLBCL.

Case Presentation A 39-year-old white female presented to an outside facility with a breast mass that was rapidly growing. She stated that the mass had been stable and present for the previous 5 years with just a minimal increase in size. The mass measured approximately 9.0 × 3.6 × 7.9 cm. Following several core needle biopsies and a right total mastectomy with conflicting pathology, removal of a mass in the surgical incision site yielded the diagnosis of DLBCL. The patient had a normal LDH and staging revealed disease confined to the breast. The patient was subsequently started on cyclophosphamide, vincristine, Adriamycin, prednisone, and rituximab (CHOP-R.).

Discussion DLBCL is the most common form of NHL. Primary extranodal disease arising from the breast has been documented but remains an uncommon site of initial disease. A plausible explanation of the initial benign nature of this patient's mass is an initial low-grade lymphoma with subsequent conversion to a high-grade lymphoma. At present, there is a lack of randomized trials for the treatment of primary breast lymphoma.

Conclusion Diffuse large B-cell lymphoma can present in unusual manners and arise from a previously benign-appearing lesion. Difficulty obtaining a diagnosis can lead to a delay in treatment and potentially more advanced stage of disease at the time of initiation of treatment. An appropriate index of suspicion and thorough evaluation may expedite diagnosis and prevent a delay in treatment.

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