Primary breast lymphoma: Clinical and imaging features

Abstract

Aim: To determine imaging features of primary breast lymphoma (PBL). Methods: The local Institutional Review Board approved this study and the consent form was waived. We retrospectively reviewed the clinical, imaging and pathologic features of nine patients who had presented with PBL between May 2000 and April 2010. A mammography was performed on six patients, ultrasonography (US) and computed tomography (CT) on seven, and magnetic resonance (MR) imaging on two. Results: All nine patients were females and had been diagnosed with primary non-Hodgkin lymphoma of B-cell phenotype. The subjects were aged between 39 and 73 years. Presenting symptoms were palpable breast masses (6), bilateral diffuse breast enlargement (1) and asymptomatic (2). Of those involved in the study, five experienced symptoms in the right breast, one in the left and three had synchronous bilateral involvement. Five out of the six masses assessed using a mammogram had an irregular ill-defined margin and macrocalcification was observed in one. The remaining mass was lobulated obscured margin. The US revealed five irregular hypoechoic masses with macrocalcification in one, lobulated circumscribed masses in three, two bilateral diffuse irregular hypoechoic breast parenchyma with multiple small-circumscribed masses in one. The CT revealed bilateral diffuse breast enlargement without focal lesion (2), rim enhancement (2), ill-defined homogeneous enhancing mass (1) and circumscribed heterogeneous enhancing mass (3). MR imaging showed two lobulated circumscribed isointense masses on T1WI with washout pattern of enhancement and two irregular isointense masses on T1WI with plateau type curve enhancement. Conclusion: While palpable breast mass is the most common clinical presentation of PBL, bilateral diffuse breast enlargement should also be considered, particularly during pregnancy. The imaging features of PBL are not pathognomonic. However, familiarity with these findings may alert radiologists to a possible diagnosis of PBL, and biopsy should be performed to avoid delayed diagnosis. © 2012 Biomedical Imaging and Intervention Journal. All rights reserved.