A Case of Primary Breast Lymphoma with Brain Metastasis Detected during Pregnancy

Jae Yun Lim; You Kyung Choi; Ek Seong Kim; Jong Tae Moon; Ki Keun Oh; Jae Yong Cho

doi:10.5045/kjh.2006.41.3.194

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Lim, Choi, Kim, Moon, Oh, and Cho: A Case of Primary Breast Lymphoma with Brain Metastasis Detected during Pregnancy

Case Report

Korean J Hematol 2006;41(3):194-198.

Published online: 19 September 2006

DOI: https://doi.org/10.5045/kjh.2006.41.3.194

A Case of Primary Breast Lymphoma with Brain Metastasis Detected during Pregnancy

Jae Yun Lim, M.D.¹, You Kyung Choi, M.D.¹, Ek Seong Kim, M.D.¹, Jong Tae Moon, M.D.¹, Ki Keun Oh, M.D.², Jae Yong Cho, M.D.^1,

¹Departments of Internal Medicine, Seoul, Korea

²Diagnostic Radiology, Yongdong Severance Hospital, Yonsei University College of Medicine, Seoul, Korea

Correspondence to：Jae Yong Cho, M.D. Department of Internal Medicine, Yongdong Severance Hospital, Yonsei University College of Medicine 146-92, Dogok-dong, Gangnam-gu, Seoul 135-720, Korea Tel: +82-2-2019-3297, Fax: +82-2-3463-3882 E-mail: chojy@yumc.yonsei.ac.kr

Received 11 April 2006 Revised 22 May 2006 Accepted 20 June 2006

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Primary breast lymphoma (PBL) is a rare clinical presentation of localized non-Hodgkin's lymphoma (NHL), and it makes up 0.04～1.1% of all breast tumors and it is 0.38～0.7% of all NHLs. The prognosis and patterns of relapse of PBL are still not clearly defined. The clinical features of PBL are different from those of breast carcinoma and the usual form of lymphoma. These features are a rapidly enlarging breast mass, multiple lesions, the absence of nipple discharge and retraction, and softer axillary lymph nodes as compared to the metastatic lymph nodes from breast carcinoma. B symptoms are unusual in PBL. A 30-year-old pregnant woman was admitted due to dysarthria and right side weakness that she had experienced for 7 days. She had several medical problems: intrauterine pregnancy at 34 weeks, some neurologic deficits and enlargement of both breasts. A biopsy from the breast and a brain magnetic resonance image (MRI) revealed diffuse large B cell lymphoma and multiple brain metastases, respectively. After delivery of a healthy, premature infant by Cesarean section, whole brain radiation therapy and combination chemotherapy (rituximab, cyclophosphamide, adriamycin, vincristine and prednisone) were started. She showed good response to therapy. We report here on this unusual case and we review the related literature.

Keywords: Primary breast lymphoma, Pregnancy, Brain metastasis, Chemotherapy

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Fig. 1

Breast ultrasonogram shows diffuse infiltrative mass forming lesions.

Fig. 2

Brain diffusion MRI shows multiscattered diffuse inflammatory reactive change in near entire brain parenchyme.

Fig. 3

(A) Biopsy specimen of breast shows diffuse infiltration of relatively uniform tumor cells with starry-sky pattern (H&E stain ×100). (B) The tumor cells have scanty cytoplasm and large, vesicular nucleus with small distinct nucleoli (H&E stain ×400).

Fig. 4

Breast ultrasonogram shows multiple low echoic masses.

Fig. 5

Brain CT scan shows no definite previously noted lesions.

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