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\begin{document}

\title{Synchronous Invasive Ductal Carcinoma and Mucosa-Associated Lymphoid
Tissue (MALT) Lymphoma of the Breast}



\author[1]{Jung Hee Byon}%
\author[1]{Eun Jung  Choi}%
\affil[1]{Jeonbuk National University Hospital}%


\vspace{-1em}



  
  \date{May 17, 2024}


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\begin{abstract}
We described a rare presentation of synchronous extranodal marginal zone
lymphoma of mucosa-associated lymphoid tissue (MALT) lymphoma and
invasive ductal carcinoma of the breast. This case highlights that one
should keep an open mind to the possibility of synchronous multiple
primary neoplasms in patients with carcinoma.%
\end{abstract}%



\sloppy


\textbf{Synchronous Invasive Ductal Carcinoma and Mucosa-Associated
Lymphoid Tissue (MALT) Lymphoma of the Breast}

Jung Hee Byon, M.D., Ph.D. \textsuperscript{1}, Eun Jung Choi, M.D.,
Ph.D.\textsuperscript{1}

Jung Hee Byon, M.D., Ph.D.

\textsuperscript{1}Department of Radiology and Research Institute of
Clinical Medicine of Jeonbuk National University-Biomedical Research
Institute of Jeonbuk National University Hospital, Jeonbuk National
University Medical School, 20 Geonji-ro, Deokjin-gu, Jeonju City,
Jeollabuk-Do 54907, South Korea, ORCID: 0000-0002-5139-552X, Email:
a98038304@gmail.com

Eun Jung Choi, M.D., Ph.D.

\textsuperscript{1}Department of Radiology and Research Institute of
Clinical Medicine of Jeonbuk National University-Biomedical Research
Institute of Jeonbuk National University Hospital, Jeonbuk National
University Medical School, 20 Geonji-ro, Deokjin-gu, Jeonju City,
Jeollabuk-Do 54907, South Korea, ORCID : 0000-0002-2339-4327, Email:
cejcej80@hanmail.net

\emph{Reprint requests to: Eun Jung Choi, MD, PhD}

\textsuperscript{1}Department of Radiology and Research Institute of
Clinical Medicine of Jeonbuk National University-Biomedical Research
Institute of Jeonbuk National University Hospital, Jeonbuk National
University Medical School 20 Geonji-ro, Deokjin-gu, Jeonju City,
Jeollabuk-Do 54907, South Korea

Telephone number: +82-63-250-1150

Fax number: +82-63-272-0481

Email: cejcej80@hanmail.net

Written informed consent was obtained from the patient to publish this
report in accordance with the journal's patient consent policy

\textbf{Key Clinical Message}

We described a rare presentation of synchronous extranodal marginal zone
lymphoma of mucosa-associated lymphoid tissue (MALT) lymphoma and
invasive ductal carcinoma of the breast. This case highlights that one
should keep an open mind to the possibility of synchronous multiple
primary neoplasms in patients with carcinoma.

\textbf{Case description}

A 36-year-old woman was referred to our center with a painless palpable
mass in the upper central portion of the left breast. She had no family
history of breast cancer and no personal history of other malignancies.
Ultrasonography (US) showed an approximately 3.5x3cm irregularly shaped,
indistinct, hypoechoic mass with multiple ipsilateral enlarged axillary
lymph nodes (Fig. 1A). Preoperative magnetic resonance imaging (MRI)
showed an approximately 3.9x3.5cm irregular mass with heterogeneous
enhancement and multiple enlarged axillary lymph nodes (Fig. 1B). On
MRI, an irregular mass with heterogeneous enhancement was found on the
upper inner quadrant of the right breast, and we recommended MR-guided
US for this lesion (Fig. 2A). On MR-guided US, an approximately 1.4 x
0.4cm irregular-shaped and indistinct mass was detected that correlated
to the MR lesion (Fig. 2B). US-guided core biopsies for both breast
lesions and the left axillary lymph node were performed, and the
pathologic results confirmed invasive ductal carcinoma in the left
breast, suggested MALT lymphoma in the right breast, and confirmed
metastatic adenocarcinoma in the left axillary lymph node. Although the
synchronous occurrence of multiple neoplastic processes is uncommon, the
possibility of synchronous breast carcinoma and primary breast lymphoma
should be considered to avoid inaccurate staging and delays in diagnosis
and to ensure good therapeutic and prognostic implications (1, 2).

\textbf{Conflict of interest}

The authors have stated that they have no conflicts of interest.

\textbf{Funding}

This work was supported by a National Research Foundation of Korea (NRF)
grant funded by the Korean government (No.2021R1G1A1006474).

\textbf{Author contribution}

JH Byon and EJ Choi: contributed to the design and implementation of the
research, analysis of the results, and writing of the manuscript.

\textbf{REFERENCES}

1. Liu W, Zhu H, Zhou X. Synchronous bilateral non-Hodgkin's diffuse
large B-cell lymphoma of the breast and left breast invasive ductal
carcinoma: a case report and review of literature. Int J Clin Exp
Pathol. 2014;7(10):7042-8.

2. Cuff KE, Dettrick AJ, Chern B. Synchronous breast cancer and
lymphoma: a case series and a review of the literature. J Clin Pathol.
2010;63(6):555-7.

\textbf{Figure legend}

Figure 1. Primary invasive ductal carcinoma in the left breast was
demonstrated on ultrasound (US) and magnetic resonance imaging (MRI).

1A: Invasive ductal carcinoma involving the left upper breast was
revealed on ultrasound as an irregularly shaped, indistinct, hypoechoic
mass.

1B: Maximum intensity projection (MIP) of breast MRI showed invasive
ductal carcinoma involving the left whole breast with advanced axillary
lymph node metastasis.

Figure 2. Synchronous mucosa-associated lymphoid tissue (MALT) lymphoma
was shown on magnetic resonance imaging (MRI) and ultrasound (US).

2A: Irregular mass with heterogeneous enhancement was found on the upper
inner quadrant of the right breast on breast MRI.

2B: On MR-guided US, an approximately 1.4 x 0.4cm irregular-shaped and
indistinct hypoechoic mass was found. MALT lymphoma was diagnosed on
subsequent core needle biopsy.\selectlanguage{english}
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