Case Report-
49-year-old female patient presented with palpable painless mass in her
left breast with palpable left axillary nodes. X Ray Mammogram done as
preliminary investigation revealed diffusely glandular dense breasts
with only a vague asymmetric density in upper outer quadrant of left
breast (Figure 1). No obvious mass lesion was seen on right side. DCE -
MR revealed multiple round to oval well defined masses with slightly
irregular margin in left breast ranging between 1.2 to 2 cm in size
(Figure 3). All these lesions had isointense to hypo intense signal on
T2W images with hypo intense signal on T1W images. ADC value within
these masses ranged between .7 to 0.9 x 10mm/sec. On post contrast study
they showed early enhancement with type 2 and type 3 kinetics (Figure
3,4). One of the lesions also showed enhancing internal septations. One
similar mass of approx. 1cm was also seen in right breast with plateau
type 2 kinetic enhancement pattern. Multiple other small enhancing foci
were seen in bilateral breasts which were indeterminate in nature in the
sense that they could be representing part of the disease process or
benign proliferative changes( Figure 4). There were also enlarged left
axillary nodes seen which showed asymmetrical cortical thickening(Figure
3). Correlative ultrasound done for biopsy guidance showed these masses
to be hypoechoic with slightly irregular margins without any significant
posterior shadowing or calcifications (Figure 2). Initially FNAC was
done from bilateral breasts which revealed primary lymphoid cellular
pattern. Biopsy was then done which showed Non-Hodgkin’s lymphoma - SLL,
B-cell type confirmed on IHC. Subsequent bone marrow biopsy was done to
rule out breast involvement from systemic disease. The bone marrow
showed normocellular marrow with no evidence of CD 23 expressing
lymphoid cells. FDG PET was also done which showed FDG avid multiple
masses in left breast and one lesion in right breast with no evidence of
any activity in rest of the body. The patient was treated with
chemotherapy followed by radiotherapy to the left breast.
Figure.1 X Ray Mammogram (MLO view) shows dense glandular breasts with
poorly marginated density in upper quadrant of left breast.