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.