CASE REPORT
In 1995, at the age of 48, the patient presented with a rapidly growing, painless left breast mass. Staging with CT of the chest/abdomen/pelvis showed no other abnormalities. She underwent lumpectomy. Pathology showed a diffuse, high-grade, large cell, non-Hodgkin’s lymphoma (NHL), LCA positive. Margins were positive. She underwent CHOP chemotherapy x 6 cycles and radiation therapy (5040 cGy in 28 fractions to left breast, supraclavicular, and axillary nodes and 1000cGy boost in 5 fractions to the lumpectomy site). There was no evidence of disease (NED) in follow up.
In 2022, at the age of 75, the patient presented with a rapidly growing, painless right breast mass. Right needle core biopsy showed atypical lymphoid infiltrate, favoring lymphoproliferative disorder. PET/CT showed a right breast mass measuring 6.7 x 3.2 cm with SUV maximum of 8.5 and a right axillary node measuring 14 x 5 mm with maximum SUV max of 1.5. Right breast excisional biopsy showed involvement by a diffuse large B-cell lymphoma (DLBCL), germinal center phenotype. By IHC, the tumor was positive for CD10 (weak, subset), CD20, BCL6, PAX5 and negative for CD5, MUM1, BCL2, CD30, and cyclin D1. BCL2, BCL6, and MYC rearrangements were not detected. EBV by in situ hybridization was negative. Ki-67 proliferation index was 50-60%. Patient elected for bilateral mastectomy. Right mastectomy showed diffuse large B-cell non-Hodgkin’s lymphoma (NHL) as noted above with a positive margin. One axillary lymph node was negative. Left mastectomy showed benign breast tissue, negative for lymphoma. Echocardiogram was normal. LDH was normal. ECOG status was 0. She underwent R-CHOP chemotherapy x 3 cycles (total Adriamycin dose 360 mg/m2) and radiation therapy (3600 cGY in 18 fractions to the right chest wall). The CNS International Prognostic Index showed her to be low risk with a score of 1 (due to age >60), but she did have Stage IE DLBCL of the breast which is a possible NCCN guideline for CNS prophylaxis. After discussion, mutual decision was made not to undertake CNS prophylaxis. Repeat PET/CT obtained six months following completion of therapy revealed NED. Patient has no family history of any cancers. INVITAE multi-Cancer Panel, Hereditary Lymphoma Panel, and Preliminary Evidence Genes for Lymphoma identified no pathogenic inherited variants (129 genes total assessed- see Figure 1).
Written informed consent was obtained from participant. Ethical approval was non sought from an Institutional Review Board prior to writing manuscript.