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.