Malignant lymphoma is a neoplasm which originates in lymph tissue, but lymphoma is not actually breast cancer. However, lymphoma can be difficult to distinguish from breast cancer in the early stages of thedisease. The early breast cancer screening mammography indicators for potentially malignant breast cancer are quite similar to malignant lymphoma. So, as a result, malignant lymphoma of the breast is often a surprise when the biopsy result comes back.
A primary non-Hodgkin’s lymphoma of the breast is a very rare occurrence. Indeed, lymphoma accounts for only about 0.1 to 0.5 % of all malignant breast tumors. Most patients who develop primary breast lymphoma will also have metastasis in other regions of the body.
There are various kinds of lymphomas, but the most common breast lymphoma is the B cell non-Hodgkin’s lymphoma. In terms of prognosis, an early diagnosis of a low grade or stage I lymphoma generally gives the best outlook.
Breast lymphoma mostly affects older women
The majority of patients with breast lymphoma present with a localized intermediate-grade lymphoma. In fact most cases presenting with disseminated disease actually have a low-grade lymphoma. On average, patients presenting with breast lymphomas are split between stage I and stage II tumors about 50% of the time. The average age of development for a breast lymphoma is around 57 years. Lymphoma of the breast can develop in a younger women, but on the whole it is a disease that mostly affects older women.
Clinical and mammographic presentation of breast lymphomas
In the clinical setting, a breast lymphoma might present as elastically firm, well-defined, and often multiple tumors. There might be other symptoms going on in other areas of the body, however.
A women with lymphoma might also present with some enlarged lymph nodes in her neck or armpits.
The most common symptoms of breast lymphoma is a painless breast mass. Specialists usually locate the lump in the outer quadrants of the breast. Interestingly, lymphoma usually shows up in the right quadrant.
Breast lymphomas rarely show microcalcifications
Ultrasound of breast lymphomas tend to show a hypoechoic lobulated mass
An ultrasound of lymphoma of the breast might typically reveal a coarse internal echo, a hypoechoic mass with an irregular border and occasionally a lobulated mass representing a very large tumor. The most likely ultrasound image for a breast lymphoma will be of a heterogeneous lobulated hypoechoic mass.
Sometimes MRI can help detect a malignant breast lymphoma. A primary breast MRI is often visualized as a lobulated lesion with expansive and infiltrating features. However, breast MRI findings on lymphomas are quite non-specific. Still, breast MRI can help in the diagnosis and treatment of a breast lymphomas in that it can help determine the extent and number of lesions, and in finding any cutaneous, subcutaneous or nodal involvement of the contralateral breast.
Breast lymphoma imaging cannot predict histology
Although the various imaging characteristics of a given breast tumor may suggest non-Hodgkin’s lymphoma none of the findings are pathognomonic. The imaging pattern of breast lymphoma is unrelated to its histopathologic subtype. In fact, only a very small number of patients with a diagnosis of lymphoma present with clear B-cell lymphoma symptoms.
Histological aspects of lymphoma of the breast
Histologically, breast lymphoma-tumors tend to infiltrate between mammary ducts, but do not tend to destroy them. Interestingly, it is actually quite difficult to distinguish malignant breast lymphoma from breast in the early stages. This holds true even when examining excisional biopsy and fine needle biopsy samples.
Only when the disease really takes hold and one finds the clear presence of diffuse large B-cells can one make a definitive diagnosis. Specialists initially diagnose most breast lymphomas as breast carcinoma, because that is what they appear to be. It usually takes a really high-power microscopic view to see the B-cells of breast lymphoma in evidence. When they are present, one might typically see an abnormal lymphoid population of small to medium sized centrocyte-like B-cells and monocytoid B-cells.
Treatment options for breast lymphomas
The therapeutic management of breast lymphoma is not as fully established as the treatment options for breast cancer, and some aspects remain a bit controversial. The first treatment priority for breast lymphoma is to determine where the disease originates. This can be in the breast or systemic in nature. There are many different kinds of lymphoma, too many to discuss here. However, the types of lymphoma that form soft tissue masses in unusual locations, such as the breast, are more problematic to treat. However, there is usually some positive response to treatment.
Treatment is similar to breast cancer
The three main options for treatment are similar to breast cancers. Patients are usually treated either by surgical intervention alone (for localized breast tumors), surgery with chemotherapy, or surgery with radiation therapy and chemotherapy, a so-called multi-modal approach.
Quite often, medics will withhold chemotherapy until there is evidence of a relapse. Sometimes chemo may be necessary if there is evidence that the lymphoma is systemic in nature. Surgery may be the best treatment for some breast lymphomas. However, some may be not need surgery at all, only radiation therapy. These tumors do tend to have the best prognosis. This is because the presentation was mild enough and found early enough that surgery and chemical therapy were not necessary.
Stem cell transplantation is sometimes used
Another intensive treatment option for breast lymphoma, should circumstances indicate, is to include high-dose chemotherapy supported by peripheral blood stem cell transplantation, but the use of stem cells is very controversial and not widely discussed. Essentially what happens in these more intensive types of treatment is that first a bone marrow sample is taken. Then, the physicians attempt to grow stems cells from the bone marrow in a laboratory setting. In the chemical treatment of the breast lymphoma, the lymphoma is ‘poisoned’, which kills it, but this will often kill the patient’s bone marrow as well. So, the doctors may then attempt to ‘rescue’ the damaged bone marrow by putting the saved sample, along with the newly grown stem cells, back into the patient.
Prognosis for lymphoma of the breast
Overall, breast lymphoma has a poor prognosis, and while there is still a good deal of success, the disease-free recover rates are in general quite a bit lower than for breast cancer. Without any kind of adjuvant therapy, the relapse rate for breast lymphomas treated by surgery alone is fairly high, and relapse can even occur up to ten years following breast surgery. However, no discernible factors, including stage or histologic findings, appear to consistently effect the recurrence rate. But generally, if a patient survives the early treatment phase of the disease, they tend to do very well.
Treatment for Most breast lymphomas is with surgery and chemotherapy
Statistically, surgery and chemotherapy are the treatments in about 35% of patients with lymphoma of the breast. In addition around 36% of patients need radiation as well. Treatment with surgery and radiation occurs in around 20% of patients. However, treatment with surgery alone occurs in about 6% of patients. Whilst radiation alone is the treatment for a very small subgroup of patients.
About 1/2 of breast lymphomas go into remission
The rates of complete remission of lymphoma of the breast tend to be around the 50% range. For patients who have surgery and chemotherapy treatment, there is a slightly higher success ratio. (Statistics regarding the success rates for different treatment modalities tend to be quite variable. The average success rates are around the same. However, studies do not demonstrate the ‘best’ treatment methods across the board.) Thus, it is important to remember that the choice of treatment will usually depend upon many circumstances. These include the health of the patient and the severity of the disease at the time of presentation.
Warning. This page is a little old, and the survival information in the next paragraphs is old. Survival rates are much better now. However we have a full index of up-to-date posts on survival rates HERE
Unfortunately, the survival rates for breast lymphoma are not all that promising. Statistics estimate that about 30% to 50% of patients with lymphoma of the breast will survive beyond two years. The overall survival rates are slightly higher for patients treated with surgery and radiation therapy without chemotherapy, but one cautions that the use of chemotherapy is usually indicated when the disease is already at a more advanced or systemic state, so those statistics can be misleading. However, it does appear that for patients who succumb to the disease, closure tends to occur in an average for seven months or so rather than a prolonged battle. So, if a patient with breast survival can survive beyond one to two years, chances are that the disease is in remission.
Prognosis for stage I lymphomas is much higher
Generally speaking, the prognosis for breast lymphoma seems to be related to the histologic type and stage of the disease. If a breast lymphoma is graded as stage II, then the overall survival rates seem to be just below 30%, while the prognosis for stage I tumors is much better, with overall survival rates or ‘freedom from probable progression’ around 60%.
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