Diffuse Large B-Cell Lymphoma of the Breast: Diagnostic Challenges and Case Insights

Abstract

Background: Primary breast lymphoma  (PBL) is a rare extranodal non-Hodgkin lymphoma, accounting for less than 1% of breast cancers and 2–3% of all extranodal lymphomas, and may occur at  various physiological stages, often mimicking breast carcinoma clinically and radiologically.

Cases: We report two cases of diffuse large B-cell Primary breast lymphoma diagnosed in 2018 and 2023 . The first involved  a 72-year-old postmenopausal woman with a mass in the upper outer quadrant of the right breast and two axillary lymph nodes, evolving over a few months. She received initial R-CHOP chemotherapy, but developed a local recurrence 24 months later, which was managed with salvage chemotherapy combined with localized radiotherapy,resulting in complete remission on follow-up. The second case concerned a 41-year-old diabetic woman with a rapidly enlarging mass in the lower outer quadrant of the left breast and a single axillary lymph node. She achieved complete remission after six cycles of R-CHOP chemotherapy without recurrence.

Discussion: These cases highlight the broad spectrum of Primary breast lymphoma presentations and the diagnostic challenges in distinguishing it from breast carcinoma. Imaging features are often nonspecific; histopathology and immunohistochemistry are essential. Management relies on systemic chemotherapy, with or without radiotherapy, contrasting with the surgical-centered approach of breast carcinoma.

Conclusion: Rapidly growing or atypical breast masses should raise suspicion for primary breast lymphoma. Early biopsy and immunophenotyping are essential to ensure correct diagnosis and avoid unnecessary surgery.