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Case of the Month

May 2010

Patient Data: 60 year old female

Clinical Info: Palpable mass in the left breast and a palpable lymph node in the left axilla


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Ultrasound image of the palpable mass


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Ultrasound image of the palpable mass


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Ultrasound image of the palpable mass


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Ultrasound image of the palpable axillary lymph node


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Color Doppler image of the palpable lymph node


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The mammography shows a marked asymmetry on the cranio-caudal view


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Medio-latero- oblique view of the same patient shows asymmetry but no circumscribed mass


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A contrast enhanced MRI scan shows early uptake of contrast in an area in the left breast

The hypo-echoic enlarged lymph node in the left axilla has malignant features. The breast lesion however did not show typical features of a malignancy, but on the other hand could not be characterized as typically benign, so we classified it as BIRADS 4. Before performing a biopsy the MRI was performed. The enhancement pattern was suggestive for malignancy.
To our surprise the biopsy of the breast lesion and the lymph node both showed a diffuse large cell B cell non Hodgkin's lymphoma. Further examination of the patient revealed no other localizations of a Hodgkin's lymphoma.
Practically at the same time of this examination a case report was published by Zechmann et al in the European Journal of Ultrasound of another case of a B cell lymphoma of the breast.

For more examples of malignant breast lesions see category 5.2 Malignant breast lesions.


References
B-cell lymphoma of the female breast: comparison of mammography, ultrasound and dynamic MRI.
Zechmann CM, Buchheidt D, Hildenbrand R, Teubner J.
Ultraschall Med. 2010 Feb;31(1):71-3.

Copyright © Dr. T.S.A. Geertsma, Ziekenhuis Gelderse Vallei, Ede, The Netherlands. All rights reserved.