Keywords: breast neoplasm; Burkitt lymphoma; colon neoplasm; PET-CT
Her routine investigations revealed hemoglobin of 11.7, white cell count of 3100/mm3, platelet count of 240000/mm3, erythrocyte sedimentation rate (ESR) was 19 mm, uric acid was 10 mg/dl, liver functional tests and electrolytes were within normal range and beta2 microglobulin was 1.47.
Colonoscopy examination revealed a large tumoral lesion of 5×6 cm with superficial ulceration in proximal of ascending colon. Computed tomography (CT) scan of the abdomen showed a 55×42 mm mass in ascending colon and caecum. No lymphadenopathy, no splenomegaly and no hepatomegaly. Endoscopic ultrasonography was normal. Breast ultrasound was performed, which showed a 24×11 mm hypoechoic heterogeneous mass in the left breast. Color Doppler revealed peripheral and central vascularity. Histopathological examination of colonic and breast biopsies revealed a malignant neoplasm with ulceration composed of fibrin deposition, cell debris and neutrophilic infiltration. Extensive infiltration of atypical lymphocytes with hyperchromatic nuclei, regular borders and scattered cytoplasm were observed. Also, a few mitotic figures and a segment of necrotic tissue were noted. No grandular structures and epithelial cells were reported.
Bone marrow biopsy was normal and immunohistochemistry
(IHC) result was as follows: CD79a positive
in background B-cells, PAX5 and CD38 positive
in neoplastic B-cells, CD43, CD5 and CD3 positive
in background T-cells, CD45 positive diffusely, BCL6
positive, CD23, cyclin D1, CD56, MNF116, TdT, CD99
and chromogranin were negative in tumor cells. MYC
was positive in more than 80% of the tumor cells and
ki67 was positive in more than 95% of tumor cells, so
the findings were consistent with Burkitt's lymphoma.
Soon, she received immune-chemotherapy using Rituximab
and Hyper-CVAD (Cyclophosphamide, Vincristine,
Adriamycin, and Dexamethasone) regimen.
Since the closest time to schedule a PET scan was one
month later (due to limitations) and because of disease
nature, it was not possible to order it before chemotherapy.
One month later, PET scan revealed no evidence
in favor of metabolically active lesion throughout
the suggesting a complete remission of the disease
(Fig.
Only approximately 0.5% of breast cancers are attributed
to primary lymphoma. This rare manifestation
may occur in uni- and bilateral forms. DLBCL
accounts as the first prevalent subtype of primary lymphomas
of the breast followed by follicular lymphoma,
mucosa-associated lymphoid tissue lymphoma and
BL.[
The 5-year survival of BL from 43% in 1973-2001
reached 56% in 2002-2008; however, older patients
tend to have poorer survival.[
Also, breast BL lacks pathognomonic features in
imaging modalities, including mammography and ultrasound.[
There is still no treatment of choice for the BL. The
effectiveness of surgery is a controversial and usually
dramatic response to chemotherapy is observed with
complete remission.[
Informed consent: Informed consent was obtained from
the patient in this study.
Peer-review: Externally peer-reviewed.
Conflict of Interest: No conflict of interest.
Authorship contributions: Concept - M.E.J.; Design -
M.E.J.; Supervision - M.E.J.; Materials - M.E.J.; Data collection
&/or processing - M.E.J., A.N., E.S.B., M.M.G.H.; Analysis
and/or interpretation - M.E.J.; Literature search - M.B.;
Writing - A.A.; Critical review - A.A.
