Primary non-Hodgkin lymphoma of the breast. Is it possible to avoid mastectomy?

Primary lymphoma of the breast is a rare disease that has been estimated to represent from 0.05% to 0.53% of all malignant breast tumors and approxima tely 2.2% of all extranodal lymphomas. The aim of this study is to review a ll cases of primary lymphoma of the breast at the Institute of Oncology and Radiology of Serbia from 1984 to 1996 in order to determine the incidence, patterns of clinical presentation, radiological features, histopathology, mode of therapy and outcome of the disease. The criteria for inclusion in this retrospective study corresponded to a re vision of the original criteria suggested by Wiseman and Liao. The clinical histories of ten patients with breast lymphomas were reviewed. Clinical fo llow-up was obtained through a review of the patients hospital chart or by direct contact with the patients. Ten cases of primary lymphoma of the brea st have been identified during the 12-yr period, presenting 0.05% of all pa tients with malignant breast disease. All patients were female, median age at diagnosis 58 years (range 49-69), all presented with breast lumps (3 rig ht, 7 left) of median size 5 cm (range 3.5-8 cm). Mammography and breast ec hography were unable to bring a suspicion of lymphoma. Histologically, 6 ca ses were diffuse large cell, 3 of which with features consistent with immun oblastic lymphoma; 2 were diffuse mixed cells and 2 had small lymphocytic m orphology. In 4 out of 5 patients, in the clinical stage corresponding to t he "operable breast cancer" category, the ex tempore histological analysis could not differentiate lymphoma from cancer, so that all of them had maste ctomy with axillary dissection. Those corresponding to the "locally advance d breast cancer" category, escaped mastectomy and a classical biopsy was pe rformed, anticipating eventual neoadjuvant procedures. Thus, four patients underwent radical mastectomy, I wide local excision and 5 diagnostic biopsies. Further treatment included chemotherapy for 8 patie nts. The projected probability of a 10-years survival was 0,60. The rarity of this disease, and uneven treatment modalities make prognosis of breast l ymphoma difficult. It seems that cooperation between the surgeon and the pa thologist is necessary in order to reach the correct diagnosis during ex te mpore analysis. With the limitations of available diagnostic procedures, it appears that most patients with breast lymphoma, in the stage correspondin g to the "operable breast cancer" category, will unnecessarily undergo mast ectomy and axillary dissection as primary treatment approach.