Synchronous presentation of invasive ductal breast carcinoma and follicular lymphoma: a diagnostic challenge

Introduction: The presentation of synchronous tumors is rare. At the same time, the increase in the incidence of non-Hodgkin lymphoma in patients treated for malignant breast neoplasm submitted to radiotherapy is a known fact. However, some authors have reported cases of breast neoplasm and lymphoma at initial diagnosis. It is unclear whether they originate from common underlying mechanisms, triggering others, or if one disease process is completely independent of the other. Clinical case: A 69-year-old asymptomatic female patient was referred to the mastology department due to abnormalities in the routine mammography. Upon presentation, she had no associated B symptoms, and the physical examination revealed a palpable nodule in the left breast and suspicious palpable left axillary lymphadenopathy. Mammography prior to the appointment showed a 15 mm nodule in the left breast with well-defined margins. A complementary ultrasound revealed multiple simple cysts in the left breast, the largest with 1.3 cm and retroareolar. The anatomopathological report of the core biopsy and fine-needle aspiration biopsy (FNAB) indicated an invasive ductal carcinoma in the left breast, with T2N2M0 as the initial clinical staging. Immunohistochemical evaluation revealed estrogen receptor-positive (ER+++ 95%), progesterone receptor-negative (PR-), HER2-, Ki67 8%. FNAB of axillary lymph node showed no malignancy in the sample. Staging tomography had no evidence of distant lesions. The patient underwent a radical mastectomy and axillary lymph node dissection with plans for adjuvant chemotherapy. The final anatomopathological report of the surgical specimen revealed a well-differentiated invasive ductal breast carcinoma associated with intraductal carcinoma, measuring 2.7x1.9x1.8 cm and with free margins. A total of 45 lymph nodes were dissected, with no evidence of involvement by carcinoma. However, an atypical proliferation strongly suggestive of follicular lymphoma was identified. Immunohistochemistry was positive for CD 10, Bcl-6, and Bcl-2, compatible with follicular lymphoma, grade 1-2 (predominantly follicular >75%). Discussion: Literature reviews show that 88.9% of case reports have failed in diagnosing the second synchronous neoplasm. Usually, FNAB and even core biopsy of these lymph nodes does not guarantee the diagnosis, given the high rates of false-negative in these cases, and their findings are often insufficient. Imaging diagnosis is frequently unclear in these situations, and the diagnosis is mainly reached after surgical treatment and final histological evaluation. Final considerations: The case brings to light the discussion about the treatment of a complex, hard to diagnose situation, which leads to delayed management. Multidisciplinary follow-up is crucial for this diagnosis so as to prevent unfavorable outcomes.

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Completion axillary lymph node dissection minimizes the likelihood of false negatives for patients with invasive breast carcinoma and cytokeratin positive only sentinel lymph nodes

The American Journal of Surgery ◽

10.1016/s0002-9610(02)00958-3 ◽

2002 ◽

Vol 184 (4) ◽

pp. 302-306 ◽

Cited By ~ 46

Author(s):

James W Jakub ◽

Nils M Diaz ◽

Mark D Ebert ◽

Alan Cantor ◽

Douglas S Reintgen ◽

...

Keyword(s):

Lymph Node ◽

Breast Carcinoma ◽

Lymph Nodes ◽

Axillary Lymph Node Dissection ◽

Lymph Node Dissection ◽

Axillary Lymph Node ◽

Sentinel Lymph Nodes ◽

Axillary Lymph ◽

Node Dissection ◽

False Negatives

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Association of conventional ultrasound, elastography and clinicopathological factors with axillary lymph node status in invasive ductal breast carcinoma with sizes > 10 mm

Oncotarget ◽

10.18632/oncotarget.18969 ◽

2017 ◽

Vol 9 (2) ◽

pp. 2819-2828

Author(s):

Hui Liu ◽

Guang Xu ◽

Ming-Hua Yao ◽

Huan Pu ◽

Yan Fang ◽

...

Keyword(s):

Lymph Node ◽

Breast Carcinoma ◽

Axillary Lymph Node ◽

Ultrasound Elastography ◽

Lymph Node Status ◽

Axillary Lymph ◽

Clinicopathological Factors ◽

Axillary Lymph Node Status ◽

Invasive Ductal Breast Carcinoma ◽

Conventional Ultrasound

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Relation between the expression of E-cadherin, p53,c-erb-B2 (HER-2/neu) and steroid receptors (ER, PgR) in invasive ductal breast carcinoma with axillary lymph node metastases

Marmara Medical Journal ◽

10.5472/mmjoa.2802.07 ◽

2015 ◽

Vol 28 (2) ◽

pp. 099

Author(s):

Nihal Kılınç

Keyword(s):

Lymph Node ◽

Breast Carcinoma ◽

Lymph Node Metastases ◽

Axillary Lymph Node ◽

Steroid Receptors ◽

Axillary Lymph ◽

Invasive Ductal Breast Carcinoma ◽

Axillary Lymph Node Metastases ◽

Her 2 ◽

Node Metastases

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A comparative study to evaluate the efficacy of the USG and USG guided FNAC of axillary lymph node of carcinoma breast in clinically node negative cases

International Surgery Journal ◽

10.18203/2349-2902.isj20171607 ◽

2017 ◽

Vol 4 (5) ◽

pp. 1614

Author(s):

Ramesh H. ◽

Praveen K. N. ◽

Akshay V. Gokak ◽

Abhijit D. H.

Keyword(s):

Lymph Node ◽

Breast Carcinoma ◽

Comparative Study ◽

Lymph Nodes ◽

Axillary Lymph Node ◽

Axillary Lymph Nodes ◽

Axillary Lymph ◽

Reliable Technique ◽

Node Negative ◽

Negative Predictor

Background: Breast cancer remains the most common malignancy among women and accounts for 32% of all cancers in women. The average age of developing cancer is shifted from 50-70 years to 30-50 years. Cancers in young tend to be more aggressive. In the absence of distant metastasis, assessment of axillary status is the important part of initial staging process because of its subsequent importance in management. And the absence of presence or absence of axillary metastasis is the strongest prognostic indicator available for breast carcinoma. The objectives were to assess the accuracy USG and USG guided FNAC of axillary lymph nodes of carcinoma breasts in clinically node negative cases and to determine USG guided FNAC can be used to detect axillary lymph nodes metastasis.Methods: This was a comparative study conducted at KIMS Hospital from November 2013 to November 2015. All the patients with clinically node negative carcinoma breasts were evaluated with USG Axilla and those found to be having lymph nodes were subjected to USG guided FNAC and these were correlated with the HPR report.Results: A total 12 patients who satisfied the inclusion criteria were included in study. The most common age group involved in this study was 30-40 years. Upper outer quadrant was the most common location of the group. The sensitivity of the USG in detecting axillary lymph node was 50%, specificity 75%, positive predictor value 805, negative predictor value 42.8% and accuracy of 58.3%. Sensitivity of USG guided FNAC was 50%, specificity 100%, positive predictor value 100%, negative predictor value 50% and accuracy of 66.6%.Conclusions: In conclusion USG-FNAC of axillary lymph node is a simple, minimally invasive and reliable technique for the initial determination of ALN status in patients with breast carcinoma. In present study, the PPV of 100% and NPV of 50% indicate that the predictor power of a positive result is excellent but as expected a negative result is less helpful.

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Dedicated Axillary MRI-Based Radiomics Analysis for the Prediction of Axillary Lymph Node Metastasis in Breast Cancer

Cancers ◽

10.3390/cancers13040757 ◽

2021 ◽

Vol 13 (4) ◽

pp. 757

Author(s):

Sanaz Samiei ◽

Renée W. Y. Granzier ◽

Abdalla Ibrahim ◽

Sergey Primakov ◽

Marc B. I. Lobbes ◽

...

Keyword(s):

Breast Cancer ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Lymph Nodes ◽

Axillary Lymph Node ◽

Axillary Lymph Node Metastasis ◽

Axillary Lymph Nodes ◽

Axillary Lymph ◽

Mr Images ◽

Node Metastasis

Radiomics features may contribute to increased diagnostic performance of MRI in the prediction of axillary lymph node metastasis. The objective of the study was to predict preoperative axillary lymph node metastasis in breast cancer using clinical models and radiomics models based on T2-weighted (T2W) dedicated axillary MRI features with node-by-node analysis. From August 2012 until October 2014, all women who had undergone dedicated axillary 3.0T T2W MRI, followed by axillary surgery, were retrospectively identified, and available clinical data were collected. All axillary lymph nodes were manually delineated on the T2W MR images, and quantitative radiomics features were extracted from the delineated regions. Data were partitioned patient-wise to train 100 models using different splits for the training and validation cohorts to account for multiple lymph nodes per patient and class imbalance. Features were selected in the training cohorts using recursive feature elimination with repeated 5-fold cross-validation, followed by the development of random forest models. The performance of the models was assessed using the area under the curve (AUC). A total of 75 women (median age, 61 years; interquartile range, 51–68 years) with 511 axillary lymph nodes were included. On final pathology, 36 (7%) of the lymph nodes had metastasis. A total of 105 original radiomics features were extracted from the T2W MR images. Each cohort split resulted in a different number of lymph nodes in the training cohorts and a different set of selected features. Performance of the 100 clinical and radiomics models showed a wide range of AUC values between 0.41–0.74 and 0.48–0.89 in the training cohorts, respectively, and between 0.30–0.98 and 0.37–0.99 in the validation cohorts, respectively. With these results, it was not possible to obtain a final prediction model. Clinical characteristics and dedicated axillary MRI-based radiomics with node-by-node analysis did not contribute to the prediction of axillary lymph node metastasis in breast cancer based on data where variations in acquisition and reconstruction parameters were not addressed.

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