primary breast lymphoma
Introduction
Introduction to primary breast lymphoma Primary breast lymphoma is rare and has been reported in a variety of histological types. They can be in the breast or spread to the breast. basic knowledge The proportion of illness: 0.0005% Susceptible people: no special people Mode of infection: non-infectious Complications: breast lumps
Cause
Primary breast lymphoma cause
Cause:
The pathogenesis of breast lymphoma is unclear. Isaacson and Wright proposed "mucosa-associated lymphoid tissue (MALT)" 15 years ago. It is now known that this type occurs not only in the gastrointestinal tract but also in the breast. Other junctions, some people think that breast lymphoma is a kind of MALT lymphoma, but some scholars believe that not all cases have the pathological and clinical features of MALT lymphoma, however, because MALT lymphoma is an indolent lymphoma One, and breast lymphoma rarely has bone marrow involvement and other phenomena, so there are still people who speculate that this lymphoma is associated with MALT lymphoma. Long-term autoimmune lymphocyte infiltration plays an important role in the early progression of lymphoma.
Associated with autoimmune diseases and mucosa-associated lymphoma (MALT).
Prevention
Primary breast lymphoma prevention
There is no effective preventive measure for this disease. Early detection and early diagnosis are the key to the prevention and treatment of this disease. The disease is clinically rare, and most scholars report that the incidence of this disease accounts for 0.09% to 0.53% of breast malignant tumors. Six cases of malignant lymphoma of the breast were reported, accounting for 0.71% of malignant tumors in the same period. The Shandong Cancer Institute reported that the disease accounted for 10% of all breast malignancies and 2.2% of extranodal malignant lymphoma. This disease is different from the local manifestations of breast in systemic malignant lymphoma. There are no lymphomas in other parts of the body, and only local nodules in the breast. The disease can occur mostly in women aged 18 to 52 years (17 to 75 years old abroad), with an average age of onset of 38.8 years. Men are very rare, and the age of onset of breast cancer is lighter.
Complication
Primary breast lymphoma complications Complications breast lumps
There are also reports of other autoimmune diseases, such as Sjögren syndrome.
Symptom
Primary breast lymphoma symptoms Common symptoms Breast lumps
The most common clinical manifestations of unilateral breast masses, the right side of the invasion is more common, only one group reported that the invasion of the left side, about 5% to 25% of the two sides of the invasion, only a few occurred in men, the clinical manifestations of painless Relatively active enlarged masses generally do not adhere to the skin. This mass is often found during physical examination or breast scan and needs to be differentiated from invasive breast cancer.
The uncommon performance is that young women in pregnancy can see a rapid increase in breasts in a short period of time, can reach bilateral masses, and histological examination is Burkitt or Burkitt-like lymphoma. The prognosis of this disease is extremely poor, because the tumor grows rapidly and spreads widely. It can invade the ovaries and the central nervous system. This clinical manifestation is more common in Africa, and occasionally reported in Western countries.
Breast lymphoma occurs on the right side, and the axillary lymph node is 30% to 40%, and its texture is softer than solid tumor.
Examine
Examination of primary breast lymphoma
Early hematuria and routine, biochemical examinations were normal.
1. Imaging examination
X-ray films are clearly characterized as relatively limited masses, but it is more difficult to identify malignant lymphomas and other conventional breast diseases by mammography and ultrasound. Gallium scans (67Ga imaging), SPECT and MRI scans are used for diagnosis and follow-up. A newer approach has recently suggested that MRI is better than mammograms and ultrasound in confirming multicenter tumors.
2. Fine needle aspiration and biopsy for the diagnosis of primary breast lymphoma
Fine needle aspiration combined with flow cytometry is very effective in the diagnosis of breast tumors. The rate of misdiagnosis is higher in the diagnosis of frozen sections: 2 cases of lymphoma originating from the breast are misdiagnosed as invasive lobular carcinoma, and several cases of high-grade lymphoma are diagnosed as Invasive undifferentiated carcinoma, most of the diagnosis of breast lymphoma requires biopsy after resection, biopsy can better histopathological classification.
Diagnosis
Diagnosis and diagnosis of primary breast lymphoma
diagnosis
The following can be diagnosed as primary breast lymphoma:
1 Clinically confirmed that the mammary gland is the first or main site.
2 There is no evidence of other parts of lymphoma, excluding the presence of ipsilateral axillary lymph node invasion.
3 Local lymph node invasion should be accompanied by breast lesions and lymph node lesions. Secondary breast lymphoma can be defined as all lymphomas that do not meet the above criteria and invade the breast.
Differential diagnosis
Because breast lymphoma is uncommon and clinical manifestations are indistinguishable from breast cancer, it is often overlooked when starting biopsy. Breast lymphoma is larger than breast cancer, but this does not distinguish between the two. If the patient rapidly enlarges in a short period of time, It has a suggestive effect on malignant lymphoma, and some common symptoms of breast cancer, such as skin retraction, erythema, orange peel-like appearance, and discharge of papillary secretions are not common in primary breast lymphoma.
Differential diagnosis of low-grade malignant lymphoma of the breast includes MALT-type lymphoma, follicular lymphoma, lymphocytic breast disease, and secondary invasion of systemic lymphoma, such as small lymphocytic lymphoma/chronic lymphocytic leukemia (CLL) Or mantle-type lymphoma (MCL), MALT type and lymphocytic breast disease are mainly identified by histological background. MALT-type infiltration is mainly composed of extracellular follicles, accompanied by irregular nucleoli and a large number of cytoplasm. Lymphatic epithelial lesions are predominant, and it is necessary to confirm clonality by immunohistochemical staining, flow cytometry or molecular genetic analysis. For follicular lymphoma, a large number of follicles can be seen, of which small fissure cells are dominant; Bcl-2 protein staining may be helpful in distinguishing between benign and malignant, and small lymphocytic lymphoma or mantle cell lymphoma occurring in the breast may spread widely. Immunohistochemistry may be helpful. CLL and MCL are both CD5, cytosolic lymphoma cyclinD1 positive, while MALT and follicular lymphoma CD5 and cyclin D1 are negative, breast large cell lymphoma and Burkitt lymphoma must be identified It should also be differentiated from non-lymphatic tumors, such as common poorly differentiated breast cancer, and should also be differentiated from lymphoblastic lymphoma or leukemia infiltration. Any breast cancer without typical features should be immunohistochemically Exclude malignant lesions of the hematopoietic system.
