Bilateral breast swelling in a 23-year-old woman with Burkitt lymphoma
A 23-year-old woman suffered from redness, pruritus and tightness of her breasts in the last trimester of her pregnancy. Symptoms were considered to be related to hormonal change in pregnancy, but her problems aggravated after delivery. She also complained of fever and painful rapid enlargement of her breasts []. While feeding her child a large amount of serosanguinous fluid drained from her breasts. This time she was admitted in a general hospital under the diagnosis of breast abscess.\nPhysical examination showed tenderness, swelling, redness and ulcer in both breasts and right side axillary lymphadenopathy. No other abnormalities were found on examination and significant laboratory findings are shown in \n.\nA course of antibiotic treatment was started for her. Incision and drainage were done by a surgeon, but the patient showed no clinical improvement. Breast biopsy was done and the result was: Sheet of medium size neoplastic cells with large nuclei, multiple distinct nucleoli, amphophilic cytoplasm and frequent mitosis suggestive for malignant lymphoma probably Burkitt type []. The patient was referred to the surgical oncologic service in Emam Khomeyni Hospital in Sari, Mazandaran, Iran in 2012.\nBone marrow aspiration and biopsy (BMA/B) was done and immunophenotyping revealed a large mononuclear cell population with vacuolated dark-blue cytoplasm about 16% of total cell, immunophenotyping expressed CD19, CD20, HLA-DR (human leukocyte antigens), but negative about CD10, consistent with B-cell lymphoma []. Brain magnetic resonance imaging was normal; chest computed tomography (CT) showed bilateral breast's tissue swelling. Abdominopelvic CT showed the small amount of fluid in abdominal cavity and bilateral kidney enlargement with heterogeneous enhancement.\nChemotherapy with CODOX-M/IVAC (Cyclophosphamide, Oncovin, Doxorubicin, Methotrexate, Ifosfamide, Vepesid and Ara-C) regimen started for her, and the patient showed complete remission on BMA/B, cerebrospinal fluid analysis and clinical course.