Isolated Post-Transplantation Lymphoproliferative Disease Involving the Breast and Axilla as Peripheral T-cell Lymphoma
A 22-year-old woman, who had received allo-PBSCT due to acute myeloblastic leukemia, came to the oncology department for a regular check-up. Except for a recently developed cough, the patient had no B symptoms (i.e., fever, weight loss, night sweats). She had undergone computed tomography examinations of the chest and abdomen, in which exhibited no abnormal findings suggestive of relapse. In addition, the patient complained of a vaguely palpable mass in her right breast, and therefore, she had undergone whole breast ultrasonography (US) examination to evaluate the lesion.\nUltrasonography examination revealed 2 suspicious hypoechoic masses showing ill-defined margins, and mixed echo pattern with hyperechoic boundaries, and an area of focal parenchymal bulging in the right breast (). Mammography performed thereafter revealed 3, ill-defined, isodense masses in the right breast, which corresponded to the lesions detected on breast US (). US-guided core biopsy was performed targeting at the suspicious breast mass, and histologic examinations showed diffuse infiltration of large lymphoid cells with pleomorphic, irregular and prominent nuclei, and frequent mitoses that include some atypia (). Immunohistochemistry staining demonstrated that the tumor cells were positive for CD3, CD45, bcl-2, and focal positivity for CD5, but were negative for CD21, CD30, CD56 (). Epstein Barr Virus (EBV) in situ hybridization using Epstein-Barr-encoded RNA showed a negative reaction among the tumor cells. Final pathologic diagnosis of the breast mass was monomorphic peripheral T-cell, post-transplantation lymphoma. For further staging and evaluation of the presence of PTLD involvement of other organs, Fluorodeoxyglucose-positron emission tomography/computed tomography (18F-FDG PET-CT) was performed. Multiple hypermetabolic uptake (maximum SUV: 2.4-4.3) was observed in the right breast axilla, but no other abnormal uptake was seen on whole body PET scans ().\nSubsequent bone marrow biopsy specimen showed diffuse, interstitial infiltration of the marrow space by a monotonous population of blastoid immature cells, and the patient was diagnosed finally as having PTLD of the right breast with comorbid AML relapse, 39 months after allo-PBSCT.\nIn spite of the 6 months of chemotherapy after diagnosis, the patient died of disseminated fungal infection and multi-organ failure.