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Case of the Month

May 2010

Patient Data: 60 year old female

Clinical Info: Palpable mass in the left breast and a palpable lymph node in the left axilla

Ultrasound image of the palpable mass

Ultrasound image of the palpable mass

Ultrasound image of the palpable mass

Ultrasound image of the palpable axillary lymph node

Color Doppler image of the palpable lymph node

The mammography shows a marked asymmetry on the cranio-caudal view

Medio-latero- oblique view of the same patient shows asymmetry but no circumscribed mass

A contrast enhanced MRI scan shows early uptake of contrast in an area in the left breast

The hypo-echoic enlarged lymph node in the left axilla has malignant features. The breast lesion however did not show typical features of a malignancy, but on the other hand could not be characterized as typically benign, so we classified it as BIRADS 4. Before performing a biopsy the MRI was performed. The enhancement pattern was suggestive for malignancy.
To our surprise the biopsy of the breast lesion and the lymph node both showed a diffuse large cell B cell non Hodgkin's lymphoma. Further examination of the patient revealed no other localizations of a Hodgkin's lymphoma.
Practically at the same time of this examination a case report was published by Zechmann et al in the European Journal of Ultrasound of another case of a B cell lymphoma of the breast.

For more examples of malignant breast lesions see category 5.2 Malignant breast lesions.

B-cell lymphoma of the female breast: comparison of mammography, ultrasound and dynamic MRI.
Zechmann CM, Buchheidt D, Hildenbrand R, Teubner J.
Ultraschall Med. 2010 Feb;31(1):71-3.

Copyright © Dr. T.S.A. Geertsma, Ziekenhuis Gelderse Vallei, Ede, The Netherlands. All rights reserved.

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