CASE REPORT Disseminated high-grade malignant lymphoma involving both breasts BernaO ¨ ksu¨zog˘lu, 1 O ¨ zlemEr, 1 MehmetGu¨ler, 2 MutluDog˘anay, 2 MustafaEsen 1 andNuriAydinKama 2 1 Department of Medical Oncology and 2 Department Of General Surgery, Ankara Numune State Hospital, Ankara, Turkey SUMMARY. Primary or secondary involvement of the breast is a rare form of extranodal lymphoma. In this paper, we present a 36-year-old female patient admitted to the hospital with bilateral breast masses. Histological examination confirmed high-grade malignant lymphoma involving both breasts. r 2002 Elsevier Science Ltd. All rights reserved. INTRODUCTION Malignant lymphoma arising in the breast or involving itsecondarilyisararecondition.Thereportedincidence ofprimarybreastlymphomavariesfrom0.04%to0.5% of malignant breast neoplasms and comprises 1.7% of extranodal malignant lymphomas. 1–4 The rarity of the disease can be attributed to the relative paucity of lymphoid tissue in the breast. 4 Bilateral breast involve- ment is rarer still, and the patients can be divided into two groups: 5 a form with heterogeneous morphological featuresinvolvespredominantlyolderwomen,whilethe other aggressive form is seen in women of childbearing age. 1,5 In the case report presented in this paper, a young femalepatientwithbilateralbreastinvolvementbyhigh- grade malignant lymphoma is discussed. CASE REPORT A36-year-oldwomanwasadmittedtothehospitalafter suffering abdominal distension, nausea, vomiting, fever, andsweatingfor1monthandrapidlygrowingbilateral breast masses first noted about 15 days before admis- sion.Herperformancestatuswaspoor;shewaspaleand hadsinustachycardia.Therewasdullnessonpercussion and decreased breath sounds over the basal part of the right hemithorax, abdominal distension and diffuse ascites. There was a 5cm  8cm 2 mass in the upper outerquadrantoftherightbreast,a12  8cm 2 mass in the outer quadrant of the left breast, and a 10  8cm 2 lymphadenopathy in the left axilla. The hemoglobin level was 8.5g/dl, the leucocyte count was 11800/mm 3 , the thrombocyte count 569000/mm 3 , and the erythro- cyte sedimentation rate, 28mm/h. The LDH level was markedly high, at 1791IU/l (normal: 230–460IU/l). CEA,CA19-9,andAFPlevelswerenormal;theCA15-3 level was slightly elevated, and the CA125 level was six times the normal value. Bilateral mammography and ultrasonography revealed multiple hypoechogenic solid breastmasses,thelargestbeing36  21mm 2 intheright breast, and 35  25mm 2 in the left breast, and multiple lymphadenopathies in the left axilla. Punch biopsy of these breast masses revealed high-grade, small non- cleaved cell malignant lymphoma (Burkitt type) (Figs 1 and 2). Thoracoabdominal tomography showed bilat- eralpleuraleffusionswhichweremostprominentonthe right, increased parenchymal thickness of both kidneys with diffuse parenchymal infiltration showing up as hypodense, heterogeneous images, a left adrenal mass measuring 36  25mm 2 , and diffuse ascites and lobu- lated masses containing hypodense necrotic regions; their greatest dimensions were 15cm  10cm 2 on the right and 15  9cm 2 on the left side of the pelvis. Bone marrow biopsy examinations gave normal results. Combination chemotherapy with cyclophosphamide, adriamycin, vincristine, bleomycin, etoposide, and a Addresscorrespondenceto:BernaO ¨ ksu¨zogˇlu,M.D.,SimkentSitesi,6. BlokNo.26,Kirkkonaklar/C¸ ankayaAnkara06610, Turkey. Tel: +90-542-2211919; Fax: +90 312 2844277; E-mail: bernaoksuzoglu@hotmail.com Received: 24 April 2002 Accepted: 22 July 2002 The Breast (2002) 11, 454–456 r 2002 Elsevier Science Ltd. All rights reserved. doi:10.1054/brst.2002.0463, available online at http://www.idealibrary.com on 454