背景:具有印戒细胞成分的弥漫性大B细胞淋巴瘤(DLBCL)极为罕见。这里,我们介绍了一例DLBCL,其中印戒细胞成分累及乳腺,容易与乳腺浸润性小叶癌或胃肠道来源的转移性印戒细胞癌混淆。
方法:一名66岁的女性,她的左乳房出现无痛肿块。增强的乳房磁共振成像(MRI)显示左乳房有42×29×28mm的肿块。组织学检查显示,圆形细胞与印戒环样细胞混合在一起,呈弥散或分散排列。免疫组织化学,肿瘤细胞PAX-5,CD79a,CD20、Bcl-6和MUM-1,但细胞角蛋白阴性,ER,PR,E-cadherin,P120Ki-67增殖指数约为70%。荧光原位杂交(FISH)显示Bcl-2、Bcl-6和c-MYC基因的非重排。免疫组化和FISH检查证实了DLBCL的诊断。随后,免疫荧光显示IgM和IgG沉积在印戒环样淋巴细胞中。确诊后,患者接受了四个疗程的CHOP(环磷酰胺,阿霉素,长春新碱,和泼尼松龙)在专科医院进行化疗,并获得部分缓解;然而,3个月后,她不幸死于继发性肺囊虫肺炎感染。
结论:伴有印戒细胞形态的恶性淋巴瘤并不常见,这种变异可能是一个诊断缺陷。我们强调病理学家在恶性乳腺肿瘤的鉴别诊断中应考虑淋巴瘤。
Diffuse large B-cell lymphoma (DLBCL) with signet ring cell components is extremely rare. Here, we present a
case of DLBCL with signet ring cell components involving the breast, which can be easily confused with invasive lobular carcinoma of the breast or metastatic signet ring cell carcinoma of gastrointestinal origin.
A 66-year-old woman presented with a painless mass in her left breast. Enhanced magnetic resonance imaging (MRI) of the breast revealed a 42 × 29 × 28 mm mass in the left breast. Histological examination revealed a diffuse or scattered arrangement of round cells mixed with signet ring-like cells. Immunohistochemically, the neoplastic cells were positive for PAX-5, CD79a, CD20, Bcl-6, and MUM-1 but and negative for cytokeratin, ER, PR, E-cadherin, and P120. The Ki-67 proliferation index was approximately 70%. Fluorescence in situ hybridisation (FISH) demonstrated non-rearrangement of Bcl-2, Bcl-6, and c-MYC genes. Immunohistochemistry and FISH examination confirmed the diagnosis of DLBCL. Subsequently,
immunofluorescence showed both IgM and IgG deposits in the signet ring-like lymphocytes. After confirming the diagnosis, the patient received four courses of CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisolone) chemotherapy in a specialist hospital and achieved partial remission; however, she unfortunately died of secondary pneumocystis pneumonia infection 3 months later.
Malignant lymphoma with signet ring cell morphology is quite uncommon, and this variant can be a diagnostic pitfall. We emphasise that pathologists should consider lymphoma in the differential diagnosis of malignant breast tumours.