A Case of ALK-Positive Anaplastic Large Cell Lymphoma of the Male Breast

Abstract

Background

Primary breast lymphoma (PBL) is a very rare form of non-Hodgkin’s lymphoma (NHL). A primary T-cell lymphoma in the breast with no previously identified lymphomatous lesions is an even rarer form of this malignancy.

Case Presentation

A biopsy of a breast mass in a 60-year-old Caucasian man showed a morphologic-immunophenotypic profile with features characteristic of an ALK-positive (AKT+), anaplastic large cell lymphoma. Fluorescence in situ hybridization (FISH) analysis of fixed, paraffin-embedded tissue of this lesion was performed at our institution for IRF4/DUSP22 gene rearrangement. No rearrangement was detected. The patient presented with mutations in the following genes; BCOR_p.Q600X, DNMT3A_p.F609fs, NOTCH1_p.P2320fs, and IDH2_p.R140Q. However, the patient’s consultation was complicated by the fact that he had been diagnosed with breast cancer at a local hospital and had come to our institution for further consultation. The histology findings were confirmed by immunohistochemistry and FISH. Computed tomography and positron emission tomography did not reveal nodules elsewhere in the body, which allowed the staging of the patient to be completed. However, although the patient had previously received the chemotherapy CCOP regimen (ie, cyclophosphamide, vincristine, prednisolone acetate) he did not go into remission in a timely manner and relapsed after six months, followed by a drastic deterioration in his condition after four months, resulting in his death in less than one month.

Conclusion

This report of a male patient describes a case of a rare T-cell lymphoma of the breast that occurs considerably more frequently in female patients. The differential diagnosis of the histology of this tumor showed mutations that occur more often in lymphoblastic lymphoma or leukemia. This rare malignancy and associated mutations led to the death of this patient during treatment.

Keywords:

• tumors
• lymphopoietic system
• male breast
• diagnostic histopathology
• misdiagnosis

Ethical Statement and Consent to Participate

The study was reviewed and approved by the Ethics Committee of The Fourth Hospital of Hebei Medical University (approval number, 2022KS023. The study did not involve interaction with human subjects and/or the use of personally identifiable information. There was no need for informed consent to be obtained from the patient for the use of existing pathological materials in the study and identifiable patient information was not disclosed in the manuscript.

Availability of Supporting Data

The source of data for all the Figures and Tables is provided in the paper. No new datasets have been generated or analyzed for this article.

Informed Consent Statement: Informed consent was obtained from the patient involved in this study. Written informed consent was obtained from the patient for publication of this case report and any accompanying images.

Consent for Publication

All the authors agree to the publication of this article.

Acknowledgments

We acknowledge the excellent technical assistance of the members of the tumor genetics laboratory at the Institutes of Human Genetics in Hebei Medical University, particularly Zi Zhang, Fei Lu, Xudi Liu, Yongjun Wang, Huichai Yang, Huazi Hao, and HongLei Wang, and also the team of the Lymph Node Registry, Beijing Friendship Hospital, particularly Xiaoge Zhou and Jianlan Xie.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors declare that they have no competing interests.

Additional information

Funding

The work reported in this article did not receive funding.