Synchronous diffuse large B cell lymphomas of the endometrium and breast: a staging dilemma

• Published in: Irish journal of medical science Vol. 186; no. 4; pp. 867 - 873
• Main Authors: Gleeson, J. P., Woods, G. B., Watson, G. A., Ryan, J., Doyle, E., Quinn, F., O’Keane, J. C., McCaffrey, J. A.
• Format: Journal Article
• Language: English
• Published: London Springer London 01-11-2017
• Subjects: Aged; Breast - pathology; Case Based Review; Endometrium - pathology; Family Medicine; Female; General Practice; Humans; Internal Medicine; Lymphoma, Large B-Cell, Diffuse - pathology; Medicine; Medicine & Public Health; Neoplasm Staging; Non-Hodgkin lymphoma; Synchronous; DLBCL; Dilemma; Staging; Endometrial lymphoma; Diffuse large B cell lymphoma; Breast lymphoma
• ISSN: 0021-1265; 1863-4362
• DOI: 10.1007/s11845-017-1599-7

Background
A 66 years old presented with abnormal postmenopausal vaginal bleeding and was diagnosed with an endometrial lymphoma (diffuse large B cell type, DLBCL). A left breast lesion was found on PET CT which was subsequently biopsy-proven as a separate stage IE DLBCL, but she had no lymph node, bone marrow or spleen involvement.
Aims
This study aimed to review the available literature and discuss the management and staging of synchronous extra-nodal DLBCL’s.
Results
Our patient was staged as having synchronous stage IE DLBCL’s of the endometrium and breast. Subsequent molecular analysis (IgH gene rearrangement analysis) on both lesions, confirmed the two lesions to be clonally unrelated.
Conclusions
Staging of synchronous extra-nodal lymphomas, particularly when they arise in rare sites such as the endometrium and breast, is difficult and previously unreported. We present our rationale for defining our patient’s disease as synchronous stage IE DLBCL’s.