Breast lymphoma combined with postoperative acute hematopoietic disorder in an immediate breast reconstruction patient

摘要

Primary breast lymphoma (PBL) is a type of extra-nodal Non-Hodgkin lymphoma (NHL) in which breast tissue is the primary site of malignancy. They comprise only a small percentage of all mammary malignancies and the breast is an unusual site of involvement by lymphoma.1 Lymphomas may clinically, radiological, and morphologically mimic both benign and neoplastic conditions.A 32 years old female patient found a 3 x 2 cm2 tumor in right breast 1 month before admission. Ultrasound showed 3.2 x 2.7 x 1.8 cm and 3.2 x 1.2 cm low resonance tumors in the right breast, with rich blood supply; lymph node (-). Regular blood test showed her white blood cell (WBC), red blood cell (RBC), hematocrit (HCT) were all in normal range. Her hemoglobin (Hb) level was 110 g/L. The frozen pathological result of biopsy was infiltrating ductal carcinoma and the patient received right breast resection and immediate breast reconstruction with DIEP flap. Blood loss was about 300 ml in operation. At 48 h post operation, the patient suffered dizzy and fatigue, regular blood test showed: Hb 30 g/L, WBC 5.27 x 109/L, RBC 1.02 x 1012/L, HCT 8.6%. The patient's blood type is B Rh(-) and she received blood. Her Hb level was kept stable at 73 g/L after 5u B Rh(-) RBC transfusion. While the color of the DIEP flap turned from pale into deep blue gradually since the 2nd day post operation and she received another operation to remove the flap on the 3rd day post operation. 7 days later the final pathological result turned out to be diffused large B cell lymphoma (DLBCL) (Stage: IE, IPI:0), AE1/AE3(+), ALK(-), CD20(++), CD3(diffused+), CD68(diffused+), Ki-67 75% (Figure 1). She received bone marrow biopsy to confirm the diagnosis and the stage (Figure 2), and then she was referred to the hematologist to receive chemotherapy (R-CHOP). At that time her Hb was 105 g/L.