Case Report

Collision Tumor: Invasive Ductal Carcinoma in Association with Mucosa-associated Lymphoid Tissue (MALT) Lymphoma in the Same Breast

Authors: Joanne M. Quilon, MD, Thomas A. Gaskin, MD, Arthur S. Ludwig, MD, Catherine Alley

Abstract

Synchronous occurrence of multiple neoplastic processes is uncommon and the relationship between breast cancer with lymphoproliferative diseases is unusual as well. Furthermore, breast involvement by malignant lymphoma is a rare event and primary breast mucosa-associated lymphoid tissue (MALT) lymphoma is even rarer. We report a patient with synchronous occurrence of malignant lymphoma of MALT type and ductal carcinoma of the breast, presenting as “collision tumor,” invading each other and occurring as a single mass in the breast. Involvement of the sentinel lymph node by MALT lymphoma was demonstrated with no evidence of metastatic carcinoma. Staging bone marrow biopsy did not show involvement by malignant lymphoma or carcinoma. Our patient was treated with chemotherapy for the lymphoma. She also received radiotherapy and aromatase inhibitor as adjuvant therapy for the breast carcinoma.


Key Points


* The relationship between breast cancer and lymphoproliferative disease is unusual with an association rate of 1.5%.


* Primary breast lymphomas are uncommon and represent 0.04% to 0.52% of all breast malignant neoplasms.


* The incidence of MALT lymphomas among the breast lymphoma cases ranges from 8.5 to 35%.


* Among other factors implicated in the occurrence of synchronous breast carcinomas and lymphoma, mouse mammary tumor virus (MMTV) has recently been suggested to be a common etiologic agent of the two neoplasms.


* It is important to keep an open mind to the possibility of multiple primary neoplasms in patients with carcinoma.

This content is limited to qualifying members.

Existing members, please login first.

If you have an existing account please login now to access this article or view your purchase options.

Purchase only this article ($15)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Lee T, Myers RT, Scharyj M, et al. Multiple primary malignant tumors (MPMT): study of 68 autopsy cases (1963-1980). J Am Geriatr Soc 1982;30:744–752.
 
2. Herrmann JB. Lymphoproliferative disease secondary to breast cancer. NY State J Med1971;711108–1111.
 
3. Mattia AR, Ferry J, Harris N. Breast lymphoma a B-cell spectrum including the low grade B-cell lymphoma of mucosa associated lymphoid tissue. Am J surg Pathol 1993;17:574–587.
 
4. Knowles DM. Neoplastic Hematopathology, 2nd ed. Philadelphia, Lippincot Williams & Wilkins, 2001.
 
5. Brogi E, Harris NL. Lymphomas of the breast: Pathology and clinical behavior. Semin Oncol1999;26:357–364.
 
6. Allal AS, Weintraub J, et al. Concurrent interfollicular Hodgkin's disease and metastatic breast carcinoma in lymph nodes. Pathol Int 1996;46:787–790.
 
7. Stierer M, Rose HR, et al. Synchrony of malignant lymphoma and breast cancer. JAMA1990;263:2922–2923.
 
8. Caraway NP, Wojcik EM, et al. Concomittant lymphoma and metastatic carcinoma in the lymph node: diagnosis by fine-needle aspiration biopsy in two cases. Diagn Cytopathol 1997;17:287–291.
 
9. Pandey U, Naraynan M, et al. Carcinoma metastasis to unexpected synchronous lymphoproliferative disorder: report of three cases and review of literature. J Clin Pathol 2003;56:970–971.
 
10. Luciana A, Stefano B, et al. Breast carcinoma metastatic to a lymphoma: report of a case with review of literature. Histopathology 1999;34:87–89.
 
11. Benoit L, Arnould L, et al. Concurrent lymphoma and metastatic breast carcinoma in the axillary, confounding sentinel lymph-node biopsy. Eur J Surg Oncol 2003;30:462–463.
 
12. Frey BM, Morant R, et al. Simultanes Auftreten von Mammakarzinom und malignem lymphom.Scweiz Med Wochenschr 1994;124:1010–1016.
 
13. Rosen PP. Rosen's Breast Pathology, 2nd ed. Philadelphia, Lippincot Williams & Wilkins, 2001.
 
14. Susnik B, Rowe JJ, et al. A unique collision tumor in breast invasive ductal carcinoma and mucosa-aaociated lymphoid tissue lymphoma. Arch Pathol Lab Med 2004;128:99–101.
 
15. Wiernik PH, Hu X, et al. Non-Hodgkin's lymphoma in women with breast cancer. Cancer J2000;6:336–342.
 
16. Etkind P, Du J, et al. Mouse mammary tumor virus-loke ENV gene sequences in human breast tumors and in a lymphoma of a breast cancer patient. Clin Cancer Res 2000;6:1273–1278.
 
17. Cotterchio M, Nadalin V, Sauer M. Human breast cander and lymphomas may share a common etiology involving mouse mamary tumour virus (MMTV). Med Hypotheses 2002;59:492–494.