A Multidisciplinary Approach to the Diagnosis and Management of a Mammary Myofibroblastoma in a Male with a History of Diffuse Large B-Cell Lymphoma: A Case Report

TL;DR

An 80-year-old man with a history of lymphoma was diagnosed with a rare benign breast tumor, which was successfully managed with surgery and no further complications.

Contribution

This case report highlights the importance of multidisciplinary evaluation in distinguishing benign tumors from residual lymphoma in post-treatment imaging.

Findings

A benign mammary myofibroblastoma was diagnosed in a patient with a history of DLBCL.

The patient remained in complete remission with no recurrence 12 months post-surgery.

PET-CT showed a low SUVmax, which aided in the differential diagnosis.

Abstract

Background and Clinical Significance: Diffuse Large B-Cell Lymphoma (DLBCL) is a morphologically and molecularly heterogeneous lymphoproliferative disorder that originates from a clonal B-cell ancestor. Patients usually present with rapidly enlarging lymph nodes or mass(es) at single or multiple sites. Generally, 18F-Fluorodeoxyglucose (18F-FDG) positron emission tomography with computed tomography (PET-CT) is performed post-treatment to evaluate remission status, especially in radiologically residual tumors. Myofibroblastoma (MFB) is a benign mesenchymal tumor of the mammary stroma composed of fibroblasts and myofibroblasts. These entities do not often present concurrently. Case presentation: The patient was an 80-year-old man with a history of stage IV-BS Diffuse Large B-Cell Lymphoma (DLBCL) with a high-risk International Prognostic Index (IPI). The patient underwent treatment with a six-cycle R-CHOP regimen. Immediately after the last cycle, an 18F-Fluorodeoxyglucose (18F-FDG) positron emission tomography with computed tomography (PET-CT) scan revealed a nodular solid lesion with a faintly increased metabolic standardized uptake value (SUVmax) of 3 in the upper outer quadrant of his left breast. A biopsy of the breast lesion was performed, and it revealed a benign mesenchymal tumor, specifically a Myofibroblastoma. The patient has not presented any symptoms or complications since surgery (12 months) and remains in complete remission (CR). Conclusions: Given the potential diagnostic pitfalls and therapeutic implications of residual tumors in the context of DLBCL, a conscientious evaluation by a multidisciplinary team (MDT) is highly recommended.

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