Case history:
A 63-year-old male patient with history of chemotherapy for
follicular lymphoma presented
with a left breast mass detected on a periodic computed tomography (CT)
scan. He was diagnosed with follicular lymphoma five years ago and
treated with six cycles of a combination of rituximab and bendamustine,
followed by treatment with rituximab for two years as maintenance
therapy. Recurrence of lymphoma was detected at the cervical and
axillary lymph nodes after two years of an uneventful post-therapeutic
course. Lenalidomide and rituximab were administered as treatment for
recurrence. A CT scan performed at the end of chemotherapy showed
disappearance of all target lesions, but appearance of a new mass in his
left breast. The patient was referred to our department for further
evaluation. On physical examination, a mass measuring approximately 1 cm
in diameter was palpable in the subareolar area of his left breast,
while no swollen lymph nodes were detected in the ipsilateral axillary
region. Laboratory tests including tumor marker analyses were all within
normal levels (white blood cell, 2840 /µl; C-reactive protein, 0.032
mg/dl; carcinoembryonic antigen, 3.8 ng/ml; cancer antigen 15-3, 17
U/ml; sIL-2R, 385 U/ml). CT scan confirmed the presence of a lesion
measuring 13.9 × 12.9 × 6.1 mm in the subareolar portion of the left
breast (Fig. 1). Breast ultrasonography revealed an ill-defined
hypoechoic irregular mass with peripheral vascularity in the subareolar
portion (Fig. 2). Ultrasound-guided core needle biopsy was performed,
and histological examination showed a granulomatous structure comprising
mononuclear inflammatory cell infiltration accompanied by foam cells
without any evidence of caseous necrosis (Fig. 3). No specific pathogen
or foreign bodies were detected. These findings confirmed the diagnosis
of GM.
Since there was no suspicion of malignancy and the patient was
asymptomatic, he was admitted for observation. Ultrasonography performed
after three months revealed that the size of the tumor was 7.9 × 5.5 ×
5.2 mm (Fig. 4), which was smaller compared to the initial diagnosis.
The patient is currently under observation.