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The aim of this study is to present a case of Primary Diffuse Large B Cell Lymphoma of lactating left breast and after 10 years treatment in the right breast again during lactating period in a 31 years old female. Mammography showed a 4 cm lobule contoured mass in the outer quadrant of the left breast. Thorax CT showed a 42.6 mm and a few smaller nodular lesions in the middle and lower outer quadrants of the left breast and 27.3 mm diameter lymphadenopathy and smaller lymph nodes. In the past history of patient a mobile mass of 4 cm was found in the upper outer quadrant of the right breast during breastfeeding period after the 2nd birth at the 8th month in July 2010. Breast ultrasonography showed 37×22 mm solid lesion. Segmental mastectomy was performed for the mass (7x5x2.5 cm) at the state hospital in September 2010. The patient was diagnosed with Primary Diffuse Large B Cell Lymphoma (DLBCL), stage III. Six cycles of CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) and 2 cycles of monoclonal antibody rituximab were applied to the patient. In March 2011, the right chest wall was irradiated. Patient was under follow since that time. Almost 10 year later patient applied to our clinic with left breast mass again during lactating period. Mastectomy and axillary dissection were performed for local control and patient request. In pathological specimen examination, 5x4x4 cm gray a white hard mass was observed and gray-yellow lesion-like areas were observed in other areas. Two of 8 lymph nodes of axilla, the largest 3 cm, were found metastatic. In immunohistochemical staining, CD20, CD79a and PAX5 positive, Ki 67 70%, CD3, CD5, CyclinD1, CD10, CD30, CD99, TDT, CD38, CD1A, BCL- 2, CD34, EMA were negative. Pathological diagnosis was found primary DLBCL. The patient is currently good and receiving chemotherapy.
CONCLUSION: Although bilateral primary DLBCL during breast feeding is very rare, mothers should be examined for breast mass during pregnancy and breastfeeding term. Surgery may be choice for local control of disease and supplementary radiotherapy, chemotherapy, and immunotherapy should be administered promptly following surgery.
