Plasmablastic lymphoma of the oral cavity with breast recurrence: a case report.
BACKGROUND
Plasmablastic lymphoma is an aggressive variant of diffuse large B cell lymphoma, mostly found in the oral cavity and associated with human immunodeficiency virus. There are no clear guidelines for its treatment. Therapies more intensive than cyclophosphamide, doxorubicin, vincristine, and prednisone are not associated with a prolonged survival. Lymphomas of the breast are rare, in one series representing 0.14% of all female breast malignancies, with diffuse large B cell lymphoma comprising up to 55% of all cases. Only one case of plasmablastic lymphoma involving the breast has been reported in the literature.


METHODS
A 30 year old Pakistani woman, presented with a small nodule in the floor of the mouth. An excisional biopsy revealed CD20, CD3, and CD117 negative and CD138, CD79a, CD56, MUM1/IFR4 and CD30 positive lesion with Ki-67 of 60% with cells which were plasmablastic in appearance. The morphological and immunohistochemistry features were consistent with plasmablastic lymphoma. The staging scans did not reveal any lymphadenopathy and the bone marrow biopsy and human immunodeficiency virus test were both negative. After treatment with four courses of CHOP and later radiation to the floor of the mouth, her disease was in complete remission. Two months later, she presented with velvety red lesions in both breasts and its trucut biopsy was consistent with plasmablastic lymphoma. Her CT scans revealed multiple nodules involving both breasts with no lymphadenopathy. The bone marrow was now positive for disease. Her disease continued to progress despite second and third line chemotherapy with DHAP (dexamethasone, cisplatin and cytarabine) and ICE (ifosfamide, carboplatin and etoposide) respectively. Her last CT scans revealed progressive disease with new lung lesions. The patient decided to opt for best supportive care.


CONCLUSIONS
To our knowledge this is the second report of plasmablastic lymphoma involving the breast. The patient who was human immunodeficiency virus negative and immune competent had progressive disease despite three lines of chemotherapies with an overall survival (to date) of 15 months.
Department of Oncology, The Aga Khan University Hospital, Stadium Road, PO BOX: 3500, Karachi, 74800, Pakistan. zarka.samoon@aku.edu.
Zarka
Z
Samoon
Department of Pathology, The Aga Khan University Hospital, Stadium Road, PO BOX: 3500, Karachi, 74800, Pakistan. romana.idrees@aku.edu.
Romana
R
Idrees
Department of Oncology, The Aga Khan University Hospital, Stadium Road, PO BOX: 3500, Karachi, 74800, Pakistan. nehal.masood@aku.edu.
Nehal
N
Masood
Department of Oncology, The Aga Khan University Hospital, Stadium Road, PO BOX: 3500, Karachi, 74800, Pakistan. tayyaba.ansari@aku.edu.
Tayyaba Zehra
TZ
Ansari
D000328:Adult; D001706:Biopsy; D001940:Breast / Q000473:pathology; D001943:Breast Neoplasms / Q000473:pathology*; D051925:CD79 Antigens / Q000378:metabolism; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D009055:Mouth / Q000473:pathology*; D009062:Mouth Neoplasms / Q000473:pathology*; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D000069293:Plasmablastic Lymphoma / Q000473:pathology*; D053668:Syndecan-1 / Q000378:metabolism
D051925:CD79 Antigens; D053668:Syndecan-1