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A case of bilateral methotrexate-associated diffuse large B-cell lymphomas of the breasts with unique clinical presentation and outcome

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Abstract

A 54-year-old woman on methotrexate (MTX) treatment developed reddish skin change in her right breast. Mammography and ultrasound showed no masses in the breasts but bilateral mammary glands presented diffuse lower-level echoes. Only 19 days later, the patient developed bilateral breast masses. Histological examination showed that diffuse large B-cell lymphoma cells spread widely and sparsely in the bilateral breasts in addition to the tumor cell conglomerate, leading to the diagnosis of MTX-associated lympho-proliferative disorders (MTX-LPDs). Withdrawal of MTX resulted in complete disappearance of the left MTX-LPD in 2 months but no regression of the right MTX-LPD. Chemotherapy led to a partial response followed by re-growth of the right MTX-LPD. Re-biopsy of the right MTX-LPD revealed double/triple hit lymphoma. Second-line and later-line chemotherapies caused no regression of the right MTX-LPD. The patient died in a year after the diagnosis of MTX-LPDs. Breast oncologists should note the presence, biology, and diagnostic images of MTX-LPD.

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Authors and Affiliations

  1. Department of Surgery, Kishiwada Tokushukai Hospital, 4-27-1, Kamori-cho, Kishiwada, Osaka, 596-8522, Japan

    Masafumi Tomita & Shinichirou Makimoto

  2. Division of Breast Surgery, Kishiwada Tokushukai Hospital, 4-27-1, Kamori-cho, Kishiwada, Osaka, 596-8522, Japan

    Shoji Oura

  3. Breast Surgery, Wakaura Chuo Hospital, 6-2-70, Shioya, Wakayama, Wakayama, 641-0055, Japan

    Haruka Nishiguchi

Authors
  1. Masafumi Tomita
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  2. Shoji Oura
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  3. Haruka Nishiguchi
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  4. Shinichirou Makimoto
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Correspondence to Shoji Oura.

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Tomita, M., Oura, S., Nishiguchi, H. et al. A case of bilateral methotrexate-associated diffuse large B-cell lymphomas of the breasts with unique clinical presentation and outcome. Breast Cancer 27, 1038–1043 (2020). https://doi.org/10.1007/s12282-020-01102-2

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  • DOI: https://doi.org/10.1007/s12282-020-01102-2

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