A Case of Diffuse Large B Cell Lymphoma with Unusual Extranodal Breast, Brain Involvement and Autoimmune Hemolytic Anemia: Clinical and Radiological Presentations

Diffuse large B cell lymphoma (DLBCL) is a heterogeneous tumor group consisting of large and transformed B cells that make up 30-40% of all non-Hodgkin lymphomas. Extranodal breast involvement of DLBCL is very rare. We present a case of breast derived DLBCL who presented with coombs positive hemolytic anemia and neurological symptoms. A 54-year-old female patient was admitted to the emergency department with complaints of weakness and palpitations. Hemolytic anemia was considered in the foreground in the patient who did not show atypical cells in the peripheral blood smear. There were an increased fluorodexiglucose uptake detected in the middle and upper quadrant of the left breast in positron emission to-mography–computed tomography. She had impaired consciousness, her speech was dysarth-ric, orientation restricted, muscular strength and sensory examination was natural, and there was no pathological reflex. Cranial magnetic resonance imaging revealed a T2 and FLAIR hyperintense lesion at the pons level, which did not correspond to apparent diffusion coeffi-cient, and had an expansile feature that restricted the diffusion. In the tru-cut biopsy of the breast associated mass, CD20 (+), PAX5 (+), CD3 (-), CD5 (-) large b-cell lymphoma infiltra-tion was observed. The patient's need for transfusion regressed after a course of R-CHOP and MTX treatment. The patient's neurological symptoms and radiological findings improved and regressed completely after one course of therapy. This patient makes a significant contribution to the literature in terms of referring with neurological symptoms, getting a diagnosis of DLBCL from the breast associated mass during the investigation of autoimmune hemolytic anemia etiology and treatment preference.

Ekstranodal Meme, Beyin Tutulumu ve Otoimmun Hemolitik Anemisi Olan Alýþýlmadýk Bir Diffüz Büyük B Hücreli Lenfoma Olgusu: Klinik ve Radyolojik Prezentasyonlar

Diffüz büyük B hücreli lenfoma (DBBHL), tüm Hodgkin dýþý lenfomalarýn %30-40'ýný oluþturan büyük ve transforme B hücrelerinden oluþan heterojen bir tümör grubudur. DBBHL'nin ekstranodal meme tutulumu oldukça nadirdir. Coombs pozitif hemolitik anemi ve nörolojik semptomlarla baþvuran, meme kaynaklý bir DBBHL olgusunu sunmaktayýz. Elli dört yaþýnda kadýn hasta acil servise halsizlik ve çarpýntý þikayetleri ile baþvurdu. Periferik kan yaymasýnda atipik hücre görülmeyen hastada hemolitik anemi düþünüldü. Pozitron emisyon tomografi-bilgisayarlý tomografide sol meme orta ve üst kadranda florodeksiglikoz tutulumunda artýþ saptandý. Bilinci bozuk, konuþmasý dizartrik, oryantasyon kýsýtlý, kas kuvveti ve duyu ise muayenesi doðaldý, patolojik refleksi yoktu. Kranial manyetik rezonans görüntülemede pons seviyesinde difüzyonu kýsýtlayan ekspansil özellikte T2 ve FLAIR hiperintens lezyon saptandý. Meme iliþkili kitlenin tru-cut biyopsisinde CD20(+), PAX5(+), CD3(-), CD5(-) büyük B hücreli lenfoma infiltrasyonu görüldü. Bir kür R-CHOP ve MTX tedavisi sonrasý hastanýn transfüzyon ihtiyacý geriledi. Nörolojik semptomlarý ve radyolojik bulgularý bir kür tedaviden sonra tamamen düzeldi. Bu hasta, nörolojik semptomlarla baþvurmasý, otoimmun hemolitik anemi etiyolojisinin araþtýrýlmasý sýrasýnda meme iliþkili kitleden DBBHL tanýsý almasý ve tedavi tercihi açýsýndan literatüre önemli bir katký saðlamaktadýr.