Contributed by Nicole Nicosia Esposito, MD and Steven H. Swerdlow, MD
Published on line in November 2006
The patient is a 65-year-old woman with a history of diabetes mellitus and sarcoidosis who presented with a right breast mass detected on routine mammography.
Histologic sections of the excisional biopsy demonstrated an extensive lymphoplasmacytic infiltrate involving the breast (Figure 1) that surrounded some ducts and demonstrated focal lymphoepithelial lesions (Figure 2). The infiltrate was composed of relatively small lymphocytes, plasmacytoid lymphocytes, and plasma cells (Figure 3). Some Dutcher bodies were present (Figure 4). In addition, there were numerous histiocytic-like cells with eosinophilic, intracytoplasmic crystalline inclusions present in sheets at the margins of the lymphoplasmacytic infiltrate as well as scattered in other areas of the infiltrate (Figures 5 and 6).
In order to characterize the lymphoplasmacytic and histiocytic infiltrate, paraffin-section immunohistologic studies were performed. Many of the lymphocytes were CD20 positive (Figure 7). CD3 highlighted scattered positive cells (Figure 8). CD68 showed scattered positive cells within the lymphoid infiltrate, and numerous positive cells with the crystalline material (Figure 9). The plasma cells and histiocytes were immunoreactive with anti-kappa, while anti-lambda was positive in only infrequent plasma cells (Figure 10 composite). Anti-IgG was positive in occasional plasma cells and stained the histiocytes (possibly non-specific uptake), while anti-IgM was positive in numerous cells and strongly stained the histiocytes. Anti-IgA and IgD showed rare positive cells and were negative in the histiocytes (Figure 11 composite). Cytokeratin AE1/AE3 highlighted very focal apparent lymphoepithelial lesions (Figure 12). The B-cells were CD5 and cyclin D1 negative. CD138 showed some positivity.