case_images: PMC6467037_01
case_images: (A) MLO and (B) CC view of right breast showing well-defined large hyperdense mass in the superolateral quadrant without architectural distortion. Note the enlarged node in the right axilla (arrow)
case_images: IJRI-29-85-g001.jpg
case_images: PMC6467037_01_IJRI-29-85-g001.jpg
case_images: F1
case_images: Mammography was done, and it showed well-defined round hyperdense mass lesion measuring 10 x 6 x 9 cm in the superolateral quadrant, there was no architectural distortion of adjacent breast parenchyma or any micro- or macrocalcification [Figure 1A and B].
case_images: (A-C) (A) Ultrasound showing a large hyperechoic lesion in the right breast with multiple round to oval hypoechoic nodules. (B) Round, hypoechoic, enlarged axillary nodes with loss of normal fatty hilum, and (C) a few nodes with slit-like configuration of hilum
case_images: IJRI-29-85-g002.jpg
case_images: PMC6467037_01_IJRI-29-85-g002.jpg
case_images: F2
case_images: Ultrasound (USG) of breast revealed a large hyperechoic lesion in the right breast with multiple round to oval hypoechoic nodules [Figure 2A]. The right axillary nodes were enlarged, round, hypoechoic, and showed loss of normal fatty hilum or slit-like configuration of hilum [Figure 2B and C].
case_images: Histopathological examination showed a diffuse growth pattern of medium to large lymphoid cells with vesicular chromatin and inconspicuous nucleoli (H and E). These lymphoid cells were positive for CD45 and CD20 and negative for ER, PR, and CK
case_images: IJRI-29-85-g003.jpg
case_images: PMC6467037_01_IJRI-29-85-g003.jpg
case_images: F3
case_images: Proliferation index by Ki-67 was high >90%; the findings were suggestive of diffuse large B-cell lymphoma (DLBL) (high grade) [Figure 3].
case_images: MRI of breast showing a well-defined, smoothly marginated mass in right breast iso- to hypointense on T1W (A) and hyperintense on STIR with few hypointense nodules (B). On dynamic contrast study, the lesion shows heterogeneous enhancement (C) with plateau and slow washout of contrast in time-intensity curve (D)
case_images: IJRI-29-85-g004.jpg
case_images: PMC6467037_01_IJRI-29-85-g004.jpg
case_images: F4
case_images: MRI showed a solitary well-defined, smoothly marginated lesion measuring 10 x 5.4 x 9 cm (AP x TR CC) in size which was iso- to hypointense on T1W and hyperintense on short TI inversion recovery (STIR) sequence with few hypointense nodules [Figure 4A and B]. There was early enhancement with plateau followed by slow washout of contrast on time-intensity curve (type 2 kinetic curve) [Figure 4C and D].
case_images: PET/CT image showing increased FDG uptake in the mass in the right breast with SUVmax of 9.4
case_images: IJRI-29-85-g005.jpg
case_images: PMC6467037_01_IJRI-29-85-g005.jpg
case_images: F5
case_images: It showed well-defined rounded large soft tissue density mass with increased 2-fluorodeoxyglucose (FDG) uptake in the mass (SUVmax of 9.4) (standardized uptake value) and right axillary nodes [Figure 5].