Abstract
Primary breast lymphoma (PBL) is a rare entity, accounting for less than 1% of all breast malignancies. PBL is often difficult to differentiate from other benign and malignant breast tumors. This case report describes the contrast-enhanced ultrasound (CEUS) diagnosis of PBL in a 34-year-old female patient, initially presenting with a left breast lump. CEUS revealed some distinctive features: diffuse hyperenhancement with the “floating vessel” sign. These findings enabled a timely diagnosis. Histopathological analysis confirmed diffuse large B-cell lymphoma. After more than two years of chemotherapy, CEUS revealed significant lesion shrinkage with well-defined margins alongside delayed arrival time, reduced peak intensity, and a decreased area under the curve, collectively indicating a favorable chemotherapeutic response. Eventually, the patient underwent surgery, and pathological examination confirmed the absence of significant lymphoma cells following chemotherapy. This case underscores the value of CEUS in identifying PBL and assessing chemotherapy efficacy through qualitative characterization and quantitative parameters, thereby demonstrating its dual role in both lesion identification and therapeutic monitoring. It also emphasizes the significance of including lymphoma in the differential diagnosis of breast masses.
Introduction
Primary breast lymphoma (PBL) is a rare malignancy, representing less than 1% of all breast cancers and approximately 2% of extranodal lymphomas (, ). Its clinical and imaging presentation often mimics that of breast carcinoma or benign lesions, posing a significant diagnostic challenge (, ). Timely and accurate diagnosis is crucial for effective treatment planning and improved patient outcomes. Imaging modalities such as computed tomography (CT), magnetic resonance imaging (MRI) and conventional ultrasound (CUS) play a pivotal role in the diagnostic workup of breast lymphoma.
CUS is the most commonly used imaging modality for breast lesions due to its accessibility, affordability, and non-invasiveness (, ). CUS typically reveal a hypoechoic mass with posterior acoustic enhancement and lack of microcalcifications, yet these findings overlap significantly with other breast pathologies (). Contrast-enhanced ultrasound (CEUS), as an advanced ultrasound technique, has unique advantages in displaying micro-vessels and enhances the visualization of blood flow within tissues, providing additional diagnostic information (, ). Studies suggest that CEUS features of Lymphomas—such as marked homogeneous hyperenhancement and the “floating vessel” sign—may help distinguish it from other tumors (). The “floating vessel” sign, which indicates a large vessel encased by a mass without vascular involvement. Furthermore, emerging evidence indicates that quantitative CEUS parameters—such as arrival time (AT), peak intensity (PI), time to peak (TTP), and area under the curve (AUC)—may not only aid in diagnosis but also hold potential for predicting and monitoring treatment response in lymphomas treated with regimens such as R-CHOP (, –).
This case report focuses on a rare instance of PBL diagnosed and efficacy predicted through CEUS and discusses the diagnostic challenges and the utility of this new technology.
Case presentation
Clinical presentation
A 34-year-old female patient was admitted to the Department of Thyroid and Breast Surgery on July 10, 2021, following the incidental self-detection of an egg-sized, painless lump in her left breast one month prior. She denied any associated symptoms such as pain, redness, fever, chest tightness, cough, expectoration, nausea, or vomiting. The patient had no personal history of malignant tumors. A detailed timeline of her diagnostic and therapeutic course is summarized in Table 1.
Table 1
| Date | Category | Event |
|---|---|---|
| July 2021 | Symptom Onset | Self-detection of a painless lump in the left breast |
| 10 Jul 2021 | Clinical Visit | Initial presentation to the Department of Thyroid and Breast Surgery |
| 12 Jul 2021 | Imaging Diagnosis | Multimodal ultrasound (CEUS) and breast MRI performed |
| 14 Jul 2021 | Pathological Confirmation | Ultrasound-guided core biopsy confirmed non-Hodgkin B-cell lymphoma |
| 22 Jul 2021 | Metabolic Imaging | PET/CT revealed a hypermetabolic breast lesion (SUV max 16.1) and reactive axillary nodes |
| 27 Jul 2021–5 Jan 2022 | CNS Prophylaxis | 4 sessions of intrathecal chemotherapy (methotrexate/cytarabine/dexamethasone) |
| 30 Jul 2021–Jan 2022 | Chemotherapy | 7 cycles of R-CHOP regimen completed |
| 17 Mar 2022–Sep 2023 | Maintenance Therapy | 18 cycles of lenalidomide (25 mg/day, d1–21, q4w) |
| 28 Mar 2024 | Preoperative Assessment & Surgery | Preoperative CEUS followed by lumpectomy, histopathology showed no residual lymphoma |
| Postoperative | Follow-up | Ultrasound at 6 months showed no abnormalities |
Diagnostic, therapeutic, and follow-up timeline for the patient with primary breast lymphoma.
Initial CEUS
The patient underwent multimodal ultrasound evaluation using a GE LOGIQ E9 system with a linear array transducer (frequency range: 4–15 MHz). The mechanical index (MI) was set at 0.06–0.08 for CEUS. Gray-scale imaging identified a hypoechoic, architecturally distorted area at the 3 o’clock position of the left breast, measuring approximately 57 mm × 51 mm × 27 mm, with echogenicity similar to the surrounding glandular tissue, ill-defined margins, and internal heterogeneity (Figure 1A). Color Doppler flow imaging (CDFI) revealed neovascularization within the lesion (Figure 1B). Bilateral axillary lymph nodes were enlarged with cortical thickening.
Figure 1
A 4.8 mL bolus of sulfur hexafluoride microbubble contrast agent (SonoVue®, Bracco, Milan, Italy) was administered intravenously via the left median cubital vein, followed by a 5 mL saline flush. CEUS was performed in contrast-specific mode with low MI. The lesion showed diffuse hyperenhancement with the presence of “floating vessel” sign –a characteristic observation wherein enhanced vascular structures appear to be suspended or floating within the diffusely enhancing glandular tissue, without clear evidence of vascular stenosis, encirclement, or invasion (Figure 1C). Quantitative analysis was performed using the built-in Q-Contrast® software (GE Healthcare). Enhancement parameters included an AT of 7.47 s, PI of –38.80 dB at 18.14 s and AUC (a parameter reflecting total blood volume) of 981.88 dB·s (Figure 1D). The lesion exhibited rapid wash-in and delayed wash-out kinetics. The overall imaging features were classified as ACR BI-RADS 4C, suggestive of breast lymphoma.
Further diagnostic investigations
Breast MRI (Supplementary Figure 1) indicated the presence of a mass in the upper-outer and lower-outer quadrants of the left breast, measuring approximately 79.6 mm × 47.1 mm. On T1-weighted imaging, it showed mixed high-and-low signal; on T2-weighted imaging, it presented high signal; on diffusion-weighted imaging, it displayed high signal, and on apparent diffusion coefficient mapping, it showed low signal. The mass was inhomogeneous and demonstrated disordered glandular structure on plain scan, with inhomogeneous enhancement after contrast administration. The time-signal intensity curve was of the plateau type, leading to an ACR BI-RADS category 5 assessment.
Laboratory tests showed decreased monocyte percentage and elevated uric acid. On July 14, an ultrasound-guided core needle biopsy using a 16-gauge (G) needle was performed on the left breast mass, obtaining adequate tissue cores for histopathological and immunohistochemical analysis. Pathological and immunohistochemical analyses confirmed diffuse large B-cell lymphoma (DLBCL). Molecular studies revealed negative EBV EBER in-situ hybridization, BCL2/MYC gene integrity, BCL6 gene breakage positivity, and wild-type MYD88. Immunohistochemistry results of tumor cells showed AE1/AE3(-), GATA3(-), LCA(+), CD3(-), CD20(+), Ki-67(80%+), CD19(+), CD10(weak +), Bcl - 6(+), MUM - 1(+), CD5(-), Bcl - 2(-), CD30(-), C - MYC(+, 30%), CyclinD1(-), TdT(-), CD23(-), CD43(-) (Figures 2A-H). Axillary lymph node biopsy revealed no tumor cells.
Figure 2
On July 22, 2021, an external Positron Emission Tomography-Computed Tomography (PET/CT) scan (images not available) demonstrated intense radiotracer uptake in the upper-outer and lower-outer quadrants of the left breast, showing a mass-like hypermetabolic lesion measuring approximately 59 mm × 48 mm × 58 mm with a maximum standardized uptake value (SUV max) of 16.1. Corresponding CT images revealed a well-defined soft tissue lesion with homogeneous density (CT value approximately 39.0 HU). Additionally, multiple mildly enlarged lymph nodes were observed in the bilateral axillae, the largest measuring 13 mm × 10 mm, with mildly increased metabolism (SUV max 3.0). The background liver SUV max was 2.5, and the mediastinal blood pool SUV max was 1.6. The remaining breast parenchyma appeared dense and symmetric without focal lesions or abnormal uptake. These findings were highly consistent with PBL involvement.
Treatment
The patient was transferred to the Department of Hematology for further management. Bone marrow aspiration and flow cytometry showed no involvement.
Prior to initiation of chemotherapy, the patient received prephase treatment with oral prednisone 30 mg twice daily starting from July 28, 2021. Subsequently, the patient commenced systemic chemotherapy with the R-CHOP regimen (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) on July 30, 2021, completing a total of 7 cycles (on July 30, August 20, September 11, November 2, November 24, and December 15, 2021). Each 21-day cycle was administered as follows:
Day 0: Intravenous infusion of rituximab 600 mg;
Day 1: Intravenous infusion of cyclophosphamide 1.2 g, doxorubicin 60 mg, and vincristine 2 mg;
Days 1–5: Oral prednisone 100 mg once daily;
Days 6–21: Treatment interruption for recovery, during which blood counts, liver and kidney function, and other relevant parameters were monitored.
In addition, the patient received intrathecal prophylaxis with methotrexate 10 mg, cytarabine 50 mg, and dexamethasone 5 mg in 2 mL normal saline on the following dates: July 27, November 1, November 25, 2021, and January 5, 2022, to prevent central nervous system involvement.
All intravenous drugs were administered in a hospital setting. The treatment plan was tailored based on the patient’s age, performance status, disease stage, and treatment response.
From March 17, 2022, the patient began maintenance therapy with lenalidomide (25 mg orally once daily, days 1–21 of each 28-day cycle) for a total of 18 cycles, which continued until September 2023.
Follow-up CEUS
On March 28, 2024, after discontinuation of all treatment for 6 months, follow-up CUS and CEUS were performed. Gray-scale imaging demonstrated a structurally disordered area measuring approximately 26×11 mm at the 3 o’clock position of the left breast, exhibiting an irregular shape, unclear margins, parallel orientation, and heterogeneous echogenicity without posterior acoustic changes (Figure 3A). CDFI revealed no significant vascularity within or around the lesion (Figure 3B). On CEUS, the lesion demonstrated centripetal hyperenhancement with well-defined margins and a reduced size of approximately 19×9 mm (Figure 3C). It showed heterogeneous contrast distribution without non-perfused areas or penetrating vessels, consistent with a faster wash-in and delayed wash-out pattern. Quantitative analysis (Figure 3D) revealed an AT of 12.7 s, PI of –45.90 dB, and AUC of 502.88 dB·s. Compared with pre-chemotherapy values (AT: 7.47 s, PI: –38.80 dB, AUC: 981.88 dB·s), the reduced changes in the ratio of PI and AUC were 18.3% and 48.7%, indicate significantly attenuated perfusion, suggesting a favorable treatment response. The inter-observer reproducibility for CEUS parameters (AT, PI, and AUC) in our study was acceptable and satisfactory (ICC > 0.75). These CEUS findings collectively reflect marked reduction in lesion vascularity and size after chemotherapy. Preoperative CEUS was used to localize the lesion prior to excision.
Figure 3
Surgery
Under CEUS guidance, the patient underwent left breast lumpectomy (local excision of the residual lesion) on March 28, 2024. Lymph node dissection was not performed due to the following reasons: initial biopsy of axillary nodes showed no malignancy, PET-CT indicated only mild metabolic activity suggestive of reactive hyperplasia rather than metastasis, and the primary lymphoma had shown significant response to chemotherapy with no clinical evidence of nodal involvement at the time of surgery. Histopathological examination of the surgical specimen revealed breast adenosis, stromal collagenization, and focal atypical ductal hyperplasia, with no residual lymphoma cells (Figure 2I). Examination of all submitted tissue specimens confirmed consistent pathological findings with no evidence of residual tumor. The patient recovered well, and no abnormalities were detected on ultrasound during six months of follow-up.
Discussion
Breast lymphoma represents an uncommon hematologic malignancy arising from the lymphoid tissue within the breast, encompassing both PBL and secondary breast lymphoma (SBL) (, ). The diagnostic criteria for PBL were initially proposed by Wiseman and Liao in 1972 (). Pathologic specimen showing a close link between mammary tissue and lymphomatous infiltrate, combined with the absence of systemic lymphoma history and specific lymph node involvement patterns, are key determinants in diagnosing PBL (). SBL represents metastatic involvement of the breast by systemic lymphoma, usually accompanied by disease in other sites (e.g., lymph nodes, spleen) ().
As a rare manifestation of lymphoma, PBL predominantly originates from B-cell lineages, constituting approximately 50% of all cases. The vast majority of PBL cases are classified as non-Hodgkin lymphoma, with high-grade B-cell lymphomas being the most prevalent (). Among these, DLBCL is the most frequently observed subtype. Less commonly, PBL may present as follicular lymphoma, mucosa-associated lymphoid tissue lymphoma, or Burkitt lymphoma (, ). Notably, breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a distinct CD30+ T-cell lymphoma specifically associated with breast implants, classified separately by the WHO ().
PBL exhibits a strong predilection for females, with the median age of diagnosis typically ranging between 60 and 65 years (). Clinically, the most common clinical manifestation is a solitary, painless, and palpable mass, observed in approximately 61% of cases, although multifocal lesions may occasionally be present (). Cutaneous or local inflammatory signs, such as nipple discharge, skin retraction, or erythema, are uncommon and rarely reported (, ). Anatomically, PBL demonstrates a slight predominance in the right breast, accounting for 48% of cases, while bilateral involvement is noted in approximately 11% of patients ().
PBL exhibits imaging characteristics across various modalities, which are crucial in the diagnostic workflow. At mammography, PBL most commonly manifests as a solitary, non-calcified, oval-shaped mass (). The margins of these masses are typically either circumscribed or indistinct, with spiculated margins being a rare finding. Additionally, global asymmetry is an infrequent presentation of PBL at mammography (). When evaluated with MRI, PBL masses are isointense on T1WI and hyperintense on T2WI. Enhancement patterns can be either homogeneous or heterogeneous (). In certain instances, MRI may reveal a spiculated lesion with polycyclic boundaries (). PET/CT scans of PBL tumors display intense, diffuse hypermetabolism (). Despite the availability of various imaging modalities mentioned above, CUS and CEUS remain crucial methods for the differential diagnosis of PBL.
In this case, gray-scale ultrasonography detected a thickened and disorganized region with echogenicity similar to adjacent glandular tissue, ill-defined boundaries and inhomogeneous internal echoes. CDFI revealed neovascularization within the lesion. Overall, both grayscale and Doppler sonographic features showed limited specificity (, ). Except for homogeneous hyperenhancement and the characteristic “floating vessels” sign, CEUS revealed enhancement features suspicious for malignancy—specifically, a rapid wash-in and delayed wash-out kinetic pattern with a large AUC. Although the CEUS features of PBL have a certain degree of specificity, they are not pathognomonic and must be differentiated from: atypical fibroadenomas and breast carcinoma. The main distinguishing points are summarized in Supplementary Table 1. Atypical fibroadenomas are characterized by a regular shape, absence of surrounding vessels penetrating into the lesion, lack of perfusion defects, and no significant change in the enhanced area compared to two-dimensional imaging (). Breast carcinoma typically shows an enlarged lesion area, heterogeneous perfusion, perfusion defects, and crab-like enhancement (). Crab-like enhancement refers to irregular, spiculated, or radiating branches of enhancement extending from the margin of the mass into the surrounding breast tissues (). This reflects the infiltrative growth pattern of carcinomas, which destructively invade adjacent structures and induce chaotic angiogenesis. While, the “floating vessel” sign is own to the lymphoma cells growing diffusely around and preserving the native vascular architecture, rather than destructively invading it ().There have been no currently published reports on the use of CEUS for diagnosing BIA-ALCL. Therefore, CUS remains the key modality for distinguishing it from PBL for high sensitivity (84%) and specificity (100%) for detecting peri-implant fluid and solid masses in BIA-ALCL (). Typical findings of BIA-ALCL include a homogeneous peri-implant effusion accompanied by inflammatory changes in surrounding tissue. Masses typically appear as oval, hypoechoic, and well-circumscribed lesions without internal blood flow on CDFI ().
In this case, we utilized CEUS to dynamically monitor the patient’s lesion changes following chemotherapy. Of particular significance, CEUS serves as a valuable imaging modality not only for the initial diagnosis of breast lymphoma but also for the sequential monitoring and quantitative assessment of chemotherapeutic efficacy (, ).The observed lesion regression, coupled with delayed AT, reduced PI, and smaller AUC—parameters indicative of attenuated tumor perfusion dynamics, underscoring the significance of CEUS utility in evaluating chemotherapeutic efficacy for PBL. Our findings are consistent with the majority of current studies. In Lu’s study, CEUS shows promise in assessing non-Hodgkin’s lymphoma response to R-CHOP/CHOP therapy, as perfusion changes precede morphological alterations in indicating treatment efficacy and pretreatment PI values may help predict perfusion response and outcomes (). However, there are also divergent findings in the existing literature. For instance, a study by Trenker et al. indicated that CEUS does not provide additional predictive value beyond B-mode ultrasound for early prediction of treatment response in lymphoma (). Therefore, further large-scale studies will be needed to validate its value.
The final diagnosis of PBL relies primarily on core biopsy or surgery results and immunohistochemical staining (31). Compared to core biopsy, surgery can obtain sufficient tissue samples for a more accurate pathological diagnosis. When it comes to the treatment of PBL, the approach remains a subject of debate (32). Although several guidelines have been formulated, there is a lack of unanimity regarding the optimal treatment strategy (33). Treatment usually involves a combination of surgery, radiotherapy, chemotherapy, and immunotherapy (34). The choice of treatment guidelines is contingent upon the histological subtype and stage of the disease (34). For instance, the CHOP regimen has been firmly established as the standard treatment for primary breast DLBCL (33, 34). In this case, following chemotherapy, surgical resection was performed. After the operation, the patient’s condition stayed stable, and breast ultrasounds performed in the six months following the procedure showed no significant abnormalities.
Conclusion
In conclusion, PBL is very rare and usually manifests as a palpable mass with or without an ipsilateral axillary lymph node and no prior or current history of lymphoma in a middle-aged woman. Although no CEUS characteristics for PBL were reported, we believe when a young woman develops a rapidly growing, large, palpable breast mass, and CEUS reveals floating vessels and homogeneous enhancement of the surrounding lesional tissues, PBL should be highly considered in the differential diagnosis, and a biopsy should be promptly performed. CEUS can provide valuable diagnostic information for PBL. Moreover, the qualitative and quantitative parametric analysis of CEUS provides robust evidence for evaluating chemotherapeutic efficacy in PBL.
Statements
Data availability statement
The original contributions presented in the study are included in the article/Supplementary Material. Further inquiries can be directed to the corresponding author.
Ethics statement
The studies involving humans were approved by The Ethics Committee of the First Affiliated Hospital of Shenzhen University/The Second People’s Hospital of Shenzhen City. The studies were conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study. Written informed consent was obtained from the individual(s) for the publication of any potentially identifiable images or data included in this article.
Author contributions
ST: Investigation, Writing – original draft, Methodology. YM: Investigation, Writing – original draft, Formal Analysis. XZ: Writing – review & editing. JL: Writing – review & editing, Supervision. WT: Writing – review & editing, Resources. PZ: Supervision, Writing – review & editing.
Funding
The author(s) declare financial support was received for the research and/or publication of this article. Shenzhen Second People’s Hospital Clinical Research Fund of Shenzhen High-level Hospital Construction Project (Grant No. 2023yjlcyj003), Shenzhen Health Economics Association Scientific Research Fund (Grant No. 2023107) and Shenzhen Key Medical Discipline Construction Fund (Grant No. SZXK052).
Conflict of interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Generative AI statement
The author(s) declare that no Generative AI was used in the creation of this manuscript.
Any alternative text (alt text) provided alongside figures in this article has been generated by Frontiers with the support of artificial intelligence and reasonable efforts have been made to ensure accuracy, including review by the authors wherever possible. If you identify any issues, please contact us.
Publisher’s note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
Supplementary material
The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fonc.2025.1602270/full#supplementary-material.
References
1
SungDWLimJWYoonYKimYWLeeJHChoKS. Primary breast lymphoma. J Korean Med Sci. (1993) 8:210–3. doi: 10.3346/jkms.1993.8.3.210
2
RajSDShurafaMShahZRajKMFishmanMDCDialaniVM. Primary and secondary breast lymphoma: clinical, pathologic, and multimodality imaging review. Radiographics. (2019) 39:610–25. doi: 10.1148/rg.2019180097
3
JamesERMirandaRNTurnerSD. Primary lymphomas of the breast: A review. JPRAS Open. (2022) 32:127–43. doi: 10.1016/j.jpra.2022.01.004
4
ItoTManabeHKubotaMKomoikeY. Current status and future perspectives of contrast-enhanced ultrasound diagnosis of breast lesions. J Med Ultrason. (2024) 51:611–25. doi: 10.1007/s10396-024-01486-0
5
WangXLiuCShangGXiongJZhouHTangWet al. Multimodal ultrasonography features of breast lymphomas: 3 cases report. J Ultrasound Med. (2023) 42:1353–9. doi: 10.1002/jum.16137
6
WangJZhaoRChengJ. Diagnostic accuracy of contrast-enhanced ultrasound to differentiate benign and Malignant breast lesions: A systematic review and meta-analysis. Eur J Radiol. (2022) 149:110219. doi: 10.1016/j.ejrad.2022.110219
7
LuoRWangQZhangYJiangWWangYLuoY. Value of contrast-enhanced microflow imaging in diagnosis of breast masses in comparison with contrast-enhanced ultrasound. Acad Radiol. (2024) 31:2217–27. doi: 10.1016/j.acra.2023.11.021
8
YoshiharaSSugimotoYMatsunagaMSuzukiSTaniokaF. Coronary vessel floating sign in cardiac diffuse large B-cell lymphoma. Eur Heart J Cardiovasc Imaging. (2020) 21:233. doi: 10.1093/ehjci/jez190
9
JiaKLiLWuXJHaoMJXueHY. Contrast-enhanced ultrasound for evaluating the pathologic response of breast cancer to neoadjuvant chemotherapy: A meta-analysis. Med (Baltimore). (2019) 98:e14258. doi: 10.1097/MD.0000000000014258
10
LuWDengHChenWZhouYWuLShuHet al. Analysis of early response to chemotherapy for non-Hodgkin’s lymphoma by quantitative contrast-enhanced ultrasound: A prospective case-control crossectional study. Eur J Radiol. (2024) 176:111525. doi: 10.1016/j.ejrad.2024.111525
11
DietrichCFCorreasJ-MCuiX-WDongYHavreRFJenssenCet al. EFSUMB technical review - update 2023: dynamic contrast-enhanced ultrasound (DCE-CEUS) for the quantification of tumor perfusionEFSUMB. Ultraschall Med. (2024) 45:36–46. doi: 10.1055/a-2157-2587
12
TakemuraAMizukamiYTakayamaTTaniyaTOkumuraH. Primary Malignant lymphoma of the breast. Jap J Radiol. (2009) 27:221–4. doi: 10.1007/s11604-009-0324-5
13
WisemanCLiaoKT. Primary lymphoma of the breast. Cancer. (1972) 29:1705–12. doi: 10.1002/1097-0142(197206)29:6<1705::aid-cncr2820290640>3.0.co;2-i
14
ShaoYBSunXFHeYNLiuCJLiuH. Clinicopathological features of thirty patients with primary breast lymphoma and review of the literature. Med Oncol. (2015) 32:448. doi: 10.1007/s12032-014-0448-z
15
RezkallahEMNElsaifyATinSMMDeyDElsaifyWM. Breast lymphoma: General review. Breast Dis. (2023) 42:197–205. doi: 10.3233/BD-220051
16
SakhriSAlouiMBouhaniMBouazizHKamounSSlimeneMet al. Primary breast lymphoma: a case series and review of the literature. J Med Case Rep. (2023) 17:290. doi: 10.1186/s13256-023-03998-8
17
TripodiDAmabileMIVaraneseMD’AndreaVSorrentiSCannistràC. Large cell anaplastic lymphoma associated with breast implant: a rare case report presentation and discussion of possible management. Gland Surg. (2021) 10:2076–80. doi: 10.21037/gs-20-853
18
LuoHYiPWangWLiKMengLLiJet al. Clinicopathological features, treatment, and prognosis in primary diffuse large B cell lymphoma of the breast: A retrospective study of 46 patients. Med Sci Monit. (2019) 25:8671–82. doi: 10.12659/MSM.917550
19
RehmanSNaveedMAAleemJ. Imaging characteristics of breast lymphoma; a case series. J Cancer Allied Spec. (2020) 6:e305. doi: 10.37029/jcas.v6i1.305
20
LyouCYYangSKChoeDHLeeBHKimKH. Mammographic and sonographic findings of primary breast lymphoma. Clin Imaging. (2007) 31:234–8. doi: 10.1016/j.clinimag.2007.02.028
21
MatsubayashiRNInoueYOkamuraSMomosakiSNakazonoTMuranakaT. MR imaging of Malignant primary breast lymphoma: including diffusion-weighted imaging, histologic features, and a literature review. Jpn J Radiol. (2013) 31:668–76. doi: 10.1007/s11604-013-0232-6
22
ZhouCLvKLinDYuYXuMBuY. Radiological analysis of breast lymphoma: Experiences from cases series studies. Med (Baltimore). (2019) 98:e18101. doi: 10.1097/MD.0000000000018101
23
PanichyawatSHansakulP. Reports of primary and secondary breast lymphoma: our experience in King Chulalongkorn Memorial Hospital. ASEAN J Radiol. (2022) 23:90–115. doi: 10.46475/aseanjr.v23i2.135
24
LiangRLianJZhangJJingJBianJXuJet al. The benefits of contrast-enhanced ultrasound in the differential diagnosis of suspicious breast lesions. Front Med (Lausanne). (2024) 11:1511200. doi: 10.3389/fmed.2024.1511200
25
LyuSQiuYXuLYeJ. Multimodal ultrasonography of male primary breast lymphoma. J Clin Ultrasound. (2023) 51:1242–3. doi: 10.1002/jcu.23504
26
SharmaBJurgensen-RauchAPaceEAttygalleADSharmaRBommierCet al. Breast implant-associated anaplastic large cell lymphoma: review and multiparametric imaging paradigms. Radiographics. (2020) 40:609–28. doi: 10.1148/rg.2020190198
27
Collado-MesaFYepesMMNetJMJordaM. Breast Implant-Associated Anaplastic Large Cell lymphoma: Brief overview of current data and imaging findings. Breast Dis. (2021) 40:17–23. doi: 10.3233/BD-201017
28
XinLYanZZhangXZangYDingZXueHet al. Parameters for contrast-enhanced ultrasound (CEUS) of enlarged superficial lymph nodes for the evaluation of therapeutic response in lymphoma: A preliminary study. Med Sci Monit. (2017) 23:5430–8. doi: 10.12659/msm.907293
29
MaXLingWXiaFZhangYZhuCHeJ. Application of contrast-enhanced ultrasound (CEUS) in lymphomatous lymph nodes: A comparison between PET/CT and contrast-enhanced CT. Contrast Media Mol Imaging. (2019) 2019:5709698. doi: 10.1155/2019/5709698
30
TrenkerCKümpelJMichelCSafai ZadehEDietrichCFTimmesfeldNet al. Assessment of early therapy response of non-hodgkin’s and hodgkin’s lymphoma using B-mode ultrasound and dynamic contrast-enhanced ultrasound. J Ultrasound Med. (2022) 41:2033–40. doi: 10.1002/jum.15887
31
JenningsWCBakerRSMurraySSHowardCAParkerDEPeabodyLFet al. Primary breast lymphoma: the role of mastectomy and the importance of lymph node status. Ann Surg. (2007) 245:784–9. doi: 10.1097/01.sla.0000254418.90192.59
32
JiaYSunCLiuZWangWZhouX. Primary breast diffuse large B-cell lymphoma: a population-based study from 1975 to 2014. Oncotarget. (2018) 9:3956–67. doi: 10.18632/oncotarget.23285
33
HuSSongYSunXSuLZhangWJiaJet al. Primary breast diffuse large B-cell lymphoma in the rituximab era: Therapeutic strategies and patterns of failure. Cancer Sci. (2018) 109:3943–52. doi: 10.1111/cas.13828
34
AvivATadmorTPolliackA. Primary diffuse large B-cell lymphoma of the breast: looking at pathogenesis, clinical issues and therapeutic options. Ann Oncol. (2013) 24:2236–44. doi: 10.1093/annonc/mdt192
Summary
Keywords
primary breast lymphoma, ultrasound, contrast-enhanced ultrasound, imaging diagnosis, case report
Citation
Tang S, Ma Y, Zhan X, Lu J, Wu T and Zhou P (2025) Contrast-enhanced ultrasound diagnosis and efficacy prediction of primary breast lymphoma: a case report and literature review. Front. Oncol. 15:1602270. doi: 10.3389/fonc.2025.1602270
Received
29 March 2025
Accepted
18 September 2025
Published
14 October 2025
Volume
15 - 2025
Edited by
Sawsan Ismail, Al Andalus University for Medical Sciences, Syria
Reviewed by
Domenico Tripodi, Saint Camillus International University of Health and Medical Sciences, Italy
Bouhani Malek, Salah Azaiez Institute, Tunisia
Updates
Copyright
© 2025 Tang, Ma, Zhan, Lu, Wu and Zhou.
This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Peng Zhou, zpdahai@163.com
†These authors have contributed equally to this work
Disclaimer
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.