Lymphoepithelioma-Like Carcinoma of the Breast Mimicking Granulomatous Mastitis- Case Report and Review of the Literature

Abstract

Lymphoepithelioma-like carcinoma (LELC) of the breast is an exceedingly rare variant of mammary cancer. To our knowledge, only twenty - one cases have been reported in the literature. Diagnosis of this type of mammary carcinoma may be challenging, owing to its rarity and the histopathological similarity to common inflammatory and malignant lesions of the breast mainly granulomatous mastitis, medullary carcinoma, pleomorphic lobular carcinoma, lymphoma and other hematological malignancies. Our case is the 22nd case of lymphoepithelioma-like carcinoma reported in the breast, presenting with a palpable tender mass in a post-menopausal female. Her clinical picture had been mistaken for inflammatory disease. We present our case, with its detailed clinical history, radiological findings, histopathological and immune-histochemical findings along with a review of the literature. Highlighting this type of tumors may help in appropriate diagnosis. Moreover, studying the behavior of these rare neoplasms is essential to expedite treatment for this tumor type.

Keywords: Lymphoepithelioma; like carcinoma; LELC; breast cancer; medullary carcinoma.

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Figures

Figure 1

A- Right Mediolateral-oblique (A), craniocaudal (B), mammographic projections demonstrate a 2.2-cm, irregular-shaped, high-density. The mass is hyperdense and has an indistinct margin with no associated microcalcifications. B- The mass was categorized as BI-RADS category 4C: high suspicion for malignancy.

Figure 2

A- Nests of anaplastic neoplastic cells, with scattered tumour giant cells and heavy lymphoid infiltrates (hematoxylin-eosin, original magnification ×200). B- The tumor cells are growing in sheets or are intimately intermingled with the very dense stromal lymphoid cell infiltrates (hematoxylin-eosin, original magnification ×400).

Figure 3

The LCA Positive Small Lymphocytes were Polymorphus with Dual CD3 and CD20 Positive Reaction Reflecting Their Reactive Nature (A, B and C). Few cells with weak CD68 positive reaction were seen scattered in the background (D). The atypical cells showed positive r action for CK with 50% nuclear reactivity for Ki-67, which also highlighted the invasive patterns of the cells (E and F). Tumor cells showed negative reaction for both ER and PR. They also showed negative overexpression for Her2 (triple negative pattern) (G, H and I).