原发乳腺淋巴瘤的诊疗现状及进展_West China Medical Journal

Authors：

翁华伟 ,  邹立群

四川大学华西医院肿瘤中心（成都 610041）;

Corresponding author：

邹立群, Email: zliqun@hotmail.com

Keywords：

原发乳腺淋巴瘤; 利妥昔单抗; 靶向治疗

DOI：

10.7507/1002-0179.201608311

Video：

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原发乳腺淋巴瘤（primary breast lymphoma，PBL）是一种罕见的结外型非霍奇金淋巴瘤，定义为原发于乳腺，伴或不伴区域淋巴结转移，但无胸外浸润的淋巴瘤。由于乳腺组织正常情况下无淋巴组织，所以其发病率较低，约占结外型非霍奇金淋巴瘤的 2%，在乳腺恶性肿瘤中约占 0.5%。PBL 无典型临床表现，诊断依赖于病理学。其主要病理学类型为弥漫大 B 淋巴细胞瘤。中枢神经系统为 PBL 治疗后常见的复发部位。目前关于 PBL 的报道少见，且多为小样本回顾性分析，尚无统一治疗规范。文献报道 PBL 治疗多以系统化学疗法联合放射治疗及免疫治疗为主，手术仅适用于明确病理学诊断，对生存获益有限。国际预后指数为 PBL 主要预后因素。对于复发/难治的 PBL，靶向治疗将是一个新的突破点，有望为临床治疗提供更多选择。该文就 PBL 的诊断，临床特征，治疗策略及研究进展等方面加以综述，旨在加深对 PBL 的认识，指导临床治疗。

Citation： 翁华伟, 邹立群. 原发乳腺淋巴瘤的诊疗现状及进展. West China Medical Journal, 2017, 32(12): 1943-1946. doi: 10.7507/1002-0179.201608311 Copy

1.	Wiseman C, Liao KT. Primary lymphoma of the breast. Cancer, 1972, 29(6): 1705-1712.
2.	Hosein PJ, Maragulia JC, Salzberg MP, et al. A multicentre study of primary breast diffuse large B-cell lymphoma in the rituximab era. Br J Haematol, 2014, 165(3): 358-363.
3.	Cheah CY, Campbell BA, Seymour JF. Primary breast lymphoma. Cancer Treat Rev, 2014, 40(8): 900-908.
4.	Ryan G, Martinelli G, Kuper-Hommel M, et al. Primary diffuse large B-cell lymphoma of the breast: prognostic factors and outcomes of a study by the International Extranodal Lymphoma Study Group. Ann Oncol, 2008, 19(2): 233-241.
5.	Jennings WC, Baker RS, Murray SS, et al. Primary breast lymphoma: the role of mastectomy and the importance of lymph node status. Ann Surg, 2007, 245(5): 784-789.
6.	Talwalkar SS, Miranda RN, Valbuena JR, et al. Lymphomas involving the breast: a study of 106 cases comparing localized and disseminated neoplasms. Am J Surg Pathol, 2008, 32(9): 1299-1309.
7.	Uesato M, Miyazawa Y, Gunji Y, et al. Primary non-Hodgkin’s lymphoma of the breast: report of a case with special reference to 380 cases in the Japanese literature. Breast Cancer, 2005, 12(2): 154-158.
8.	Ou CW, Shih LY, Wang PN, et al. Primary breast lymphoma: a single-institute experience in Taiwan. Biomed J, 2014, 37(5): 321-325.
9.	Yhim HY, Kim JS, Kang HJ, et al. Matched-pair analysis comparing the outcomes of primary breast and nodal diffuse large B-cell lymphoma in patients treated with rituximab plus chemotherapy. Int J Cancer, 2012, 131(1): 235-243.
10.	Brogi E, Harris NL. Lymphomas of the breast: pathology and clinical behavior. Semin Oncol, 1999, 26(3): 357-364.
11.	段明辉, 曹欣欣, 蔡华聪, 等. 14 例原发乳腺淋巴瘤患者临床分析. 中华血液学杂志, 2014, 35(10): 918-921.
12.	Yoshida S, Nakamura N, Sasaki Y, et al. Primary breast diffuse large B-cell lymphoma shows a non-germinal center B-cell phenotype. Mod Pathol, 2005, 18(3): 398-405.
13.	Fukuhara S, Watanabe T, Munakata W, et al. Bulky disease has an impact on outcomes in primary diffuse large B-cell lymphoma of the breast: a retrospective analysis at a single institution. Eur J Haematol, 2011, 87(5): 434-440.
14.	Ryan GF, Roos DR, Seymour JF. Primary non-Hodgkin’s lymphoma of the breast: retrospective analysis of prognosis and patterns of failure in two Australian centers. Clin Lymphoma Myeloma, 2006, 6(4): 337-341.
15.	Yhim HY, Kang HJ, Choi YH, et al. Clinical outcomes and prognostic factors in patients with breast diffuse large B cell lymphoma; Consortium for Improving Survival of Lymphoma (CISL) study. BMC Cancer, 2010, 10: 321.
16.	罗必华, 黄建清, 闫子勋, 等. 21 例原发乳腺淋巴瘤患者疗效及预后分析. 中华血液学杂志, 2015, 36(4): 277-281.
17.	Jeanneret-Sozzi W, Taghian A, Epelbaum R, et al. Primary breast lymphoma: patient profile, outcome and prognostic factors. A multicentre Rare Cancer Network study. BMC Cancer. 2008. 8: 86.
18.	Caon J, Wai ES, Hart J, et al. Treatment and outcomes of primary breast lymphoma. Clin Breast Cancer, 2012, 12(6): 412-419.
19.	Avilés A, Castañeda C, Neri N, et al. Rituximab and dose dense chemotherapy in primary breast lymphoma. Haematologica, 2007. 92(8): 1147-1148.
20.	Wong WW, Schild SE, Halyard MY, et al. Primary non-Hodgkin lymphoma of the breast: the Mayo clinic experience. J Surg Oncol, 2002, 80(1): 19-25; discussion 26.
21.	Dao AH, Adkins RB, Glick AD. Malignant lymphoma of the breast: a review of 13 cases. Am Surg, 1992, 58(12): 792-796.
22.	Roschewski M, Dunleavy K, Wilson WH. Diffuse large B cell lymphoma: molecular targeted therapy. Int J Hematol, 2012, 96(5): 552-561.
23.	Dunleavy K, Pittaluga S, Czuczman MS, et al. Differential efficacy of bortezomib plus chemotherapy within molecular subtypes of diffuse large B-cell lymphoma. Blood, 2009, 113(24): 6069-6076.
24.	Ruan J, Martin P, Furman RR, et al. Bortezomib plus CHOP-rituximab for previously untreated diffuse large B-cell lymphoma and mantle cell lymphoma. J Clin Oncol, 2011, 29(6): 690-697.
25.	Zhang LH, Kosek J, Wang M, et al. Lenalidomide efficacy in activated B-cell-like subtype diffuse large B-cell lymphoma is dependent upon IRF4 and cereblon expression. Br J Haematol, 2013, 160(4): 487-502.
26.	Hernandez-Ilizaliturri FJ, Deeb G, Zinzani PL, et al. Higher response to lenalidomide in relapsed/refractory diffuse large B-cell lymphoma in nongerminal center B-cell-like than in germinal center B-cell-like phenotype. Cancer, 2011, 117(22): 5058-5066.
27.	Friedberg JW, Sharman J, Sweetenham J, et al. Inhibition of Syk with fostamatinib disodium has significant clinical activity in non-Hodgkin lymphoma and chronic lymphocytic leukemia. Blood, 2010, 115(13): 2578-2585.
28.	Advani RH, Buggy JJ, Sharman JP, et al. Bruton tyrosine kinase inhibitor ibrutinib (PCI-32765) has significant activity in patients with relapsed/refractory B-cell malignancies. J Clin Oncol, 2013, 31(1): 88-94.
29.	Gupta E, Accurso J, Sluzevich J, et al. Excellent outcome of immunomodulation or bruton’s tyrosine kinase inhibition in highly refractory primary cutaneous diffuse large B-cell lymphoma, leg type. Rare Tumors, 2015, 7(4): 6067.
30.	Pfeifer M, Zheng B, Erdmann T, et al. Anti-CD22 and anti-CD79B antibody drug conjugates are active in different molecular diffuse large B-cell lymphoma subtypes. Leukemia, 2015, 29(7): 1578-1586.
31.	Palanca-Wessels MC, Czuczman M, Salles G, et al. Safety and activity of the anti-CD79B antibody-drug conjugate polatuzumab vedotin in relapsed or refractory B-cell non-Hodgkin lymphoma and chronic lymphocytic leukaemia: a phase 1 study. Lancet Oncol, 2015, 16(6): 704-715.

1. Wiseman C, Liao KT. Primary lymphoma of the breast. Cancer, 1972, 29(6): 1705-1712.
2. Hosein PJ, Maragulia JC, Salzberg MP, et al. A multicentre study of primary breast diffuse large B-cell lymphoma in the rituximab era. Br J Haematol, 2014, 165(3): 358-363.
3. Cheah CY, Campbell BA, Seymour JF. Primary breast lymphoma. Cancer Treat Rev, 2014, 40(8): 900-908.
4. Ryan G, Martinelli G, Kuper-Hommel M, et al. Primary diffuse large B-cell lymphoma of the breast: prognostic factors and outcomes of a study by the International Extranodal Lymphoma Study Group. Ann Oncol, 2008, 19(2): 233-241.
5. Jennings WC, Baker RS, Murray SS, et al. Primary breast lymphoma: the role of mastectomy and the importance of lymph node status. Ann Surg, 2007, 245(5): 784-789.
6. Talwalkar SS, Miranda RN, Valbuena JR, et al. Lymphomas involving the breast: a study of 106 cases comparing localized and disseminated neoplasms. Am J Surg Pathol, 2008, 32(9): 1299-1309.
7. Uesato M, Miyazawa Y, Gunji Y, et al. Primary non-Hodgkin’s lymphoma of the breast: report of a case with special reference to 380 cases in the Japanese literature. Breast Cancer, 2005, 12(2): 154-158.
8. Ou CW, Shih LY, Wang PN, et al. Primary breast lymphoma: a single-institute experience in Taiwan. Biomed J, 2014, 37(5): 321-325.
9. Yhim HY, Kim JS, Kang HJ, et al. Matched-pair analysis comparing the outcomes of primary breast and nodal diffuse large B-cell lymphoma in patients treated with rituximab plus chemotherapy. Int J Cancer, 2012, 131(1): 235-243.
10. Brogi E, Harris NL. Lymphomas of the breast: pathology and clinical behavior. Semin Oncol, 1999, 26(3): 357-364.
11. 段明辉, 曹欣欣, 蔡华聪, 等. 14 例原发乳腺淋巴瘤患者临床分析. 中华血液学杂志, 2014, 35(10): 918-921.
12. Yoshida S, Nakamura N, Sasaki Y, et al. Primary breast diffuse large B-cell lymphoma shows a non-germinal center B-cell phenotype. Mod Pathol, 2005, 18(3): 398-405.
13. Fukuhara S, Watanabe T, Munakata W, et al. Bulky disease has an impact on outcomes in primary diffuse large B-cell lymphoma of the breast: a retrospective analysis at a single institution. Eur J Haematol, 2011, 87(5): 434-440.
14. Ryan GF, Roos DR, Seymour JF. Primary non-Hodgkin’s lymphoma of the breast: retrospective analysis of prognosis and patterns of failure in two Australian centers. Clin Lymphoma Myeloma, 2006, 6(4): 337-341.
15. Yhim HY, Kang HJ, Choi YH, et al. Clinical outcomes and prognostic factors in patients with breast diffuse large B cell lymphoma; Consortium for Improving Survival of Lymphoma (CISL) study. BMC Cancer, 2010, 10: 321.
16. 罗必华, 黄建清, 闫子勋, 等. 21 例原发乳腺淋巴瘤患者疗效及预后分析. 中华血液学杂志, 2015, 36(4): 277-281.
17. Jeanneret-Sozzi W, Taghian A, Epelbaum R, et al. Primary breast lymphoma: patient profile, outcome and prognostic factors. A multicentre Rare Cancer Network study. BMC Cancer. 2008. 8: 86.
18. Caon J, Wai ES, Hart J, et al. Treatment and outcomes of primary breast lymphoma. Clin Breast Cancer, 2012, 12(6): 412-419.
19. Avilés A, Castañeda C, Neri N, et al. Rituximab and dose dense chemotherapy in primary breast lymphoma. Haematologica, 2007. 92(8): 1147-1148.
20. Wong WW, Schild SE, Halyard MY, et al. Primary non-Hodgkin lymphoma of the breast: the Mayo clinic experience. J Surg Oncol, 2002, 80(1): 19-25; discussion 26.
21. Dao AH, Adkins RB, Glick AD. Malignant lymphoma of the breast: a review of 13 cases. Am Surg, 1992, 58(12): 792-796.
22. Roschewski M, Dunleavy K, Wilson WH. Diffuse large B cell lymphoma: molecular targeted therapy. Int J Hematol, 2012, 96(5): 552-561.
23. Dunleavy K, Pittaluga S, Czuczman MS, et al. Differential efficacy of bortezomib plus chemotherapy within molecular subtypes of diffuse large B-cell lymphoma. Blood, 2009, 113(24): 6069-6076.
24. Ruan J, Martin P, Furman RR, et al. Bortezomib plus CHOP-rituximab for previously untreated diffuse large B-cell lymphoma and mantle cell lymphoma. J Clin Oncol, 2011, 29(6): 690-697.
25. Zhang LH, Kosek J, Wang M, et al. Lenalidomide efficacy in activated B-cell-like subtype diffuse large B-cell lymphoma is dependent upon IRF4 and cereblon expression. Br J Haematol, 2013, 160(4): 487-502.
26. Hernandez-Ilizaliturri FJ, Deeb G, Zinzani PL, et al. Higher response to lenalidomide in relapsed/refractory diffuse large B-cell lymphoma in nongerminal center B-cell-like than in germinal center B-cell-like phenotype. Cancer, 2011, 117(22): 5058-5066.
27. Friedberg JW, Sharman J, Sweetenham J, et al. Inhibition of Syk with fostamatinib disodium has significant clinical activity in non-Hodgkin lymphoma and chronic lymphocytic leukemia. Blood, 2010, 115(13): 2578-2585.
28. Advani RH, Buggy JJ, Sharman JP, et al. Bruton tyrosine kinase inhibitor ibrutinib (PCI-32765) has significant activity in patients with relapsed/refractory B-cell malignancies. J Clin Oncol, 2013, 31(1): 88-94.
29. Gupta E, Accurso J, Sluzevich J, et al. Excellent outcome of immunomodulation or bruton’s tyrosine kinase inhibition in highly refractory primary cutaneous diffuse large B-cell lymphoma, leg type. Rare Tumors, 2015, 7(4): 6067.
30. Pfeifer M, Zheng B, Erdmann T, et al. Anti-CD22 and anti-CD79B antibody drug conjugates are active in different molecular diffuse large B-cell lymphoma subtypes. Leukemia, 2015, 29(7): 1578-1586.
31. Palanca-Wessels MC, Czuczman M, Salles G, et al. Safety and activity of the anti-CD79B antibody-drug conjugate polatuzumab vedotin in relapsed or refractory B-cell non-Hodgkin lymphoma and chronic lymphocytic leukaemia: a phase 1 study. Lancet Oncol, 2015, 16(6): 704-715.

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