![A 57-year-old woman presented with persistent fever, marked hypoproteinemia, and right breast nodules. Positron emission tomography-computed tomography scan revealed high-density nodules within the mammary gland. The breast biopsy revealed large highly atypical cells, which were confined to the blood vessels’ lumina (panels A-C; hematoxylin and eosin, 10× objective, total magnification ×100 [A]; 20× objective, total magnification ×200 [B]; 40× objective, total magnification ×400 [C]). The histological morphology was uncannily like breast carcinoma. Using CD34 immunostaining, we observed apparent delineation of the vascular lumina (panel D; 20× objective, total magnification ×200). Strong reactivity was evident with CD3 (panel E; 20× objective, total magnification ×200), CD2, CD7, CD56, and granzyme B, which suggested a T and cytotoxic phenotype. In contrast, the CD20, CD79a, PAX5, CD5, ALK, and cytokeratins were negative. The Epstein-Barr virus–encoded RNA in situ hybridization was diffusely positive (panel F; 40× objective, total magnification ×400). Immunohistochemistry was crucial for making the correct diagnosis. Although the negative cytokeratin signal aided in the diagnosis, the patient died within 2 weeks of her disease.](https://ash.silverchair-cdn.com/ash/content_public/journal/blood/140/1/10.1182_blood.2022016228/2/m_bloodbld2022016228f1.png?Expires=1767842191&Signature=P2d-zFxrm3vdEOWBT8UGMJgCBs2yw9Agm1OF4hUSySfJV0F6R4x5ZILQZLHkX1dQ4xjyGNNkxsaDlJwZc48XlsG-FUL4VfhLyVUy6GPj9iwhnrBgaAzKBIkJnHwKqOA2l1yA8Ler-I3rdzq7nMOP57Oe6Zko-z4tOXfOkEK-SM7YpQ2e7ND1wZ9sCBo9USyHccyQ4dRzN9kfdLufXgWoweud5sj6KO4APNIrVOp6iQqAPqMh9gEPXyHpvf~DoM4QrUgcPywZYkuL-SHhi8i9AbgF2snk8ZUJyNQJdjyVAqNHPq12V5D-6JwTGeC2FC6H0ZBnEr-lcIQyI2S-nBMdjQ__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA)
A 57-year-old woman presented with persistent fever, marked hypoproteinemia, and right breast nodules. Positron emission tomography-computed tomography scan revealed high-density nodules within the mammary gland. The breast biopsy revealed large highly atypical cells, which were confined to the blood vessels’ lumina (panels A-C; hematoxylin and eosin, 10× objective, total magnification ×100 [A]; 20× objective, total magnification ×200 [B]; 40× objective, total magnification ×400 [C]). The histological morphology was uncannily like breast carcinoma. Using CD34 immunostaining, we observed apparent delineation of the vascular lumina (panel D; 20× objective, total magnification ×200). Strong reactivity was evident with CD3 (panel E; 20× objective, total magnification ×200), CD2, CD7, CD56, and granzyme B, which suggested a T and cytotoxic phenotype. In contrast, the CD20, CD79a, PAX5, CD5, ALK, and cytokeratins were negative. The Epstein-Barr virus–encoded RNA in situ hybridization was diffusely positive (panel F; 40× objective, total magnification ×400). Immunohistochemistry was crucial for making the correct diagnosis. Although the negative cytokeratin signal aided in the diagnosis, the patient died within 2 weeks of her disease.
Intravascular natural killer/T-cell lymphoma (INK/TL) is an uncommon tumor. So far, most reports are of skin and/or central nervous system involvement, and one report of renal involvement. This report of breast INK/TL is the first known published report of its kind.
A 57-year-old woman presented with persistent fever, marked hypoproteinemia, and right breast nodules. Positron emission tomography-computed tomography scan revealed high-density nodules within the mammary gland. The breast biopsy revealed large highly atypical cells, which were confined to the blood vessels’ lumina (panels A-C; hematoxylin and eosin, 10× objective, total magnification ×100 [A]; 20× objective, total magnification ×200 [B]; 40× objective, total magnification ×400 [C]). The histological morphology was uncannily like breast carcinoma. Using CD34 immunostaining, we observed apparent delineation of the vascular lumina (panel D; 20× objective, total magnification ×200). Strong reactivity was evident with CD3 (panel E; 20× objective, total magnification ×200), CD2, CD7, CD56, and granzyme B, which suggested a T and cytotoxic phenotype. In contrast, the CD20, CD79a, PAX5, CD5, ALK, and cytokeratins were negative. The Epstein-Barr virus–encoded RNA in situ hybridization was diffusely positive (panel F; 40× objective, total magnification ×400). Immunohistochemistry was crucial for making the correct diagnosis. Although the negative cytokeratin signal aided in the diagnosis, the patient died within 2 weeks of her disease.
Intravascular natural killer/T-cell lymphoma (INK/TL) is an uncommon tumor. So far, most reports are of skin and/or central nervous system involvement, and one report of renal involvement. This report of breast INK/TL is the first known published report of its kind.
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![A 57-year-old woman presented with persistent fever, marked hypoproteinemia, and right breast nodules. Positron emission tomography-computed tomography scan revealed high-density nodules within the mammary gland. The breast biopsy revealed large highly atypical cells, which were confined to the blood vessels’ lumina (panels A-C; hematoxylin and eosin, 10× objective, total magnification ×100 [A]; 20× objective, total magnification ×200 [B]; 40× objective, total magnification ×400 [C]). The histological morphology was uncannily like breast carcinoma. Using CD34 immunostaining, we observed apparent delineation of the vascular lumina (panel D; 20× objective, total magnification ×200). Strong reactivity was evident with CD3 (panel E; 20× objective, total magnification ×200), CD2, CD7, CD56, and granzyme B, which suggested a T and cytotoxic phenotype. In contrast, the CD20, CD79a, PAX5, CD5, ALK, and cytokeratins were negative. The Epstein-Barr virus–encoded RNA in situ hybridization was diffusely positive (panel F; 40× objective, total magnification ×400). Immunohistochemistry was crucial for making the correct diagnosis. Although the negative cytokeratin signal aided in the diagnosis, the patient died within 2 weeks of her disease.](https://ash.silverchair-cdn.com/ash/content_public/journal/blood/140/1/10.1182_blood.2022016228/2/m_bloodbld2022016228f1.png?Expires=1767842192&Signature=bz3eXzEeNNdFa-94-I0Dq7g4rzcbAxaP3HQlyDfnBgxqzm-zNtENk3xF5-oXNY0PxG6nGsJU34k1aNCSeYtBCY6-YuB~iZKLwSgqMBcZuxjBKu5zEXEc7cy5qIoPl23uEiM5HFTlSmaIbAZq7FZHJtbSUwQehi7Y0s625fH4orAvxxXbxuuRmb-XoKxcHsWAB~BzhJrG6x7X-h-Nqnv8Hp89cVxDsVFWG0elbzqQc8xIiB0IDPPT6sTX9iYTjs4pHfWVGOY04H4~VazCuMw8mWtH0whg6BgcHrWuY7akdg6wVYsnYdB5JTtuNqB2AH2k0x~SiLSJb0Khj1tXPZgjmw__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA)
