Diagnosis and treatment of metachronous multiple primary carcinoma: A case report and review of literature

Table 3 Reports of synchronous multiple primary carcinoma of breast cancer and non-Hodgkin lymphoma and treatment strategies

Year	Patient description	Primary carcinoma	Primary management	Second primary malignancy	Follow up management	Ref.
1998	An 87-year-old woman	Invasive lobular carcinoma of the breasts	Underwent breast conserving surgery with ipsilateral axillary lymph node dissection	Stage IV diffuse large B-cell lymphoma (REAL classification)	3 courses of combination chemotherapy, vincristine, cyclophosphamide, idarubicin and prednisolon (CIOP)	[18]
2004	A 53-year-old woman	Breast cancer	Complete axillary lymph-node dissection	Low grade lymphoma	Not mentioned	[19]
2006	A 63-year-old woman	Invasive, grade 1, ductal carcinoma	Radiotherapy to left breast and was started on tamoxifen. Chemotherapy with four courses of adriamycin, carmustine, cyclophosphamide, and melphalan	B cell lymphoma, with peripheral mantle cells	Chemotherapy with fludarabine and cyclophosphamide	[20]
	A 50-year-old woman	Grade 1 invasive ductal carcinoma	Mastectomy	B cell type non-Hodgkin’s lymphoma, mature, follicular (all follicular, grade 1)	Radiotherapy to the left breast and was started on tamoxifen (20 mg daily). Treated with six courses of chlorambucil and dexamethasone
	A 58-year-old woman	Ductal carcinoma in situ of the comedo type	Left mastectomy	Low grade follicular non-Hodgkin’s lymphoma	No systemic treatment
2008	A 50-year-old female	Infltratingductal carcinoma of mucinous type	Axillary lymph a node dissection. The patient refused further radiotherapy treatment for the breast carcinoma	Non-Hodgkin's lymphoma of axillary lymph nodes	Chemotherapy regimen for CLL (cyclophosphamide 300 mg and prednisolone 30 mg daily)	[21]
2010	74-year-old woman	Multicentric invasive ductal breast carcinoma	Modified radical right mastectomy with level 2 axillary lymph node dissection	SLL	Chemotherapy, radiation, traztuzumab and hormonal therapy	[22]
	74-year-old woman	Invasive lobular breast carcinoma	Wide local excision and sentinel node biopsy	Low-grade B cell lymphoma	6 weeks of adjuvant radiotherapy followed by an aromatase inhibitor
	79-year-old woman	Breast cancer	Modified radical right mastectomy with axillary mass excised in continuity with the whole breast	Classical Hodgkin lymphoma	Local irradiation was chosen as initial treatment
	54-year-old woman	Grade 2, invasive ductal carcinoma	Wide local excision and axillary node dissection	Small lymphocytic B cell lymphoma	The decision was made to treat the lymphoma as a priority; this patient also required radiation treatment to the breast and axilla as well as further chemotherapy for stage IIA breast carcinoma followed by hormonal treatment
2010	A 52-year-old woman	Invasive ductal carcinoma, grade 2 of 3 (moderately differentiated)	Right total mastectomy and right axillary node dissection	Stage 1A follicular lymphoma	An adjuvant chemotherapy regimen, which entailed four cycles of dose dense doxorubicin (60 mg/m2) and cyclophosphamide (600 mg/m2), followed by dose dense paclitaxel	[23]
2011	A 47-year-old female	Ductal car cinoma right breast	Modified radical mastectomy of right breast	B-cell non-Hodgkin lymphoma	Not mentioned	[24]
2012	A 72-year-old Japanese woman	Breast tumor	Surgical resection for the breast tumor	IVLBCL	7 courses of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone) at 3-week intervals	[25]
2014	A 51-year-old woman	Invasive ductal carcinoma (grade III)	Left modified radical mastectomy with ipsilateral axillary lymph node dissection	Diffuse large B-cell lymphoma	Combination of treatment including surgical excision, chemotherapy, and bone marrow transplantation	[26]
2014	A 75-year-old Malay woman	PBLs	Modified radical mastectomy with level II axillary clearance	ILBCL	Rituximab, cyclophospha-mide, hydroxydaunorubicin, Oncovin (vincristine) and prednisolone (R-CHOP) chemotherapy regimen	[27]
2014	A 47-year-old Japanese female	Invasive ductal carcinoma of the right breast	Right mastectomy with sentinel lymph node biopsy and axillary lymph node dissection	Low grade B-cell lymphoma with plasmacytic differentiation	Spontaneous regression of the MALT lymphoma originally	[8]
2014	A 51-year-old woman	Invasive ductal carcinoma of the breast	Left mastectomy, axillary clearance and right lumpectomy	DLBCL	Epirubicin, vincristine, prednisone and cyclophosphamide (CHOP) chemotherapy with rituximab and planned to follow adjuvant endocrine therapy after chemotherapy	[28]
	A 47-year-old woman	Invasive ductal carcinoma of the breast	Right mastectomy and axillary clearance	DLBCL	6-8 cycles of R-CHOP chemotherapy and planned to follow trastuzumab for one year, and adjuvant endocrine therapy after that
2017	A 65-year-old man	Grade II invasive ductal carcinoma (stage IIA)	Modified radical mastectomy	MCL (stage I, group A)	6 courses of CHOP (A chemotherapy protocol consists of cyclophosphamide 12 g day 1, doxorubicin 80 mg day 1, vindesine 4 mg day 1, and prednisone 90 mg from day 1 to 5) for lymphoma and breast cancer. The patient was also administered endocrine therapy	[29]
2018	A 73-year-old female	Breast cancer	Not mentioned	DLBCL	Not mentioned	[30]
2020	An elderly woman	Grade 2 invasive ductal carcinoma with axillary lymphadenopathy	Mastectomy and axillary node dissection	SLL	Not mentioned	[31]
2019	A woman in her early 60	Invasive ductal carcinoma	Multidisciplina-breast radiotherapy	Diffuse large B-Cell lymphoma	3 coures of R-CHOP and 3 courses of R-CEOP	[32]
2021	A 72-year-old female	Invasive lobular carcinoma of the right breast Stage IIIA (pT2pN3cM0)	Right modified radical mastectomy followed by chemotherapy	Right inguinal lymph node + follicular lymphoma Stage 2 (intermediate risk)	The lymphomas were low grade, which the oncologist closely followed	[33]
	A 60-year-old female	Stage IIB (pT2pN2acM0)	Right mastectomy and right axillary LN dissection, followed by adjuvant chemotherapy and radiotherapy	Abdominal mesenteric lymph node + follicular lymphoma Stage 2 (intermediate risk)
	A 74-year-old female	Multifocal Stage IB (pT1CpN2acM0)	Left mastectomy and complete left axillary dissection followed by chemotherapy and radiotherapy	Follicular neoplasia in situ in two of her left dissected axillary LNStage 1 (low risk)
2021	A 78-year-old male	Breast mucinous carcinoma	Modified radical left mastectomy with lymph node dissection for mucinous carcinoma	Diffuse large B-cell lymphoma	Hormonal therapy with tamoxifen and chemotherapy with the R-CHOP protocol (cyclophosphamide, doxorubi cin, vincristine, and prednisone; given every 21 days for 6 cycles) in combination	[34]
2021	A 72-year-old female	T2N1Mx (stage 2) for the breast cancer	The patient underwent courses of CHOP (cyclophosphamide, doxorubicin, vincris-tine, prednisolone) chemotherapy and was planned for surgery	Chronic lympho cytic leukemia/SLL	The patient underwent courses of CHOP (cyclophosphamide, doxorubicin, vincris- tine, prednisolone) chemotherapy and was planned for surgery	[35]
2021	A 78-year-old woman	Breast invasive ductal carcinoma	Wide local excision of the breast mass with sentinel node biopsy	Abdominal DLBCL	R-CHOP regimen (rituximab 375 mg/m2, vincristine 14 mg/m2, doxorubicin 50 mg/m, cyclophosphamide 750 mg/m2, and prednisolone 100 mg orally). The tumor rapidly relapsed, and the patient received rituximab in combination with gemcitabine and vinorelbine chemotherapy (rituximab 375 mg/m2, gemcitabine 880 mg/m2, vinorelbine 25 mg/m2). Radiotherapy was then administered	[2]
2022	A 35-year-old woman	Invasive ductal carcinoma with no special type grade III (i.e., poorly differentiated) in the breast	Modified radical mastectomy for stage IIIA IDC	NHL	Received R-CHOP chemotherapy for stage I NHL	[1]
2022	A 72-year-old female	Infiltrating ductal carcinoma grade III of the right breast	Resection.	NHL, B cell type, high grade	RHCOP for 6 cycles to overcome lymphoma then received hormonal therapy afterwards	[11]
2024	A 54-year-old post-menopausal female	Breast cancer was staged as Stage IIA	Right breast-conserving surgery with axillary lymph node dissection	DLBCL as Stage IE	3 cycles of R-CHOP protocol. Recommended weekly paclitaxel for 12 cycles and trastuzumab and pertuzumab for 1 year. Endocrine treatment will be started once chemotherapy is completed	[3]

R-CHOP: Rituximab, cyclophosphamide, vincristine, doxorubicin, and prednisolone; DLBCL: Diffuse large B cell lymphoma; RHCOP: Rituximab, cyclophosphamide, epirubicin, vincristin, and prednisone; NHL: Non-Hodgkin Lymphoma; SLL: Small lymphocytic lymphoma; MCL: Mantle cell lymphoma; ILBCL: Intravascular large B-cell lymphoma; MALT: Mucosa-associated lymphoid tissue; PBLs: Primary breast lymphomas; IVLBCL: Intravascular large B-cell lymphoma; CLL: Chronic lymphocytic leukemia.