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MRI Features of Mucosa-Associated Lymphoid Tissue Lymphoma in the Breast

¹ Department of Radiology, University of Michigan, Ann Arbor, MI.
² Department of Radiology, Stanford University, 300 Pasteur Dr. H1307, MC5621, Stanford, CA 94305.
³ Department of Surgery, Stanford University, Stanford, CA.
⁴ Department of Pathology, Stanford University, Stanford, CA.

View larger version (151K): [in a new window]   Fig. 1A —56-year-old woman presenting with a typical region of MALT lymphoma on MRI. Sagittal T2-weighted fast spin-echo fat-suppressed MR image of right breast; (TR/TE 4,000/98, slice thickness 3 mm, slice spacing 3 mm; field of view 20 cm, acquisition matrix 256 x 192) shows ovoid 1.6 x 0.7 cm lesion (arrow) in upper breast, with slightly higher signal intensity than adjacent glandular tissue (A). Contrast-enhanced water-specific 3D gradient-echo image (centric 3D spectral-spatial excitation spoiled gradient echo with magnetization transfer [3DSSMT] after 0.1 mmol/kg IV of gadopentetate dimeglumine, TR/TE 31.3/8.73, slice thickness 1.5 mm, field of view 20 cm, matrix 512 x 192) revealed multiple foci of contrast enhancement, largest being 1.6 x 0.7 cm in upper outer quadrant (arrow) (B) that had increased in size and number since previous study 5 months earlier (not shown). Time signal-intensity curves from dynamic 3D spiral MRI (scans repeated every 10.6 sec; see reference [6] for scan parameter details) performed during initial contrast enhancement ("wash-in" phase) and after high-resolution 3DSSMT ("wash-out" phase) revealed rapid initial enhancement during wash-in phase followed by gradual enhancement during wash-out phase (C). MRI localized biopsy of upper breast lesion revealed dense lymphoid infiltrate composed of monomorphous small lymphocytes involving breast parenchyma and surrounding benign breast ducts (D) (H and E stain x100). Histologic findings were same as MRI-guided biopsy of initial left breast lesion (not shown).

View larger version (121K): [in a new window]   Fig. 1B —56-year-old woman presenting with a typical region of MALT lymphoma on MRI. Sagittal T2-weighted fast spin-echo fat-suppressed MR image of right breast; (TR/TE 4,000/98, slice thickness 3 mm, slice spacing 3 mm; field of view 20 cm, acquisition matrix 256 x 192) shows ovoid 1.6 x 0.7 cm lesion (arrow) in upper breast, with slightly higher signal intensity than adjacent glandular tissue (A). Contrast-enhanced water-specific 3D gradient-echo image (centric 3D spectral-spatial excitation spoiled gradient echo with magnetization transfer [3DSSMT] after 0.1 mmol/kg IV of gadopentetate dimeglumine, TR/TE 31.3/8.73, slice thickness 1.5 mm, field of view 20 cm, matrix 512 x 192) revealed multiple foci of contrast enhancement, largest being 1.6 x 0.7 cm in upper outer quadrant (arrow) (B) that had increased in size and number since previous study 5 months earlier (not shown). Time signal-intensity curves from dynamic 3D spiral MRI (scans repeated every 10.6 sec; see reference [6] for scan parameter details) performed during initial contrast enhancement ("wash-in" phase) and after high-resolution 3DSSMT ("wash-out" phase) revealed rapid initial enhancement during wash-in phase followed by gradual enhancement during wash-out phase (C). MRI localized biopsy of upper breast lesion revealed dense lymphoid infiltrate composed of monomorphous small lymphocytes involving breast parenchyma and surrounding benign breast ducts (D) (H and E stain x100). Histologic findings were same as MRI-guided biopsy of initial left breast lesion (not shown).

View larger version (14K): [in a new window]   Fig. 1C —56-year-old woman presenting with a typical region of MALT lymphoma on MRI. Sagittal T2-weighted fast spin-echo fat-suppressed MR image of right breast; (TR/TE 4,000/98, slice thickness 3 mm, slice spacing 3 mm; field of view 20 cm, acquisition matrix 256 x 192) shows ovoid 1.6 x 0.7 cm lesion (arrow) in upper breast, with slightly higher signal intensity than adjacent glandular tissue (A). Contrast-enhanced water-specific 3D gradient-echo image (centric 3D spectral-spatial excitation spoiled gradient echo with magnetization transfer [3DSSMT] after 0.1 mmol/kg IV of gadopentetate dimeglumine, TR/TE 31.3/8.73, slice thickness 1.5 mm, field of view 20 cm, matrix 512 x 192) revealed multiple foci of contrast enhancement, largest being 1.6 x 0.7 cm in upper outer quadrant (arrow) (B) that had increased in size and number since previous study 5 months earlier (not shown). Time signal-intensity curves from dynamic 3D spiral MRI (scans repeated every 10.6 sec; see reference [6] for scan parameter details) performed during initial contrast enhancement ("wash-in" phase) and after high-resolution 3DSSMT ("wash-out" phase) revealed rapid initial enhancement during wash-in phase followed by gradual enhancement during wash-out phase (C). MRI localized biopsy of upper breast lesion revealed dense lymphoid infiltrate composed of monomorphous small lymphocytes involving breast parenchyma and surrounding benign breast ducts (D) (H and E stain x100). Histologic findings were same as MRI-guided biopsy of initial left breast lesion (not shown).

View larger version (187K): [in a new window]   Fig. 1D —56-year-old woman presenting with a typical region of MALT lymphoma on MRI. Sagittal T2-weighted fast spin-echo fat-suppressed MR image of right breast; (TR/TE 4,000/98, slice thickness 3 mm, slice spacing 3 mm; field of view 20 cm, acquisition matrix 256 x 192) shows ovoid 1.6 x 0.7 cm lesion (arrow) in upper breast, with slightly higher signal intensity than adjacent glandular tissue (A). Contrast-enhanced water-specific 3D gradient-echo image (centric 3D spectral-spatial excitation spoiled gradient echo with magnetization transfer [3DSSMT] after 0.1 mmol/kg IV of gadopentetate dimeglumine, TR/TE 31.3/8.73, slice thickness 1.5 mm, field of view 20 cm, matrix 512 x 192) revealed multiple foci of contrast enhancement, largest being 1.6 x 0.7 cm in upper outer quadrant (arrow) (B) that had increased in size and number since previous study 5 months earlier (not shown). Time signal-intensity curves from dynamic 3D spiral MRI (scans repeated every 10.6 sec; see reference [6] for scan parameter details) performed during initial contrast enhancement ("wash-in" phase) and after high-resolution 3DSSMT ("wash-out" phase) revealed rapid initial enhancement during wash-in phase followed by gradual enhancement during wash-out phase (C). MRI localized biopsy of upper breast lesion revealed dense lymphoid infiltrate composed of monomorphous small lymphocytes involving breast parenchyma and surrounding benign breast ducts (D) (H and E stain x100). Histologic findings were same as MRI-guided biopsy of initial left breast lesion (not shown).

View larger version (175K): [in a new window]   Fig. 1E —56-year-old woman presenting with a typical region of MALT lymphoma on MRI. MR images show response of MALT lymphoma to whole breast irradiation. Initial contrast-enhanced 3D spectral-spatial excitation spoiled gradient-echo with magnetization transfer (3DSSMT) MR image of left breast (E) shows focal enhancement in the lower breast (arrow). No significant areas of contrast enhancement are seen in left breast on 3DSSMT MR image performed after whole-breast irradiation, with normal nonenhancing breast parenchyma noted in region of previous abnormal enhancement (F, arrow).

View larger version (193K): [in a new window]   Fig. 1F —56-year-old woman presenting with a typical region of MALT lymphoma on MRI. MR images show response of MALT lymphoma to whole breast irradiation. Initial contrast-enhanced 3D spectral-spatial excitation spoiled gradient-echo with magnetization transfer (3DSSMT) MR image of left breast (E) shows focal enhancement in the lower breast (arrow). No significant areas of contrast enhancement are seen in left breast on 3DSSMT MR image performed after whole-breast irradiation, with normal nonenhancing breast parenchyma noted in region of previous abnormal enhancement (F, arrow).

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