T-Cell Lymphoblastic Lymphoma of the Breast: What a Rare Cancer Study Found

Table of Contents

• Key Points
• Background: What Is T-Cell Lymphoblastic Lymphoma?
• Why the Breast Is an Unusual Site for This Cancer
• How the Researchers Conducted the Study
• The New Patient Case: A 45-Year-Old Woman
• Imaging Findings: Ultrasound, Mammography, MRI, and PET-CT
• Pathology and Bone Marrow Results
• What the Literature Review Found Across 11 Patients
• Discussion: Diagnosis, Biology, and Behavior of Breast T-LBL
• Molecular and Genetic Features
• Clinical Implications for Patients
• Limitations of the Study
• Recommendations and Take-Home Points
• Frequently Asked Questions
• Source Information

Key Points

• In a review of 11 female patients with breast T-cell lymphoblastic lymphoma, 5 had tumors in both breasts and 6 in one breast.
• Ten of the 11 reviewed patients had cancer spread beyond the breast, showing it is usually not confined to the breast at diagnosis.
• Accurate diagnosis requires a full panel of immunohistochemical markers; TdT and CD3 were positive in 9 breast lesions reviewed.
• Treatment in the reviewed cases centered on chemotherapy, with some patients also receiving radiotherapy and intrathecal prophylaxis.
• The authors call for future prospective studies to improve diagnosis and treatment of this extremely rare cancer.

Background: What Is T-Cell Lymphoblastic Lymphoma?

Lymphoblastic lymphoma is a rare and aggressive subtype of non-Hodgkin's lymphoma (a group of cancers that start in the lymphatic system). It begins in precursor lymphoblastoid cells, which are early-stage immune cells at various points of development.

Doctors divide lymphoblastic lymphoma into two lineages based on the type of cell involved: B-cell and T-cell. T-cell lymphoblastic lymphoma (T-LBL) makes up about 70% to 80% of these cases.

T-LBL has a distinct pattern in the population. It mostly affects adolescents and young adults, and it is notably more common in males. The disease often appears as a rapidly growing mass in the mediastinum (the central chest area between the lungs), and it frequently involves lymph nodes.

Primary extranodal disease — meaning the cancer starts outside the lymph nodes, such as in the breast — is exceedingly rare.

Why the Breast Is an Unusual Site for This Cancer

On a cellular level, T-LBL blasts (immature cancer cells) typically carry immature T-cell markers. The most consistent and characteristic markers are cytoplasmic cluster of differentiation 3 (CD3; also written cCD3), CD7, and terminal deoxynucleotidyl transferase (TdT).

Other markers — CD1a, CD2, CD5, and CD4/CD8 (which can appear as double-positive or double-negative) — are expressed variably. This variability reflects the stage of thymic differentiation (how far the cell has matured in the thymus, an organ in the chest where T cells develop).

It is also common to see co-expression of myeloid-associated markers CD13 or CD33. This immunophenotypic profile (the pattern of proteins on the cell surface) is crucial for distinguishing T-LBL from other mature T-cell lymphomas. This profile is also crucial for confirming that the cancer comes from precursor cells.

T-LBL and T-cell acute lymphoblastic leukemia (T-ALL) share similar morphology (cell appearance), immunophenotype (marker pattern), and clinical behavior. Because of these similarities, the 2022 World Health Organization (WHO) classification regards them as a single biological entity that spans a disease spectrum.

The practical distinction between the two remains based on how much the bone marrow is involved. A blast proportion below 25% is classified as T-LBL, while 25% or higher defines T-ALL.

Primary involvement of the breast by lymphoblastic lymphoma is an exceptional clinical scenario. This article analyzes the clinical data of patients with T-LBL treated at the authors' hospital and at Shanghai Ruijin Hospital. The goal is to improve understanding of T-LBL in breast tissue.

How the Researchers Conducted the Study

The study had two parts: a detailed report of one patient case and a systematic review of the medical literature.

From July 2023 to April 2024, Jiaxing Maternity and Child Health Care Hospital and Shanghai Ruijin Hospital worked together to diagnose and treat a single case of breast T-LBL.

To ensure the literature search was transparent and reproducible, the researchers searched multiple databases up to May 10, 2024. These databases included PubMed, Web of Science, Embase, Cochrane Library, China Biomedical Literature Database, China National Knowledge Infrastructure, Wanfang, and Wipro.

The search strategy used Boolean operators (a method for combining search terms). The key terms were ("T-cell lymphoblastic lymphoma" OR "T-LBL") AND ("breast" OR "mammary") in English databases, along with their corresponding Chinese translations in Chinese databases.

Advanced filters restricted results by publication type, date range, and human studies. The selection criteria included case reports, clinical studies, and reviews relevant to breast T-cell lymphoblastic lymphoma.

The researchers excluded unrelated lymphoma types, studies without breast involvement, and duplicate publications. This methodology followed established systematic review practices to ensure a comprehensive and replicable search process.

For the identified cases, the inclusion criteria required patients with histopathologically confirmed T-LBL (confirmed by tissue examination) plus comprehensive clinical, imaging, and pathological documentation. The exclusion criteria removed T-ALL cases and literature lacking myelocentesis procedures (bone marrow sampling). Duplicate cases from identical authors, institutions, research entities, and databases were also omitted.

The New Patient Case: A 45-Year-Old Woman

The new patient was a 45-year-old woman. She discovered a walnut-sized lump in her left breast about two weeks before seeking care.

She had mild tenderness, no nipple discharge, and localized erythema (redness) and edema (swelling). She had no systemic symptoms.

On physical examination, her breasts were symmetric. A 4 cm × 3 cm firm mass was located laterally in the left breast. The mass had indistinct borders, limited mobility, and no tenderness when pressed.

The right breast had no palpable abnormalities, with convex nipples and no discharge. The axillary, clavicular, and cervical lymph nodes were unremarkable.

Surgeons removed the left breast mass. The tissue showed histological features suggesting lymphomatous involvement. Examination of 3 left axillary sentinel lymph nodes (the first lymph nodes to which cancer would spread) showed no cancer infiltration.

The patient was then referred to Ruijin Hospital, affiliated with Shanghai Jiaotong University School of Medicine, for comprehensive diagnostic evaluation. This included pathology, molecular profiling, bone marrow aspiration, and 18F-fluorodeoxyglucose positron emission tomography–computed tomography (18F-FDG PET-CT) imaging. Together, these tests confirmed the diagnosis of breast T-LBL.

Treatment included 3 cycles of chemotherapy with additional nutritional and anti-infective support. Treatment also included a lumbar puncture with intrathecal therapy (medicine delivered directly into the spinal fluid). Treatment further included allogeneic stem cell transplantation (stem cells from a donor).

Follow-up assessments, including bone marrow aspiration and 18F-FDG PET-CT scans, documented complete remission. The researchers created a schematic diagram to illustrate the patient's diagnostic and therapeutic journey.

Imaging Findings: Ultrasound, Mammography, MRI, and PET-CT

Ultrasound of both breasts showed scattered hyperechoic strips (bright lines on the image) interconnected within the internal tissues, locally fused into a nodular configuration. A 4.1 cm × 3.8 cm × 2.0 cm heterogeneous hypoechoic lesion (a dark, mixed-texture area) was seen in the left lateral breast.

This lesion had poorly defined margins, irregular morphology, and grade I blood flow, with a resistivity index (RI) of 0.60. Elastography (an imaging method that measures tissue stiffness) showed a grade 4 lesion.

In the left axilla, elliptical hyperechoic structures measuring 1.1 cm × 0.8 cm and 0.9 cm × 0.7 cm with abundant medulla were identified. No significantly enlarged lymph nodes were seen in the right axilla, and no abnormal echoes appeared in the soft tissues of either axilla.

Overall, the ultrasound findings indicated bilateral breast mastopathy (non-cancerous breast tissue changes). The ultrasound findings also indicated a left breast mass with an elastography grade of 4. The ultrasound findings further indicated a Breast Imaging Reporting and Data System (BI-RADS) category 0 on ultrasound. Lymph nodes were observed in the left axilla.

Mammographic imaging of both breasts revealed no notable masses.

Breast magnetic resonance imaging (MRI) revealed an irregularly shaped mass measuring about 4.4 cm × 3.9 cm in the lateral quadrant of the left breast, with unclear borders. The mass showed isohigh signal intensity on T2-weighted images. The mass showed iso-signal on T1-weighted images. The mass showed high signal on diffusion-weighted imaging (DWI). The mass showed a low apparent diffusion coefficient (ADC) value of 0.58 × 10⁻³ mm²/s.

The mass demonstrated heterogeneous enhancement after contrast and a plateau in the time-intensity curve (TIC) after enhancement.

Similarly, an irregularly shaped mass measuring around 2.0 cm × 2.3 cm with indistinct borders was detected in the inner lower quadrant of the right breast. This mass had an ADC value of 0.58 × 10⁻³ mm²/s, uneven enhancement, and a plateau in the TIC.

Another irregularly shaped mass of similar characteristics, measuring about 2.0 cm × 2.3 cm, was observed in the lower quadrant of the right breast. Its MRI signal patterns, ADC values, enhancement patterns, and TIC curves matched those of the left breast mass.

No distinct abnormal masses or mass-like enhancements appeared in the remaining breast tissue on both sides. MRI designated the bilateral breast masses as BI-RADS 4B. There was no evidence of nipple or skin infiltration. Lymph nodes in the left axilla were visible within the imaging field but showed no signs of enlargement.

Before chemotherapy, 18F-FDG PET-CT showed postoperative changes in the left breast after resection, with no detectable FDG-avid lesions (areas of high metabolic activity that could indicate cancer). Slightly elevated metabolic activity appeared in the medial quadrant of the right breast, possibly due to normal physiological uptake.

Several small lymph nodes in the left axilla, each measuring about 0.8 cm, showed increased metabolism with a maximum standardized uptake value (SUVmax) of about 5.1. These were initially considered inflammatory, and lymphoma infiltration was ruled out through close monitoring.

After chemotherapy, 18F-FDG PET-CT showed diffuse and uniform elevation of metabolic activity in the central bone marrow, with an SUVmax of 2.9. This was considered likely due to reactive hyperplasia (a normal increase in bone marrow cell production). No conspicuous hypermetabolic lesions were observed anywhere in the body after treatment.

Pathology and Bone Marrow Results

After all required examinations were completed and contraindications to surgery were excluded, doctors established a clinical diagnosis. The diagnosis was stage IIA malignant tumor localized in the outer lower quadrant of the left breast (cT2N0M0).

A left breast-conserving modified radical mastectomy was performed. Hematoxylin and eosin staining plus immunohistochemical (IHC) staining were conducted on 3-mm formalin-fixed, paraffin-embedded tissue sections.

The pathological diagnosis at the authors' facility indicated nodular infiltrative growth of lymphoid tissue in the left breast. The pathologists considered follicular lymphoma or mucosa-associated lymphoid tissue (MALT) lymphoma but could not definitively exclude these possibilities. They recommended referral to a specialized healthcare facility.

Examination of the 3 anterior sentinel lymph nodes in the left axilla revealed no tumor tissue.

Further consultation with Shanghai Ruijin Hospital confirmed the pathologic diagnosis of T-lymphoblastoid lymphoma in the left breast.

IHC analysis using a panel of antibodies revealed the following results:

• TdT: positive
• Myeloperoxidase: sparse positive
• CD117: partially positive
• CD3: positive
• CD5: positive
• CD7: positive
• CD10: positive
• CD43: positive
• C-MYC: about 80% positive
• CD79a: weakly positive
• BCL-2: positive
• CD20: negative
• BCL-6: negative
• CyclinD1: negative
• SOX-11: negative
• IgD: negative
• MUM-1: negative
• Kappa: negative
• Lambda: negative
• CD56: negative
• CD4: negative
• CD2: negative
• CD8: negative
• CD34: negative
• P53: about 95% positive, moderate intensity
• CD21 (follicular dendritic cell marker): positive
• CD23 (follicular dendritic cell marker): positive
• Programmed death-ligand 1 (combined positive score, CPS): less than 1
• Ki67: about 85% positive

In situ hybridization for Epstein-Barr virus Encoded RNA was negative. Evaluation of the left axillary lymph nodes revealed no concerning findings.

Fluorescence in situ hybridization analysis using the MALT1(18q21) breakage probe, BIRC3/MALT1 fusion probe, and TP53(17p13) deletion probe was negative.

A bone marrow biopsy showed essentially normal hematopoietic cell proliferation across the 3 lineages, with no evident heterogeneous component.

A comprehensive genetic screening covering 84 genes for peripheral T-lineage lymphoma did not reveal any clinically significant genetic variants.

What the Literature Review Found Across 11 Patients

The study included a total of 11 cases. Six cases with comprehensive clinical data came from English literature, 4 cases came from Chinese literature, and 1 case came from the authors' own research.

All 11 patients were female, with an average age of 31.81 ± 11.97 years.

Five cases involved both breasts, while the remaining 6 involved one breast. The unilateral cases were divided equally between the left and right breasts.

One case involved only the breast. Ten cases showed extramammary infiltration (cancer spread beyond the breast), including 3 instances confined to the axillary lymph nodes.

IHC evaluation revealed positivity for both TdT and CD3 in 9 cases with breast lesions. Five cases showed evidence of bone marrow infiltration.

Imaging use across the cases was as follows:

• Ultrasound: 6 cases
• Mammography: 6 cases
• MRI: 1 case
• PET-CT: 2 cases

The breast masses had a maximum diameter ranging from approximately 1.7 cm to 4.4 cm.

Treatment strategies centered predominantly on various forms of chemotherapy. These included 4 cases using the Cyclophosphamide, Doxorubicin, Vincristine, Prednisone regimen, 3 cases using the Hype-CVAD protocol, 3 cases using other variants, and 1 case using an unspecified approach.

Some cases received combined radiotherapy and chemotherapy. Certain cases also received a combination of radiotherapy and intrathecal drug therapy to prevent central nervous system infiltration.

Discussion: Diagnosis, Biology, and Behavior of Breast T-LBL

Breast lymphoma is a rare hematological neoplasm (blood cancer) that arises from lymphoid tissue within the breast. Its estimated incidence ranges from about 0.04% to 0.7%.

Breast lymphomas are predominantly classified as non-Hodgkin's lymphoma. The scarcity of breast lymphomas may be explained by the relatively limited presence of lymphoid tissue in this anatomical site.

T-cell lymphoblastoid lymphoma (LBL) is a subset of non-Hodgkin's lymphoma characterized by high aggressiveness. It primarily affects adolescents and young males.

T-LBL constitutes around 3% to 4% of non-Hodgkin's lymphomas in adults and about 40% of cases in pediatric populations. It often exhibits mediastinal and bone marrow infiltration.

This entity is known for its aggressive behavior, malignancy, and heterogeneity (variability). It typically originates from immature precursor T lymphocytes. T-LBL presenting in the breast is exceedingly rare, which underscores the unique nature of this pathological entity.

Breast T-LBL is typically diagnosed through biopsy or postoperative pathology. The cancer is characterized by medium-sized lymphoblasts with round, oval, or convoluted nuclei. The cancer is characterized by finely dispersed nuclear chromatin, inconspicuous or small nucleoli, and scanty basophilic cytoplasm. The cancer is characterized by frequent mitoses (cell divisions) and regions of necrosis (dead tissue).

Distinguishing T-LBL from B-lymphoblastic lymphoma requires immunophenotypic analysis.

This lymphoma subtype is predominantly of T-lymphoblastic origin, comprising about 80% of cases. It commonly shows positivity for TdT, CD3, and CD7 in 90% of instances. About half of cases show dual positivity for CD4 and CD8. CD10, CD34, CD1a, and CD99 are also frequently expressed.

The authors' investigation challenges prior notions about the sidedness of breast lymphomas. It reveals a predominant bilaterality in cases of T-lymphoblastoid lymphomas. Bilateral involvement is linked to the notably aggressive nature of this disease.

Because these lymphomas can involve the mediastinum, they are often associated with pericardial or pleural effusions (fluid around the heart or lungs). This makes thoracic imaging crucial for assessing mediastinal mass presence and evaluating the risk of pericardial tamponade (compression of the heart by fluid).

Infiltration of peripheral lymph nodes, particularly cervical nodes, is common. Central nervous system involvement is relatively infrequent, occurring in less than 5% of patients.

Bone marrow invasion is observed in about 15% to 20% of cases. It is typically characterized by active or markedly active bone marrow nucleated cell hyperplasia with primitive cell hyperplasia, although this occurs in less than a quarter of cases.

Using multiparametric flow cytometry (a technique that analyzes individual cells), T-LBL typically shows expression of T-cell specific markers such as CD3. It often also exhibits CD38, CD7, CD99, and cTdT markers.

Molecular and Genetic Features

With the rapid advancement of detection methodologies, exploration of the molecular underpinnings of T-LBL has progressed from the cellular level to the genetic level.

Researchers have identified various genetic abnormalities in T-LBL. These include:

• Antigen receptor gene rearrangements, such as clonal rearrangement of TCRαβ chain genes
• Chromosomal aberrations, such as translocations, deletions, and rearrangements
• Oncogene inactivation, involving genes such as PTEN, FBXW7, and BIM

In the authors' own patient, genetic screening of 84 genes for peripheral T-lineage lymphoma did not reveal any clinically significant genetic variants. Fluorescence in situ hybridization probes for MALT1, BIRC3/MALT1, and TP53 were also negative.

Clinical Implications for Patients

Breast T-LBL is exceedingly rare, and accurate diagnosis is crucial for management. This is the central message of the study.

Because the disease is so uncommon, it can be mistaken for other conditions. In the authors' patient, the initial pathology report at their facility suggested follicular lymphoma or MALT lymphoma and could not definitively exclude those possibilities. Only after referral to a specialized center was the correct diagnosis of T-lymphoblastoid lymphoma confirmed.

This case illustrates that specialized pathology review and a full panel of immunohistochemical markers are essential. The correct diagnosis depended on markers such as TdT, CD3, CD7, CD10, and others.

The study also found that breast T-LBL often affects both breasts. Five of the 11 patients had bilateral involvement. This bilateral pattern is linked to the aggressive nature of the disease.

Most patients in the review (10 of 11) had cancer that had spread beyond the breast. This finding highlights that breast T-LBL is usually not confined to the breast at diagnosis.

Treatment in the reviewed cases centered on chemotherapy. Ten of the 11 patients received chemotherapy, with some also receiving radiotherapy and intrathecal prophylaxis (preventive treatment delivered into the spinal fluid) to protect against central nervous system spread.

The authors' own patient received 3 cycles of chemotherapy, intrathecal therapy, and allogeneic stem cell transplantation. Follow-up bone marrow aspiration and PET-CT scans documented complete remission.

Limitations of the Study

This study is a retrospective observational study, meaning it looked back at existing records rather than following patients forward in time. This design limits the strength of the conclusions that can be drawn.

The total number of patients was very small — only 11 cases, including the authors' own patient. Six cases came from English literature, 4 from Chinese literature, and 1 from the authors' research.

Because the disease is so rare, no prospective studies or clinical trials were available to guide diagnosis and treatment. The treatment approaches described varied widely across the 11 cases, which makes it difficult to compare outcomes.

The authors state directly that future prospective studies are needed to optimize diagnostic and therapeutic strategies for breast T-LBL.

The study also notes that the rarity of breast lymphomas may be related to the limited amount of lymphoid tissue in the breast. However, this remains an observation rather than a proven mechanism.

Recommendations and Take-Home Points

For patients and clinicians, the study offers several practical points:

1. Breast T-LBL is extremely rare. In the authors' patient, the mass had indistinct borders, limited mobility, and no tenderness. The authors conclude that when MRI identifies single or multiple breast masses with low ADC values and type II or III enhancement curves in both breasts, a puncture biopsy should be recommended to avoid misdiagnosis as breast cancer.
2. Accurate diagnosis requires a full panel of immunohistochemical markers. Key markers include TdT, CD3, and CD7, which were positive in 9 of the breast lesions reviewed.
3. Referral to a specialized center may be needed. In the authors' case, the initial diagnosis was uncertain until a specialized hospital confirmed T-lymphoblastoid lymphoma.
4. Imaging plays an important role. Ultrasound, mammography, MRI, and PET-CT were all used across the reviewed cases. MRI in the authors' patient showed low ADC values (0.58 × 10⁻³ mm²/s) and plateau TIC curves in both breasts.
5. Treatment typically involves chemotherapy. Ten of 11 patients received chemotherapy, and some also received radiotherapy and intrathecal prophylaxis.
6. Bone marrow evaluation is important. Five of the reviewed cases showed bone marrow infiltration, and bone marrow invasion is reported in about 15% to 20% of T-LBL cases.
7. Central nervous system involvement is uncommon but possible. It occurs in less than 5% of patients, which is why some patients receive intrathecal preventive therapy.

The authors emphasize that breast T-LBL is exceedingly rare and that accurate diagnosis is crucial for management. They call for future prospective studies to optimize diagnostic and therapeutic strategies.

Frequently Asked Questions

What is T-cell lymphoblastic lymphoma of the breast?

It is an extremely rare and aggressive cancer that starts in early immune cells called lymphoblasts and appears in breast tissue. In a review of 11 female patients, 5 had tumors in both breasts and 6 in one breast, and 10 of the 11 had cancer spread beyond the breast. Accurate diagnosis is essential.

How is breast T-cell lymphoblastic lymphoma diagnosed?

Diagnosis is made through biopsy or tissue removed during surgery, using a full panel of immunohistochemical markers. In the reviewed cases, 9 breast lesions were positive for both TdT and CD3. Because the disease is so uncommon, it can be mistaken for other lymphomas, so referral to a specialized center may be needed.

What imaging tests were used for breast T-cell lymphoblastic lymphoma?

Across the reviewed cases, ultrasound was used in 6, mammography in 6, MRI in 1, and PET-CT in 2. In one patient, MRI showed low ADC values of 0.58 × 10⁻³ mm²/s and plateau time-intensity curves in both breasts. Imaging helps assess the breast and whether the cancer has spread.

How is breast T-cell lymphoblastic lymphoma treated?

Treatment in the reviewed cases centered on chemotherapy: 10 of 11 patients received it, and some also had radiotherapy and intrathecal prophylaxis, which is preventive treatment delivered into the spinal fluid. One patient received 3 cycles of chemotherapy, intrathecal therapy, and allogeneic stem cell transplantation, and follow-up documented complete remission.

Does breast T-cell lymphoblastic lymphoma spread to the bone marrow or nervous system?

In the reviewed cases, 5 of 11 showed bone marrow infiltration. Bone marrow invasion is reported in about 15% to 20% of T-LBL cases. Central nervous system involvement is relatively infrequent, occurring in less than 5% of patients, which is why some patients receive intrathecal preventive therapy. Bone marrow evaluation is important.

What does it mean if a breast mass has indistinct borders and limited mobility?

In one patient with breast T-cell lymphoblastic lymphoma, the mass had indistinct borders, limited mobility, and no tenderness. Such unusual features should prompt consideration of this rare cancer. However, these findings alone do not confirm the diagnosis, which requires tissue examination and a full panel of immunohistochemical markers.

Are there genetic changes in breast T-cell lymphoblastic lymphoma?

Various genetic abnormalities have been identified in T-LBL, including antigen receptor gene rearrangements, chromosomal aberrations, and oncogene inactivation involving genes such as PTEN, FBXW7, and BIM. In one patient, genetic screening of 84 genes for peripheral T-lineage lymphoma did not reveal any clinically significant variants, and FISH probes for MALT1, BIRC3/MALT1, and TP53 were negative.

I was told I have T-cell lymphoblastic lymphoma of the breast — when should I get a second opinion?

A second opinion is worth seeking when a breast mass has unusual features, such as indistinct borders, limited mobility, and no tenderness. Breast T-LBL is exceedingly rare and can be mistaken for follicular lymphoma or MALT lymphoma; in one reported case the correct diagnosis was confirmed only after referral to a specialized center. Accurate diagnosis requires a full panel of immunohistochemical markers, including TdT, CD3, and CD7. Because treatment centers on chemotherapy, with some patients also receiving radiotherapy and intrathecal prophylaxis, confirming the diagnosis first matters. Diagnostic Detectives Network provides independent expert second opinions.

Source Information

Original article title: T-cell lymphoblastic lymphoma of the breast: A retrospective observational study and literature review.

Authors: Wei Bian, Jun Yuan, Yufeng Fei, Jinjuan Feng, Xu Zhang, Sili Jin, and Yi Yang

Publication: Medicine, 2026;105:11(e47991)

DOI: http://dx.doi.org/10.1097/MD.0000000000047991

Funding: The research was funded by the Livelihood Science and Technology Innovation Research project under the Jiaxing Science and Technology Plan (Grant numbers: 2022AD30095 and 2025CGW064).

Ethics: The studies involving human participants were reviewed and approved by the Ethical Committee of Jiaxing Maternity and Child Health Care Hospital. Informed written consent was obtained from the patient for publication of this case report and any accompanying images.

This patient-friendly article is based on peer-reviewed research.