J Breast Cancer.  2016 Dec;19(4):455-458. 10.4048/jbc.2016.19.4.455.

Relapse of Biphenotypic Acute Leukemia as a Breast Mass

• Shin HC

• KMID: 2362933
• DOI: http://doi.org/10.4048/jbc.2016.19.4.455

Abstract

In acute leukemia, leukemic infiltration of the breast is extremely rare. We report a case of biphenotypic acute leukemia (BAL) that presented as a breast mass. A 30-year-old woman presented with a 4-month history of a right breast mass with nipple discharge and easy fatigue. She had received chemotherapy and peripheral blood stem cell transplantation for BAL and had been in complete remission for the last 2 years. Core needle biopsy of the breast mass revealed monomorphous infiltrates of blast cells with round nuclei and fine chromatin, consistent with leukemic infiltration. Subsequent bone marrow biopsy showed diffuse infiltration of immature cells. However, bone marrow karyotyping showed 46, XY, suggesting complete engraftment of transplanted donor cells. This is the report of BAL recurring as a breast mass. In the differential diagnosis of a breast mass, extramedullary relapse should be considered when the patient has a history of leukemia.

Keyword

Biphenotypic acute leukemia; Breast; Leukemic infiltration

MeSH Terms

Adult
Biopsy
Biopsy, Large-Core Needle
Bone Marrow
Breast*
Chromatin
Diagnosis, Differential
Drug Therapy
Fatigue
Female
Humans
Karyotyping
Leukemia
Leukemia, Biphenotypic, Acute*
Leukemic Infiltration
Nipples
Peripheral Blood Stem Cell Transplantation
Recurrence*
Tissue Donors
Chromatin

Figure

• 

  Figure 1 Radiologic findings for right breast mass. (A) Mammography showed extremely dense breast tissue but no well-defined mass. (B) Breast ultrasonography revealed a 5.7×2.1×5.9 cm and 3.0×1.4×2.5 cm masses with partly indistinct margins and heterogeneous echoic pattern in her right breast 2 o'clock direction and 8 o'clock direction, respectively.

• 

  Figure 2 Microscopic findings of right breast mass. (A) Breast biopsy specimen shows monomorphous infiltrates of blast cells with round nuclei and fine chromatin (H&E stain, ×400). (B) Immunohistochemical staining for CD34, showing staining of the majority of the blast cells (×400). (C) Immunohistochemical staining for CD117, showing diffuse positive staining of the blast cells (×400).

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