2021, Number 01
<< Back Next >>
Ginecol Obstet Mex 2021; 89 (01)
Bilateral breast disease as the first manifestation of acute T-cell leukemia/ lymphoma
Laguna-Olmos M, Ruiz-Peña AC, Fernández-García C, Esteban-Figuerola A, Atienza-Roles M, Peralta-Benítez RS
Language: Spanish
References: 15
Page: 77-83
PDF size: 393.24 Kb.
ABSTRACT
Background: Breast hematologic malignancies are a rare condition, even more
if they appear as the first manifestation of the disease and if they are T cells tumors.
Objective: The objective is to present a case report of an acute T-cell leukemia /
lymphoma that started with breast bilateral palpable nodules, as well as to review its
epidemiology, clinical characteristics, diagnosis and treatment.
Case Report: 34-year-old woman, referred from primary care to the Breast Unit
of our center after feeling two painless nodules in the right breast and one in the left
breast for one month. The ultrasound study showed the presence in the left breast of
a 12 mm rounded, isodense nodule with circumscribed outline. Another nodule with
similar characteristics was observed in the contralateral breast along with bilateral
lymphadenopathy. The histological, immunophenotypic and extension study diag-
nosed an Acute Cortical T-Thymic Leukemia / Lymphoid Lymphoma (T-III according
to WHO 2016) with High Risk with systemic involvement of the disease and started
chemotherapy induction treatment according to the PETHEMA LAL-AR/11 protocol.
The patient presented a minimal negative residual disease from the start of the treatment
without requiring an hematopoietic parents transplant despite being a high-risk case.
Conclusions: Breast leukemic infiltration is a rare entity, even more if it constitutes
the first manifestation of the disease. The presence of multiple bilateral breast nodules
suspected as malignant in young patients, should include hematological malignancies
in the differential diagnosis.
REFERENCES
Mandal S, Jain S, Khurana N. Breast lump as an initial manifestation in acute lymphoblastic leukemia: An unusual presentation. A case report. Hematology. 2007; 12: 45-7 .doi:10.1080/10245330600938158.
Rodríguez I, Vicente F, Cordoba A, Sala F, Martínez-Peñuela JM. Manifestación inicial de leucemia linfoblástica aguda en la mama. Descripción de un caso y revisión de la bi- bliografía. Rev Senol Patol Mamar. 2012;25(3):125-129. doi:10.1016/50214-1582(12)70026-9.
Basara I, Orguc SJ. Giant breast involvement in acute lymphoblastic leukemia: MRI findings. J Breast Cancer 2012;15:258–60.doi:10.4048/jbc.2012.15.2.258.
Payandeh M, Khodarahmi r, sadeghi M, et al. Appearance of acute myelogenous leukemia (aML) in a patient with breast cancer after adjuvant chemotherapy: case report and review of the literature. Iran J Cancer Prev 2015;8(2):125–8.
Thanka J,Krishnarathinam K, Rajendiran S. Extramedullary relapse of acute lymphoblastic leukemia in breast: A rare presentation. Indian J Pathol Microbiol. 2010; 53(1): 155-6. doi: 10.4103/0377-4929.59212.
Yang WT, Muttarak M, Ho LW. Nonmammary malignancies of the breast: ultrasound, CT, and MRI. Semin Ultrasound CT MR 2000;21: 375-94. doi: 10.1016/s0887- 2171(00)90031-3.
Poon LM, Hamdi A, Saliba R, et al. Outcomes of adults with acute lymphoblastic leukemia relapsing after allogeneic hematopoietic stem cell transplantation. Biol Blood Marrow Transplant. 2013;19(7):1059–64. doi:10.1016/j. bbmt.2013.04.014.
Todo K, Morimoto A, Osone S, et al. Isolated relapse of acute lymphoblastic leukemia in the breast of a young female. Pe- diatr Hematol Oncol. 2008; 25(6): 607-13.doi: 10.1080/08880010802258399.
Glazebrook KN, Zingula s, Jones KN, et al. Breast imaging findings in haematological malignancies. Insights Imaging 2014;5:715–22. doi: 10.1007/s13244-014-0344-2.
Mandal S, Jain S, Khurana N. Breast lump as an initial manifestation in acute lymphoblastic leukemia: an unusual presen- tation. A case report. Hematology. 2007; 12(1): 45-7. doi: 10.1080/10245330600938158.
Likaki-Karatza E, Mpadra FA, Karamouzis MV, et al. Acute lymphoblastic leukemia relapse in the breast diagnosed with gray-scale and color Doppler sonography. J Clin Ultrasound. 2002; 30(9): 552-6. doi: 10.1002/jcu.10118.
Yang WT, Metreweli C. Sonography of nonmammary malignancies of the breast. AJR Am J Roentgenol 1999;172:343- 8. doi: 10.2214/ajr.172.2.9930779.
Guía PETHEMA: Programa español para el tratamiento de las hemopatías malignas sociedad española de hematología y hemoterapia: tratamiento de la LAL de alto riesgo BCR/ ABL negativa en adultos (LAL-AR-2011). https://www.sehh. es/servicios-para-los-socios/557-servicios-para-los-socios/ pethema/protocolos/lal.
Stella M. Davies,1 Jacob M. Rowe,2 Frederick R. Appelbaum. Indications for Hematopoietic Cell Transplantation in Acute Leukemia. Biology of blood Marrow transplatation 14:152-164 (2008) doi:10.1016/j.bbmt.2007.10.024.
Fianchi L, Pagano L, Piciocchi A, et al. Characteristics and outcome of therapy-related myeloid neoplasms: Report from the Italian network on secondary leukemias. Am J Hematol. 90:E80-5, 2015. doi: 10.1002/ajh.23966.