DOI: 10.5958/j.2319-5886.2.2.

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International Journal of Medical Research & Health Sciences

www.ijmrhs.com
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Volume 2 Issue 2 April-June

Coden: IJMRHS
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Copyright @2013

ISSN: 2319-5886
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Received: 20 Feb 2013 Case report

Revised: 22 Mar 2013

Accepted:28 Mar 2013

BILATERAL BREAST INVOLVEMENT IN ACUTE MYELOID LEUKEMIA. *Hakeem A1, Mandakini BT1, Asif K2, Firdaus2, Shagufta1 Department of Pathology, 2Department of Medicine, Khaja BandanaWaz Institute of Medical Sciences, Gulbarga, Karnataka, India
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*Corresponding author email: attar.hakeem@gmail.com

ABSTRACT

Breast involvement by leukemic infiltration is usually bilateral, but may be unilateral. Clinically patients can present with either single or multiple masses, or with diffuse breast engorgement, with or without nodularity. The affected patients are predominantly young adults. We present a case of an adolescent girl with acute myeloid leukemia having bilateral breast infiltration by leukemic cells. Keywords: Breast, Acute myeloid leukemia, Bilateral
INTRODUCTION

Involvement of breasts with haemato,logic malignancy is uncommon1,2,3. It is most often due to lymphoma, less frequently leukemia and rarely multiple myeloma. Lymphomatous and leukemic breast involvement constitutes approximately 0.25% of all breast tumors. All forms of leukemia have been reported to occur in breasts3. Breast infiltration by leukemic cells may occur either on presentation or during relapse of leukemic disease or may also develop in women who undergo radiation therapy for breast carcinoma3. We reported a case of a 13 year old girl, AML M2, with bilateral leukemic breast infiltration.
CASE

Patient was an adolescent girl, aged 13 years, who had attained menarche 1 year ago. Her main

complaints were generalized weakness and bilateral painful breast engorgement of 4 months duration. She also complained of severe backache, since 1 year for which she consulted an orthopaedicean, who referred her to a physician and routine investigations were carried out. As the patient was unaffordable she was not given timely treatment and patient expired within 2 weeks. Lab Findings: Report findings were Hb-3gm, Platelets-6000/cumm, Peripheral smear showed Acute Myeloid Leukemia M2. FNAC of both breasts were done and the smears revealed myeloid blasts along with epithelial cells of the breasts. She was diagnosed as a case of AML M2 with bilateral leukemic breast infiltration and was referred to cancer centre

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. Fig.1: Photograph showing bilateral tense breast engorgement

Fig. 2: Blood smear showing myeloid blasts (FEILDS STAIN,100X)

Fig.3: FNAC smear showing myeloid blasts along with epithelial cells of breast(MGG,100X)

DISCUSSION Breast involvement by leukemic infiltration is usually bilateral, but may be unilateral. Clinically patients can present with either single or multiple masses or with diffuse breast engorgement, with or without nodularity3. Myeloid sarcoma is described as a tumor mass consistency of myeloblasts or immature myeloid cells involving extramedullary tissues. It can be initial manifestation of myeloproliferative disorders, MDS, or relapse of previously treated AML6, 8, 9. Manteleone et al. reported a case of an 11.5 year old girl, with M1 AML who had isolated extramedullary relapse developed in both breasts, 12 months after diagnosis and 7 months off chemotherapy4. Sato E et al reported a case of CD56 positive AML M1, with t(16;21) (p11;q22)presenting an extramedullary tumor in the right breast at relapse. Because of the high occurrence rate of relapse, they consider various additional chromosomal abnormalities of CD56 as prognostic factors of this condition5. Satomi Asai, assessed the ultrasonographic appearance and clinical implication of bilateral breast involvement in three cases of acute leukemia L1, L3 & M1 of the FAB subtype. Their studies suggested bilateral breast involvement occurred as a part of the diffuse and generalized leukemic process7. Granulocytic sarcoma also known as one variant of myeloid sarcoma in the WHO classification, in an extramedullary solid tumor comprised of
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myeloid precursor cells. The most common form is granulocytic sarcoma composed mainly of myeloblastsn neutrophils and myeloid precursors. The less common form is monoblastc sarcoma. This tumor occurs commonly in patient with AML and less common in patients with MDS or CML. The incidence of granulocytic sarcoma varies from 3-9% I AML patients and most frequently occur in AML with maturation (M2). However other subtypes including FAB, M4 or M5 or M7 have also been described. The most common sites of involvement include bones, soft tissues, lymphnodes and skin. However breast involvement is rare. It most often represents relapse, or the initial presentation of AML; in that case, granulosytic sarcoma is misdiagnosed most frequently as a ltymphoma or sarcoma9 CONCLUSION Breast involvement in acute myeloid leukemia is rare in young children and adolescent females. However regular breast examination should be performed as a part of routine follow up in all girls with AML. In any patient with a known malignancy, any enlarging breast mass, even one with a reassuring benign sonographic appearance, must be investigated promptly, initially with FNAC or core-needle biopsy.
ACKNOWLEDGEMENT

2. Orell RS, Sterret FG, Darrel Whitaker. Manual and Atlas of Fine needle aspiration cytology. Breast. Churchill Livingstone; 1993.162-65 3. Khoury NJ et al. Letters to editor. Bilateral Breast involvement in Acute Myeloid Leukemia. Eur Radiol. 2000;10:1031 4. Manteleone et al. Letters to editor. Bilateral Breast relapses in Acute Myeloid Leukemia. J Pediatr Hematol Oncol 2001;23(2) :126-29. 5. Sato et al. CD 56 positive Acute Myeloid Leukemia presenting an extrtamedullary tumor in the right breast at relapse. 2002;43(7):560-66. 6. Slavcheva V, Lukanov T, Tzvetkov N. Two cases of extramedullry myeloid tumor in patients with continuous remission of Acute Myeloid Leukemia. 2008; 13(4):589-92 7. Satomi Asai at al. Letters to editor. Ultrasonographic appearance and clinical implication of bilateral breast infiltration with leukemic cells. 8. Jelic puskaric B et al. Myeloid sarcomka involving the breast. Coll Antropol.2010; 34(2)641-44 9. Ben yousuf Y et al. Acute myeloid leukemia with synchronous granulocytic sarcoma of the breast and spine. Clinical and experimental medical sciences, 2013;1(2):4958.

The work was indeed a mammoth task to accomplish and would not have been possible without active co-operation, constant strategic support and encouragement by our beloved PRESIDENT- (Khaja Bandanawaz Institute of Medical Sciences) -DR.SYED SHAH KHUSRO HUSSAINI.
REFERENCES

1. Wintrobes Clinical Haematology. Unusual presentation of Acute Leukemias.1998.10th edn.2272-19

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