A clinical review of breast involvement in acute leukemia

Abstract

The breast continues to be reported as a site of resistant leukemia despite current curative protocols. To characterize disease behavior and potential for lengthy survival after breast relapse, a study was undertaken of 153 cases reported between 1969 and 2005. Authors were contacted for follow-up. There were 105 AML and 48 ALL cases identified. Ninety percent of female patients were younger than 50 and leukemia was temporally related to pregnancy in 13. Eight cases were males. Remissions were typically of short duration, principally due to further extramedullary relapses, in 3 main sites in both AML and ALL: contralateral breast, gynecologic organs, and CNS. However, there are cases of disease-free survival up to 26+ years after intensive treatment. Leukemia growing in the breast may follow a distinctive pattern, and prompt initiation of intensive multi-cycle treatment, assuming occult site involvement, with consideration of CSF prophylaxis, should increase the potential for disease eradication.

Immunohistochemistry and molecular analyses in myeloid sarcoma of the breast in a patient with relapse ofNPM1-mutated andFLT3-mutated AML after allogeneic stem cell transplantation

“…Myeloid sarcoma of the breast is an uncommon condition with only few reported cases in the literature and is seen either isolated or as an extramedullary manifestation of AML or other myeloproliferative disorders 6. Without simultaneous morphological involvement of the bone marrow, the diagnosis may be especially difficult.…”

Bilateral Breast Enlargement and Reddish Skin Macules as First Signs of Acute Lymphoblastic T Cell Leukemia

“…More than 50% of breast-infiltrating T-ALLs are part of a relapse of the disease after initial treatment [6]. Skin involvement in ALL is less frequent, but the most common occurrence of extramedullary infiltration in women is the breast [12].…”

“…The frequency of intramammary T-ALL can only be estimated and is about 15% [6]. More than 50% of breast-infiltrating T-ALLs are part of a relapse of the disease after initial treatment [6].…”

“…Extramedullary manifestations with breast involvement in T-ALL are exceptional cases. In her review with all published cases between 1969 and 2005, Cunningham [6] reported on 153 cases of leukemia with breast involvement. Only 7 cases out of the 46 with ALL were of T cell origin.…”

Acute Lymphoblastic Leukemia Relapse in the Breast: Fine Needle Aspiration Diagnosis of a Rare Presentation

“…1 Leukemia infiltration of the breast, at diagnosis or at relapse, is also clinically rare. 2 We present a case of a breast infiltration by ALL that was first diagnosed by cytology and confirmed by immunohistochemistry in a young female patient.…”