Acute lymphoblastic leukemia presenting as a breast lump: A report of two cases

Abstract

Extra-medullary leukemic infiltration of the breast by acute lymphoblastic leukemia (ALL) is very rare. We report two cases of ALL presenting as breast masses and diagnosed on fine-needle aspiration (FNA). Our first patient, a post-partum 30-year-old female, developed bilateral breast lumps in her last trimester of pregnancy and complained of easy fatigability. Our second patient, a 14-year-old girl, presented with a right-breast lump of 1-week duration. She had received treatment for ALL 1 year back and had been in complete remission for the last 1 year. FNA of the breast nodules done in both the cases revealed diffuse infiltration by lymphoblasts. Subsequent hematological investigations confirmed bone marrow involvement by ALL in the first case and extra-medullary relapse in the second case. Fine-needle aspiration cytology (FNAC) is an easy and cost effective method for the early diagnosis of metastatic leukemic infiltration, avoiding unnecessary excisional biopsies in such cases.

An unusual presentation of chronic lymphocytic leukemia/small lymphocytic lymphoma on mammography: Case report

“…For instance, acute myelogenous leukemia could present as granulocytic myeloid sarcoma, 11 while acute lymphocytic leukemia of the breast could present as a diffuse bilateral process with lymphadenopathy. 12 Our patient's peripheral blood exhibited lymphocytosis with characteristic smudge cells (basket cells) which is a typical feature of CLL/SLL.…”

Relapse of Biphenotypic Acute Leukemia as a Breast Mass

“…A CNB under ultrasono-graphy guidance is an acceptable and safe method to establish the diagnosis and avoid unnecessary surgical biopsy. The cytologic features of breast infiltration of ALL include dispersed monomorphic blastic cells with variable size, high ratio of nuclear to cytoplasmic, round or convoluted nuclei with dispersed chromatin, and scanty cytoplasm [10]. Our case showed monomorphic blast cells with round nuclei and fine chromatin.…”

An Unusual Presentation of CLL/SLL on Mammography: Case Report

“…Hematologic malignancies of the breast tend to present differently based on their classification. For instance, acute myelogenous leukemia could present as granulocytic myeloid sarcoma (11), while acute lymphocytic leukemia of the breast could present as a diffuse bilateral process with lymphadenopathy (12). Our patient's peripheral blood exhibited lymphocytosis with characteristic smudge cells (basket cells) which is a typical feature of CLL/SLL.…”