Breast myeloid sarcoma presenting as a palpable breast lump after allogeneic stem cell transplantation for acute myelomonocytic leukemia: a rare case report

Abstract

Background Myeloid sarcoma (MS) is a tumor secondary to myeloid leukemia that consists of immature granulocytes with or without mature granulocytes and is a rare extramedullary manifestation of acute myeloid leukemia (AML). Case presentation We report a case of a 34-year-old woman diagnosed with AML-M4 who achieved remission after chemotherapy and received allogeneic stem cell transplantation (allo-SCT) for consolidation. Her past medical history showed that she received bilateral breast implants 7 years ago. This patient underwent ultrasound examination of the breast and multiple bilateral breast nodules were revealed that were not considered by clinicians to be concerning. Several months later, the patient’s bilateral nodules rapidly progressed to large palpable masses. Ultrasound-guided biopsy revealed diffuse infiltration of undifferentiated tumor cells and immunohistochemistry (IHC) indicated that the tumor was positive for myeloperoxidase (MPO), cluster of differentiation (CD) 34, CD43, CD68, CD117, and Ki67. The pathological diagnosis was extramedullary recurrence of AML as MS of breast. After the diagnosis, the patient received systemic chemotherapy and drugs containing cytarabine, azacitidine, and methotrexate. However, 1 year after achieving partial remission, the patient died from intracranial invasion of leukemia, brain herniation, and respiratory failure. Conclusion It is necessary for the specialist to have a high suspicion index by careful inquiry of the patient’s medical history if a patient presents at the breast clinic with a breast tumor as the chief complaint. Combining information from the patient’s medical history with a tumor biopsy is critical for obtaining the correct diagnosis of the disease.

Relapsed Acute Myeloid Leukemia Presenting as Multiple Breast Masses: A Case Report

“…Even so, an intensive chemotherapy regimen might not be ideal in relapsed patients because they have a higher probability of having a poor general condition or weak immunity due to the previous chemotherapy. There was a case report where a 34-year-old female patient with relapsed AML involving breast received chemotherapy, but died of respiratory failure within one year of treatment ( 8 ).…”

Breast manifestation of extramedullary myeloid sarcoma: A case report

“…US findings are variable and include homogeneous or heterogeneous hypoechoic lesions that are hypervascularized on color Doppler scans and cannot be easily distinguished from benign lesions [ [15] , [16] , [17] ]. Additionally, MRI can be a valuable diagnostic tool with breast MS presenting as hypointense lesions on T1-weighted images, hyperintense on T2-weighted images, and with inhomogeneous enhancement [18] . While nonspecific, these findings are suspicious and warrant a biopsy.…”

“…These patients typically have a good response to chemotherapy and high complete remission rate when treated with high dose cytarabine (HiDAC) plus anthracycline/anthracenedione-based induction therapy [ 19 , 20 ]. Most common induction regimen includes “7+3” therapy (7 days of cytarabine (Ara-C) followed by 3 days of idarubicin (4-demethoxydaunorubicin)) [18] . It is recommended to perform a bone marrow aspirate and biopsy 14-21 days after the start of the induction therapy to evaluate the efficacy of the treatment [20] .…”

Pediatric acute myeloid leukemia with breast chloromas

“…Myeloid sarcoma (MS; also known as granulocytic sarcoma or chloroma) is a solid extramedullary mass composed of primitive myeloid cells that disrupts the normal architecture of the tissue in which it is found. MS can present concurrently with acute myeloid leukemia (AML), precede the diagnosis of AML without evidence of leukemia in the blood or bone marrow or as a relapse in a patient with previously treated AML [ 1 , 2 , 3 ]. In children, the overall incidence of MS in association with AML varies, but has been reported to be as high as 24% [ 4 , 5 , 6 , 7 , 8 ].…”

“…Flow cytometry revealed that the blasts expressed CD34, CD13, CD33, CD117, and CD40. She was classified as CNS [2]. Chromosomal analysis demonstrated 46,XX,der(21)t(8;21)(q22;q22)ins (5;21) (q12q21;q22) [20], and fluorescence in situ hybridization (FISH) analysis demonstrated RUNX1-RUNX1T1/t(8;21) variant gene fusion in 98.5% of cells and gain of chromosome 15q24 in 7% of cells.…”