Isolated Relapse of Acute Lymphoblastic Leukemia in the Breast of a Young Female

Abstract

A 20-year-old female developed a relapse of B-precursor acute lymphoblastic leukemia (ALL) as a mass in her left breast after 6 years of maintained continuous complete remission. No leukemic lesions were identified in other sites such as the bone marrow or cerebrospinal fluid. The relapsed leukemic cells in the breast revealed the same immunophenotypes (CD10(+), CD19(+), CD20(+), HLA-DR(+), CD34(+)) as those of the onset ALL cells in the bone marrow. A literature survey found 10 other cases of ALL relapse in the breast without bone marrow involvement, mostly consisting of adolescent girls. Including the present report, a total of 11 cases were analyzed; the onset ages of ALL were a median of 16.5 (range 5-50) years old and the ages of relapse in the breast a median of 20 (range 12-51) years old. Data suggest that, although rare, the breast could become one of the extramedullary relapse sites of ALL developed in adolescent girls.

A basis for updating our approach to resistant acute leukemia

“…In both AML and ALL cases, the median time was 12 months after diagnosis, but some relapses occurred late. Nine AML breast relapses occurred between 3 and 10 years [6–14] and four cases in ALL occurred 3–7 years after diagnosis [15, 16, Milpied N. Unpublished case. 2010, Dutra AP.…”

“…Three had short responses ending in extramedullary relapses [53–55] and one patient continued disease‐free at 10 years, after busulfan/cyclophosphamide and autologous transplant followed by breast irradiation [15]. All five treated with chemotherapy alone had clinical responses; three relapsed in extramedullary sites within 8 months [51, 54, 56], one relapsed in breast and marrow at 24 months [57], and one was disease‐free at 16+ months [16]. Similar, almost universal, response to therapy was seen among the 19 post‐transplant cases (17 allogeneic, two autologous), which were short‐lived in most cases.…”

“…2002, Mensah‐Glanowska P. Unpublished case. 2005] and four were disease‐free at 8 and 16 months and 10 and 12 years after breast relapse [15, 16, 70, Milpied N. Unpublished case. 2010].…”

Magnetic Resonance Imaging Features of Breast Leukemia

“…MR imagingˆndings of leukemia of the breast have been described in 7 cases (Table). [3][4][5][6][7][8][9] Thesê ndings have included hyperintense masses on T 2weighted images that showed marked inhomogeneous enhancement after administration of contrast. In Case 7, the text described MR imagingˆndings as a mass without further details or actual images.…”

Isolated Breast Relapse Mimicking Breast Cancer in Elderly Patient with Acute Lymphoblastic Leukemia

“…The most common sites of relapse in ALL are the marrow,the central nervous system, and occasionally the ovaries.Breast involvement is not so rare in ALL but is usually seenin teenagers and is generally associated with the disease atother extramedullary sites as well as the bone marrow [2]. The published literature revealed a total of 14 cases of isolatedbreast relapse in ALL.…”