Acute Lymphoblastic Leukemia Presented as Multiple Breast Masses

Abstract

Breast metastases in cases leukemia are very rare and occur primarily in patients with acute myeloid leukemia. We report the involvement of breast metastases in a 30-year-old woman with acute T cell lymphoblastic leukemia. The patient's mammograms revealed an extremely dense pattern with ill-defined, denser mass-like lesions in both breasts. A bilateral breast ultrasonographic evaluation revealed lobular-shaped and partly ill-defined hypoechoic masses with a multi-septated nodular (mottled) appearance.

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

“…There is no correlation between histopathological subtype and mammographic appearance [28]. An ultrasound of the breast reveals a broad range of patterns, but frequently shows oval, hypoechoic lesions [18,27]. Particularly the subtype of LBL and T-ALL can show a complex echoic parenchyma without clear margins, like in our case [18,31].…”

“…However, T-ALL relapse in the breast of a young man has also been reported [13]. Case reports with a primary bilateral breast involvement in ALL are rare [14][15][16][17][18], and only 1 report of T-ALL showed a clinical presentation with diffuse, ill-defined involvement of both breasts [18].…”

“…Well-defined margins mimicking a benign lesion occur in more than 10% of all cases [28,29]. A diffuse increase of the parenchymal density is also possible, sometimes accompanied by skin thickening, and is more typical of a highly malignant lymphoma or leukemia [18,29,30]. Calcifications of the lymphoma have not yet been described.…”

Leukemia Recurrence Exclusively in the Breast after Stem Cell Transplant

“…Sonographically, primary breast leukemia may present as single or multiple heterogeneous hypoechoic masses and majority have indistinct or microlobulated margins (Glazebrook et al, 2014). In a particular case series, two patients with acute leukemia demonstrated masses with irregular shape, non-circumscribed margins, and heterogeneous echogenicity with a significant echogenic component (Bayrak et al, 2009). No axillary adenopathy was seen in either patient with acute leukemia in the case series.…”

“…It may occur in isolation, in the setting of widespread disease, or in the setting of leukemic relapse as the only site. Both myeloid leukemia and lymphocytic leukemia involving the breast have been described previously (Surov et al, 2012;Bayrak et al, 2009). Acute myeloid leukemia (AML) is the most common type of leukemia presenting in breasts whereas chronic myeloid leukemia (CML) and chronic lymphocytic leukemia (CLL) in the breast are exceedingly rare.…”