Sonographic Features of a Myeloid Sarcoma of the Breast as a Relapse of Acute Myeloid Leukemia After Stem-Cell Transplantation: A Case Report

Abstract

Patient: Female, 24 Final Diagnosis: Myeloid sarcoma of the breast Symptoms: Breast lump Medication: — Clinical Procedure: Core needle biopsy Specialty: Radiology Objective: Rare disease Background: Myeloid sarcoma is a rarely observed extramedullary presentation of myeloid leukemia that seldom manifests in the breast. Myeloid sarcoma can occur before, concurrently with, or following acute myeloid leukemia presentation. Few reports have focused on the imaging findings in cases of myeloid sarcoma of the breast, and the existing findings are variable and nonspecific; the present case report aimed to bridge this gap. Case Report: A 24-year-old female presented with a palpable lump at the upper outer quadrant of her right breast. She had noticed the mass 2 days prior to presentation. She was first diagnosed with acute myelogenous leukemia 18 months before the lump presentation and had undergone haploidentical stem cell transplantation 6 months prior. At the time of the breast lump presentation, she was undergoing chemotherapy for relapsed acute myeloid leukemia. Ultrasonography of her right breast revealed a circumscribed, oval mass corresponding to the palpable lump. Ultrasonography-guided 14-gauge core needle biopsy was performed on the breast mass, leading to a pathological diagnosis of myeloid sarcoma. Conclusions: We reported a case of myeloid sarcoma involving the breast. On sonography, although the internal echotexture resembled that of breast hamartoma, the observed hard elasticity and high vascularity raised suspicions of malignancy.

Breast manifestation of extramedullary myeloid sarcoma: A case report

“…Mammogram findings previously described include large, noncalcified irregular masses with poorly defined margins [11] , [12] , [13] , [14] . 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] .…”

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

“…Recently, Bubulac et al [ 19 ] reported a 30-year-old female diagnosed with AML-M4 who achieved complete remission after chemotherapy and subsequently underwent allo-SCT for consolidation. After 5 months, the patient presented with right breast tumors resulting from AML relapse with breast MS. Another recent study [ 13 ] reported MS of the breast as a relapse of AML after stem-cell transplantation. In 2018, Cheng et al [ 20 ] presented the case of a 46-year-old woman with a known history of AML who had bilateral breast masses with pain and itchiness.…”

“…Despite the importance of breast imaging for the initial assessment of the disease, this technique lacks specificity, and MS can mimic several other tumors, including breast carcinoma and lymphoma. Moreover, only a few reports on breast MS have been published to date [ 13 – 16 ]. Currently, only histological examination with IHC can be used to confirm the diagnosis of breast MS [ 7 , 17 ].…”

Myeloid sarcoma in the breast in a patient withacute myeloid leukemia: a case report

“…Most breast masses are hyperdense, have a rounded shape and microlobulated margins, and occasionally accompany internal microcalcifications. On ultrasound, they usually present as solitary or multiple masses that tend to be homogeneously hypoechoic with microlobulated or indistinct margins 2 . The immunohistochemical study is extremely useful in recognizing MS, the most specific markers of myeloid differentiation being myeloperoxidase and lysozyme, both positive in this case.…”

“…Other synonyms are granulocytic sarcoma and extramedullary myeloid tumor 1 . Although it can affect any region of the body, its presentation in the breast is extremely uncommon, having been, until 2005, only 67 cases recorded in the literature 2 , with additional episodes reported sporadically until recently 3 . Skin, lymph nodes, gastrointestinal tract, bone, soft tissues and testicles are the most frequent sites of involvement 4 .…”