MR findings of granulocytic sarcoma of the breasts

Granulocytic Sarcoma Presenting as a Palpable Breast Lump

We report the case of a 45-year-old woman who palpated a voluminous painless lump in the superior outer quadrant of her left breast. Her past medical history revealed an acute myeloid leukemia (AML) treated and considered in remission 1 month prior to this discovery. Imaging work-up by mammogram, US, and MRI showed multiples masses suspect of malignancy in both breasts. US-guided needle biopsy was performed in the palpable mass and in one of the multiple lesions located in the right breast. Histologic findings were compatible with a granulocytic sarcoma in both breasts, which was considered as a relapse of the AML treated a few months earlier.

Granulocytic sarcoma of the breast: A case report

Granulocytic sarcoma (GS) is an unusual type of tumor composed of immature cells outside the bone marrow. The disease exhibits a correlation with acute myeloid leukemia and other myeloproliferative disorders. Although it can invade a number of areas of the body, the involvement of the breast is uncommon. The present study reports the case of a 58-year-old female with a mildly tender lump in the left breast that had been apparent for one year. Available diagnostic techniques, including ultrasound, magnetic resonance imaging and mammography, were systematically used to determine a diagnosis of GS, and lumpectomy and systemic chemotherapy were performed. The patient was satisfied with the result of no local recurrence at the one year follow-up examination. The present study discusses the clinical and pathological characteristics of the present case of GC.

Radiotherapy for granulocytic sarcoma of the breast-Case report and review of the literature

Granulocytic sarcomas are rare tumors that can present in innumerous locations; thus there is very little clinical experience with these cases. Therefore there is no consensus on which is the best treatment for patients with this malignancy. The authors present a case of a female with a granulocytic sarcoma of the breast and review the literature for the role of radiotherapy in the management of this clinical entity.

Magnetic resonance imaging features of breast leukemia

Breast leukemia is extremely rare. Only 7 other reports describe its magnetic resonance (MR) imaging findings. This report describes a case of breast leukemia presenting as isolated intramammary leukemic relapse in the breasts after complete remission of acute myeloid leukemia. Dynamic contrast-enhanced MR imaging showed diffuse heterogeneous non-mass-like enhancement in one breast and a diffuse irregular heterogeneously enhancing mass in the other. Previous reports of MR imaging findings in breast leukemia have included only mass-like lesions; hence, the finding reported here is uncommon.

Breast leukemia: an update

BACKGROUND

Breast leukemia is extremely rare. The published data on this manifestation include predominantly case reports and do not provide any statistical information.

PURPOSE

To identify clinical signs and radiological features of breast leukemia.

MATERIAL AND METHODS

PubMed and Medline databases between 1980 and 2010 were screened using 'breast leukemia' and 'leukemia of the breast' as keywords. Secondary references were also reviewed. By this search, a total of 139 patients were identified from the literature.

RESULTS

In most patients (n = 85, 61.2%) acute myeloid leukemia was diagnosed. Acute lymphatic leukemia occurred in 35 patients (25.2%). Isolated BL before bone marrow infiltration was seen in 24 patients (17.3%). Involvement of the breast during the course of leukemia was diagnosed in 25 cases (18%). Intramammary leukemic relapse after therapy/stem cell transplantation occurred in 59 patients (42.4%). In 71 cases (51.1%) the lesions were solitary and in 57 (41%) multiple. The number of lesions was not reported in 11 patients (7.9%). There was no significant difference between the number of lesions in ML and LL. Clinically, 73% of the patients presented with palpable breast masses. Most of them were painless. Mammography was performed in 39 patients, allowing the identification of the following three mammographic patterns: breast masses (28 patients, 72%), architectural distortion (5 patients, 13%), no abnormalities (6 patients, 15%). On ultrasound, most identified masses were homogeneously hypoechoic with microlobulated or indistinct margins. On MRI, on T2-weighted images breast lesions were hyperintense. After venous administration of contrast medium, BL showed marked inhomogeneous contrast enhancement. Treatment of BL is the same as for other localizations and is based on chemotherapy and/or radiotherapy.

CONCLUSION

In the present study the clinical and radiological features of BL are described. They are non-specific. However, BL should be considered in the differential diagnosis of breast disorders, especially in patients with leukemia.