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LETTER TO THE EDITOR
Year : 2014  |  Volume : 10  |  Issue : 1  |  Page : 208-209

Breast mass as a clinical feature of B-cell chronic lymphocytic leukemia


Department of Hematology and Oncology, St Michael's Medical Center, 111 Central Avenue, Newark, New Jersey 07102, New York, USA

Date of Web Publication23-Apr-2014

Correspondence Address:
Hamid Shaaban
111 Central Avenue, Newark, New Jersey 07102, New York
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-1482.131424

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How to cite this article:
Shaaban H, Modi Y, Guron G. Breast mass as a clinical feature of B-cell chronic lymphocytic leukemia. J Can Res Ther 2014;10:208-9

How to cite this URL:
Shaaban H, Modi Y, Guron G. Breast mass as a clinical feature of B-cell chronic lymphocytic leukemia. J Can Res Ther [serial online] 2014 [cited 2019 Sep 19];10:208-9. Available from: http://www.cancerjournal.net/text.asp?2014/10/1/208/131424

Sir,

We report a rare and interesting case of B-cell chronic lymphocytic leukemia (CLL) with secondary involvement of the breast in which the diagnosis was obtained by histopathology and immunohistochemistry. CLL must be considered in the differential diagnosis of a newly identified breast mass so that the underlying hematological malignancy can be managed and treated effectively. The most frequent tumors to metastasize in breast tissue are lymphoproliferative diseases, melanoma, lung cancer, and gynecological malignancies (uterus and ovary). [1]

A 65-year-old woman presented to our clinic with a palpable lump in her right breast. She had a past medical history of B-cell chronic lymphocytic leukemia Rai Stage 0. On physical examination, a 1.5 cm retroareolar mobile mass was palpable in the right breast. She had no palpable lymphadenopathy or hepatosplenomegaly. Laboratory tests were ordered: White blood cells 22.7 Χ 109/L (81% lymphocytes); platelets 450 Χ 109/L; hemoglobin 13 g/dL. Mammogram studies revealed a nodular mass with a diameter of 10 mm, regular margins and without microcalcifications. Ultrasonogram confirmed the presence of a hypoanechoic mass with the diameter of 8 mm. An ultrasound-guided fine-needle aspiration was performed and specimens were sent for histopathologic studies. The cytological examination revealed hypocellularity with atypical ductal cells. The lymphocytes that were isolated or grouped in microaggregates and characterized by hyperchromatic nuclei and the absence of nucleoli [Figure 1]. Immunohistochemical analysis was performed on the specimen and cytogenetic markers were positive for CD5, CD19, and CD23. Considering the medical history in addition to the histological, radiologic, and clinical findings, the diagnosis of secondary breast involvement with chronic lymphocytic leukemia was made. The patient was offered radiation therapy however she refused. Six months later, repeat mammograms were negative for any suspicious masses.
Figure 1: Histopathological examination revealing nodular lymphocytic clusters invading the breast stromal tissue (H and E, ×400)

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CLL is typically characterized by an accumulation of monoclonal B lymphocytes in the hematopoietic organs and rarely do these atypical cells accumulate in a single atypical site. Extramammary malignant neoplasms rarely spread to the breasts and when they do occur, they rarely involve the ducts, nipple retraction, skin dimpling, and nipple discharge. [2] Radiologic findings are not specific and it is very difficult to differentiate between primary and secondary breast malignancies. [3] A definitive diagnosis can only be obtained by fine-needle aspiration cytology or histopathology. In the case of ruling out breast metastases secondary to hematological malignancy, it is essential to perform immunohistochemical studies including testing for cytogenetic markers. [4] As evidenced by our case, PCR (polymerase chain reaction) demonstrated cellular monoclonality and the classic CD5-CD23 immunophenotype was clearly suggestive of a diagnosis of B-cell lymphocytic leukemia involving the breast. This disease entity must be considered in the differential diagnosis of a breast mass to avoid unnecessary mastectomy and ensure the proper management and treatment of the underlying hematological malignancy. There are some cases demonstrating clinical and radiologic regression with local radiation to the affected breast. [5]



 
 > References Top

1.Famà F, Barresi V, Giuffrè G, Todaro P, Mazzei S, Vindigni A, et al. An unusual presentation of secondary involvement of B-cell chronic lymphocytic leukemia. A case report. Tumori 2008:94:617-20.   Back to cited text no. 1
    
2.Bartella L, Kaye J, Perry NM, Malhotra A, Evans D, Ryan D, et al. Metastases to the breast revisited: Radiological-histopathological correlation. Clin Radiol 2003;58:524-31.  Back to cited text no. 2
    
3.Sabate JM, Gomez A, Torrubia S, Camins A, Roson N, De Las Heras P, et al. Lymphoma of the breast: Clinical and radiologic features with pathologic correlation in 28 patients. Breast J 2002;8:294-304.   Back to cited text no. 3
    
4.Domchek SM, Hecht JL, Fleming MD, Pinkus GS, Canellos GP. Lymphomas of the breast: Primary and secondary involvement. Cancer 2002;94:6-13.   Back to cited text no. 4
    
5.Sabate JM, Gomez A, Torrubia S, Camins A, Roson N, De Las Heras P, et al. Lymphoma of the breast: Clinical and radiologic features with pathologic correlation in 28 patients. Breast J 2002;8:294-304.  Back to cited text no. 5
    


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