Clinical characteristics and management of primary granulocytic sarcoma of the breast: A case report

Primary breast myeloid sarcoma: A case report and literature review

Myeloid sarcoma (MS) is a rare extramedullary tumor originating from immature bone marrow cells. MS of the breast is an extremely uncommon disease with non-specific clinical and radiological features. The present case report describes a distinctive case of MS of the breast, which posed diagnostic challenges due to the absence of typical imaging characteristics at the time of presentation. The patient was a 58-year-old woman who presented with a breast mass. Further examination and testing confirmed the diagnosis of MS in the right breast, with metastases to the right iliac, pubic and ischial regions. Immunohistochemical analysis identified metastatic tumors distinguished by the expression of a number of markers, including Ki-67, myeloperoxidase and cluster of differentiation 43. The patient underwent six cycles of chemotherapy with a regimen comprising etoposide, methylprednisolone, cytarabine and cisplatin, and 28 cycles (56 cGy each) of consolidation radiotherapy. Extensive examination and long-term follow-up revealed no further tumor recurrence or metastasis. Myeloid sarcomas of the breast typically manifest as palpable masses requiring diagnostic imaging. However, due to the rarity of MS of the breast without any signs of leukemia, its diagnosis and treatment are challenging. The present case report highlights the importance of maintaining high clinical, radiological and pathological standards when diagnosing this disease. Additionally, a comprehensive review of the literature on breast MS is provided. This highlights the necessity for clinicians to consider this rare diagnosis in patients presenting with a breast mass, to facilitate the appropriate treatment and prevent unnecessary procedures such as mastectomies.

Myeloid Sarcoma of the Breast: A Diagnostic Dilemma With Pathologic Correlation

Myeloid sarcoma (MS) is a rare extramedullary solid tumor arising most often in patients with current or subsequent acute myeloid leukemia (AML). Patients of all ages may present with involvement of the skin, lymph nodes, intestinal tract, bone, and/or central nervous system. Isolated involvement of the breast is rare, and only a small number of cases have been described in the literature. Breast MS may present as a palpable mass on clinical evaluation. In this broad literature review from 2010 to 2022, the most common findings on mammography are either solitary or multiple masses, followed by architectural distortion and, less commonly, no discrete findings. Sonography may demonstrate hypoechoic or mixed echogenicity mass(es) with circumscribed or indistinct, not discrete margins. Myeloid sarcoma may present as an enhancing mass or nonmass enhancement on breast MRI and is typically moderately radiotracer avid on 18F-fluorodeoxyglucose-PET. At histopathology, MS is characterized by myeloid blasts in varying stages of granulocytic or neutrophilic maturation; diagnosis typically requires immunophenotyping. There is no consensus for treatment of MS, although systemic chemotherapy for AML is often used as MS is considered the tissue equivalent of AML. This article will discuss and illustrate imaging and pathology findings when the breast is involved by MS.

Myeloid Sarcoma of the Breast as Blast Phase of JAK2-Mutated (Val617Phe Exon 14p) Essential Thrombocythemia: A Case Report and a Systematic Literature Review

INTRODUCTION

Myeloid sarcoma (MS) is a mass-forming proliferation of myeloid blasts. Frequently, it arises as blast phase of pre-existing myeloproliferative, myelodysplastic disorders or consequent to bone marrow transplant. Its molecular characterization has become an increasingly important requirement for the diagnostic definition of this solid leukemia.

CASE PRESENTATION

Our case report concerns an MS arising in the breast of a woman with a previous diagnosis of JAK2-mutated essential thrombocythemia (Val617Phe exon 14p) mimicking, on histology, a lobular carcinoma of the breast. The immunohistochemical study of the neoplasm provided the key that solved the diagnostic doubt and the immunohistochemical evaluation of NPM protein expression, which turn out to be negative, provided a clear indication on the molecular status and prognosis of the disease. A year later, the neoplasm relapsed in the pelvic area.

DISCUSSION

This diagnostic challenge led us to review the literature of the past 10 years concerning MS of the breast. To the best of our knowledge, this was the first case of MS of the breast occurring in a patient with a history of essential thrombocythemia and recurred in the pelvic region.

Liver Granulocytic Sarcoma With Megakaryocytic Differentiation: A Rare Extra Medullary Involvement That Warrants Liver Biopsy for Prompt Diagnosis

Granulocytic sarcoma (GS) is an extramedullary manifestation of acute myeloid leukemia (AML), myelodysplastic syndrome (MDS) or myeloproliferative neoplasms. The diagnosis depends on morphology, immunohistochemistry and flow cytometry. An unusual location of this tumor may mask its primary source, therefore, a strategy involving immediate symptom control, and investigation is crucial in preventing clinical deterioration. We present a case of a 53-year-old man who initially presented with tumor lysis syndrome and transaminitis, with a subsequent CT Scan that revealed multiple liver lesions. This case describes a rare clinical entity of granulocytic sarcoma as multiple hypoattenuating liver lesions mimicking metastatic disease in its radiographic appearance. Since the imaging features of hepatic masses are nonspecific, and considering the aggressive nature of AML with concomitant tumor lysis syndrome, a confirmatory prompt biopsy should routinely be considered.

Breast Recurrence of Acute Myeloid Leukemia After Bone Marrow Transplantation: A Case Report About Myeloid Sarcoma of the Breast

Myeloid sarcoma of the breast is a rare malignancy, can be seen after bone marrow transplantation. Although there are no specific features for this malignancy which is difficult to diagnose, some common features draw attention in the published case reports. Since there is no consensus on the treatment of myeloid sarcoma of the breast, we aimed to explain our own diagnosis and treatment methods in this case report.