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Acute myeloblastic leukemia without maturation presenting an extramedullary tumor in the breast

Breast involvement in AML is rare. Myeloid sarcoma is a neoplasm of immature myeloid cells that can arise before, concurrent with, or following acute myeloid leukaemia. A 25-years-old woman presented with large node in the left breast. The lesions were detected by physical examination as mass in the left breast, without associated local symptoms such as breast retraction, nipple retraction or discharge. Ultrasonography picture showed hypoechoic area with well-defined margin. Fine needle aspiration cytology (FNAC) was performed. That was the first manifestation of systemic disease. Following diagnostic procedure patient was presented with moderate anemia, thrombocytopenia, leukocytosis and atypical blasts without granules in peripheral blood and bone marrow. Flow cytometry immunophenotypic analysis of bone marrow and FNAC of breast lesion, showed that the blasts were positive for CD13, CD33, CD34, myeloperoxidase and HLA-DR. Multiple cytogenetic abnormalities, high level of aneuploidy and mitoses were identified. Acute myeloblastic leukaemia (AML) without maturation (World Health Organization Classification - WHO) or AML-M1 (French-American-British classification [FAB]) was finally established. Patient was treated with chemotherapy for AML. Shortly remission was archived, then experienced two relapses in the bone marrow and breast, 6 and 12months later, and died within one year of diagnosis. In cases of isolated myeloid sarcoma, the diagnosis can be missed if the possibility of myeloid sarcoma is not remembered in the differential diagnosis of a breast neoplasm. Immunocytochemical studies are extremely helpful for recognizing isolated myeloid sarcoma.

Myeloid sarcoma; breast involvement; fine needle aspiration

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