Granulocytic Sarcoma in Breast after Bone Marrow Transplantation
A 48-year-old woman was admitted to our breast clinic for palpable mass on each breast that had been increasing in size for the previous 2 weeks. Fixed and firm masses were palpable on both breasts by physical examination at the time of her visit. Mammography showed multiple masses on both breasts and bilateral enlargement of axillary lymph nodes (). Sonographic images showed multiple heterogeneous hypoechoic masses with echogenic boundaries at both breast (). Breast magnetic resonance imaging (MRI) showed contrast enhancement of multiple masses on both breasts with central necrotic lesions, suggestive of malignant tumors (). Gun biopsy was performed on her breast mass. The periductal parenchymal hyperchromatic cells were infiltrated diffusely (). Immunohistochemical staining was performed in order to rule out other malignant tumors and the results were positive for CD34, CD43, and MPO and negative for CD3 and CD20. These findings were matched with granulocytic sarcoma ().\nThe patient had a past history of visiting a local obstetrics-gynecology for hypermenorrhea. White blood cell count was 169,800/µL, hemoglobin was 7.7 g/dL, and platelet count was 12,000/µL. Ninety-two percent of blast cells were observed by peripheral blood smear. She was referred to the Department of Hematology-Oncology. Abnormal blast cells in bone marrow were infiltrated diffusely and cellularity was increased to more than 90% by bone marrow examination. The results of bone marrow aspiration biopsy were positive for CD7, CD13, CD33, CD34, and HLA-DR. She was diagnosed with acute myeloid leukemia (M1) and received remission induction therapy (cytarabine 200 mg/m2/day for 7 days, idarubicin 12 mg/m2/day for 3 days), consolidation therapy (danorubicin 45 mg/m2/day for 3 days, cytarabine 2 g/m2/day for 4 days), and allogenic hematopoietic stem cell transplantation. During following observation, she visited our breast clinic for palpable masses that were increasing in size. There was incomplete remission after starting second-line remission induction therapy (MEC543: mitoxantrone 10 mg/m2/day for 3 days, etoposide 100 mg/m2/day for 4 days, and cytarabine 2,000 mg/m2/day for 5 days) and almost complete clinical remission after receiving radiation therapy at the remaining breast tumor for 2 months. However, the tumor metastasized to ear, skin, and ovaries and she eventually expired 2 years after diagnosis of granulocytic sarcoma.