Acute lymphoblastic leukemia presenting as a breast lump: A report of two cases
A 14-year old female presented with a 1-week history of a painless swelling in the right breast. She was diagnosed with ALL-L2 a year-and-a-half back; flow cytometry had shown CALLA positive B-Cell ALL with breakpoint cluster region–abelson gene (BCR–ABL) fusion in 98% cells. The patient received chemotherapy (UK ALL XII protocol with CNS prophylaxis), and stem cell transplant was declined for financial reasons. The patient responded and had been in remission for the last 1 year.\nOn general physical examination, the patient looked healthy. There was no pallor, lymphadenopathy or organomegaly. Clinical examination of her breast swelling revealed a 1.5 cm firm, painless, mobile swelling, in the right breast. There was no axillary lymphadenopathy. A complete blood count revealed a total leukocyte count of 9.4 × 103/mm3, a hemoglobin level of 14.2 mg/dL, and a platelet count of 184 × 103/μL. A clinical diagnosis of fibroadenoma was made. An aspirate obtained from the lump using a 22-gauge syringe was stained with May-Grünwald-Giemsa (MGG). Microscopic examination revealed highly cellular smears, showing diffuse infiltration by round cells with inconspicuous nucleoli and scanty cytoplasm (lymphoblasts) []. Abundant mitotic figures were seen. The findings were consistent with those of infiltration by ALL.