Diagnostic challenges: Atypical breast onset of acute myeloid leukemia in a middle-age, apparently healthy woman

Abstract

We present the case of a 46-year-old woman with unremarkable medical history and a right palpable breast mass.

Standard mammograms revealed in the upper-outer quadrant of the right breast an opacity with imprecise delineation. The ultrasound showed a corresponding hypoechoic, irregular mass. An excision biopsy was performed. The initial pathology result indicated a possible lobular breast carcinoma or a lymphoma. Whole body computer tomography and regular blood workout were negative for a hematological malignancy.

Further immunohistochemistry tests shifted the diagnostic towards an acute myeloid leukemia (AML), not otherwise categorized.

The patient received specific chemotherapy and underwent an autologous stem cell transplantation with complete remission.

Acute myeloid leukemia may determine bilateral breast metastases, but it is extremely uncommon to generate a primary breast deposit.

A correct and early diagnostic is often problematic, “delays” or initial misdiagnosis being more frequent than rare in such cases. That is why, thorough investigations should follow whenever confronted with a mononuclear cell infiltrate within the breast.