Breast Nodules: First Manifestation of LLA.

INTRODUCTION: Malignant hematological process that affects breast are infrequent in lymphoma and leukemia, only 0.25%, being most common in non Hodgkin lymphoma (NHL), acute myeloid leukemia (AML), and very rare in acute lymphoblastic leukemia (ALL), with very few cases reported. The infiltration of breast due to leukemia cells may occur initially, during relapse, after bone marrow transplantation (ABMT) or after radiotherapy in cancer. Affect young people presenting single or multiple mass, with diffuse increment of breast, unilateral or bilateral. The following report belongs to one case of ALL with initial presentation of nodules in breast.

DESCRIPTION: 35 years old female patient who presented increased volume in breasts, intermittent fever and generalized weakness. The echogram showed solid nodules in both breasts. The needle biopsy reported diffuse infiltration of lymphoid cells, being confirmed by biopsy and inmunohistochemical study, which results were: bcl-2, cd99, cd10, cd34, cd43 and cd45ro positives in neoplastic lymphocytes. The diagnosis of ALL/lymphoblastic lymphoma was made. The Oncologist referred the case to the Hematology Service and blood peripheral studies were made: Hemoglobin: 9.4grs/dl, hematocrit 29%, WBC; 86000 dl., 80% of blasts. Bone marrow was infiltrated by immature lymphoid cells. It was confirmed by morphology and flow cytometry studies. The diagnosis was ALL L1 CALLA positive. Cytogenetic studies revealed t(2:7)(q11:q11), t(9:22)(q34:q11) [20] Philadelphia chromosome positive. The patient was treated with chemotherapy without remission, allogenic bone marrow transplant with recidive in breasts, including the scalp and bone marrow by lymphoid blasts and confirmed by inmunophenotype. The patient received Imatinib Mesylato and Hyper CVAD as reinduction. She, eventually, died.

CONCLUSION: The importance of this case is the atypical and unusual presentation of ALL Ph (+) and the association of Philadelphia chromosome with balanced translocation t(2:7)(q11:q11), which has been rarely reported in hematological malignances. The biopsy of nodules allowed the early diagnosis. This is the first case reported in Venezuela.