CASE REPORTGranulocytic sarcoma of the breast antedating acute myelogenous leukemia
Introduction
Granulocytic sarcoma (previously called extramedullary myeloblastoma or chloroma) is an unusual variant of myeloid malignancy, mainly myeloblastic leukaemia, presenting as a solid tumour mass composed of aggregates of immature granulocytic precursors in extramedullary sites like CNS, bones, soft tissues of the head and neck, skin and breast.1 It occurs during either leukaemia relapse or remission but only very rarely as the sole presentation of the disease.2 Isolated granulocytic sarcoma in the breast without bone marrow evidence of leukaemia is exceedingly rare. We present such a case of extramedullary leukaemia of the breast without haematological features of myeloid malignancy.
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Case Summary
A 72 year old woman presented to the fast track breast clinic with a left breast lump of 2 weeks duration discovered on self-examination. She did not give a history of nipple discharge or retraction and was otherwise fit with no positive family history. Clinical examination revealed a 3 cm×2 cm firm to hard lump in the upper quadrant of her left breast, suspicious of malignancy. There was no axillary or supraclavicular lymphadenopathy.
Mammography revealed a dense, spherical solid mass with
Discussion
Granulocytic sarcoma is an unusual variant of myeloid malignancy in which there is an extramedullary tumour composed of immature granulocytes. It was first described by Burns in 1811 and first linked by Dock to myeloid neoplasms in 1893.3 The tumour is associated with acute myeloid leukaemia (AML), chronic myeloid leukaemia (CML), chronic idiopathic myelofibrosis, hypereosinophilic syndrome and polycythemia vera.4 In earlier literature, the term chloroma was used for such entities because of
Conclusion
Granulocytic sarcoma in breast tissue without evidence of underlying haematogenous malignancy is very rare and requires a high index of suspicion on the pathologist's part to confirm the diagnosis. If correctly diagnosed, it saves the patient from unnecessary surgical trauma and appropriate chemotherapy might be instituted earlier, improving patient prognosis.
References (11)
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