Rare Case of Breast Tissue Involvement by CLL/SLL
Posted: Wednesday, October 13, 2021
In Clinical Case Reports, a rare case of chronic lymphocytic leukemia/small lymphocytic (CLL/SLL) involvement of the breast was highlighted. Tian Li, MD, of East Carolina University/Vidant Medical Center, Greenville, North Carolina, and colleagues examined and tracked the medical history of a patient with intermediate-grade ductal carcinoma in situ in the left breast. She was treated by partial mastectomy, followed by a combined treatment of whole-breast radiation and antihormonal therapy (tamoxifen). About 13 years later, she was diagnosed with a lesion of the upper outer quadrant of the right breast. Overall, the pathologic findings revealed breast involvement by CLL/SLL.
“Leukemic or lymphoma involvement of the breast could be easily misinterpreted as an invasive carcinoma on imaging due to their very low incidence or their presentation together with coexisting breast cancer. Therefore, the importance of distinguishing between breast lymphoma and carcinoma conditions has recently emerged,” stated Dr. Li and colleagues.
A 59-year-old woman was referred to the hospital for a lesion confined to the right breast. Targeted ultrasonography was performed and revealed a cluster of multiple prominent lesions, the largest of which was 1 cm in diameter. Considering her history of intermediate-grade ductal carcinoma in situ, an ultrasound-guided biopsy was performed for further analysis.
Clinical analyses revealed the lesion demonstrated solid hypercellular sheets of small, dark basophilic cells, although no abnormal vascularity was observed. These findings ruled out primary and metastatic breast carcinoma, as there was a negative pan-cytokeratin staining pattern. Additionally, an initial complete blood cell count analysis revealed a differential leukocytic count of 30 K/μL, with 69% lymphocytes, which increased to 59 K/μL during follow-up. These overall findings were consistent with breast involvement by CLL/SLL.
Based on these findings, Dr. Li and colleagues concluded that chemotherapy was not needed. However, they noted, awareness of this patient’s profile may offer better insight into the value of long-term surveillance for other patients after recovery.
Disclosure: The study authors reported no conflicts of interest.