T cell-prolymphocytic leukemia detected in a patient of breast cancer at the time of recurrence: a case reportReportar como inadecuado




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Cases Journal

, 3:4

First Online: 04 January 2010Received: 19 October 2009Accepted: 04 January 2010DOI: 10.1186-1757-1626-3-4

Cite this article as: Singhal, M., Raina, V., Gupta, R. et al. Cases Journal 2010 3: 4. doi:10.1186-1757-1626-3-4

Abstract

IntroductionTherapy related second malignancy of the hematological system is small but real risk after adjuvant chemotherapy for breast cancer. It includes acute myeloid leukemia AML and myelodysplastic syndrome MDS; however T-cell prolymphocytic leukemia T-PLL has not been described earlier in relation to breast cancer and its therapy. T-PLL is a rare chronic T-cell lymphoproliferative disease with a mature post-thymic T-cell immunophenotype and aggressive clinical course.

Case presentationA 45 year old Indian female of Nordic origin presented 5 years back with a lump in the right breast and the axilla. She underwent modified radical mastectomy. Histophotomicrograph of the excised breast lesion showed a 2.1 cm duct carcinoma, positive for ER and PR with 1 out of 25 lymph nodes positive for metastasis. She received 6 cycles of chemotherapy with cyclophosphamide, epirubicin, and 5-fluorouracil. This was followed by tamoxifen 20 mg per day for five years. She was doing well on follow up until the completion of fifth year of her disease, when she presented with complaints of mild fever and weakness. Examination revealed generalized lymph node enlargement along with hepatomegaly.

Hemogram showed mild anemia, normal platelet count and a leukocyte count of 1.2 × 10-L. Peripheral blood examination revealed medium sized lymphoid cells, constituting almost 75% of total nucleated cell population. Immunophenotying, established a diagnosis of post thymic T-cell prolymphocytic leukemia. Contrast-enhanced computed tomography of the chest and abdomen was done which revealed an anterior mediastinal mass with destruction of sternum along with multiple small nodular shadows in bilateral lung fields suggestive of lung metastasis. Fine needle aspiration cytology of the mass showed atypical ductal cells with nuclear pleomorphism, which were positive for ER, PR and Her2neu protein. This confirmed a co-existent metastatic breast carcinoma. She was started on chemotherapy for T-PLL along with hormonal therapy with aromatase inhibitor. Unfortunately, both her malignancies progressed after an initial stable disease of two months.

ConclusionOur case describes the potential of breast chemotherapy to cause grave second hematological malignancies of the T-cell lymphoid lineage, not described earlier. Such events highlight the importance to identify those patients of breast cancer in whom chemotherapy can safely be avoided.

AbbreviationsAMLAcute myeloid leukemia

MDSMyelodysplastic syndrome

T-PLLT-cell prolymphocytic leukemia

IUInternational unit

EREstrogen receptor

PRProgestrone receptor

TTumor stage

NNodal stage

CDCluster differentiation

ZAPZeta-associated protein

TdTTerminal transferase detection

FNAFine needle aspiration

CECTContrast enhanced computed tomography

RRRelative risk.

Electronic supplementary materialThe online version of this article doi:10.1186-1757-1626-3-4 contains supplementary material, which is available to authorized users.

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Autor: Manish Singhal - Vinod Raina - Ritu Gupta - Prasenjit Das

Fuente: https://link.springer.com/







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