A Rare Case of Acute Lymphoblastic Leukaemia Breast Metastasis – Sonography’s Role
Ciara Maguire, St James' Hospital, Ireland; University College Dublin, Ireland
Background
Medullary and osseous metastases of haematological malignancies are common; however, mammary infiltration is extremely rare. Mammary manifestation in acute lymphoblastic leukaemia (ALL), is exceptionally rare, with <200 reported cases. ALL typically has high relapse rates and a young presentation, thus precluding mammographic investigation. Therefore, sonography plays an important role in lesion detection and characterisation. Sonographic findings are non-specific, requiring biopsy to consolidate findings. However, ultrasound can demonstrate both typically benign and malignant image features, from which decisions to biopsy can be determined. It can also safely guide any subsequent biopsies, reducing post-biopsy complications. This poster discusses ultrasound’s application in a case of leukemic mammary metastasis in a 34-year-old female with a solitary non-tender breast lump on a background of ALL. It highlights ultrasound’s strengths and weaknesses in lesion assessment and demonstrates common yet non-specific sonographic appearances of leukemic deposits.
Ultrasound findings
Sonographic investigation revealed multiple bilateral lesions demonstrating hypoechogenicity with significant solid, echogenic components. Both irregular and well-defined lesion outlines were demonstrated. Heterogenous echotextures of cystic and solid appearances were identified with individual lesions, demonstrating capsulation, acoustic shadowing and varied Doppler patterns. Variation in lesion appearances highlighted the non-specificity of this pathological process sonographically. While image findings were inconclusive, ultrasound permits its use to guide tissue sampling to accurately categorise lesions. The lesions were found to have leukemic infiltration attributable to ALL relapse. The patient underwent multiple multiagent chemotherapy cycles to no avail and sadly passed away.
Conclusion
The incidence of this case presentation is rare, while literature and research are sparse and common sonographic findings are non-specific, ultrasound remains a valuable modality in the assessment leukemic mammary infiltration. It allows lesion evaluation, especially in young and mammographically occult cases and guides biopsies for conducive lesion diagnosis.