|LETTER TO EDITOR
|Year : 2010 | Volume
| Issue : 4 | Page : 477-479
Synchronous carcinoma breast with chronic myelogenous leukemia: A rare presentation
A Bahl, A Dhiman, V Talwar, DC Doval
Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Center, New Delhi - 110 085, India
|Date of Web Publication||4-Dec-2010|
Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Center, New Delhi - 110 085
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Bahl A, Dhiman A, Talwar V, Doval D C. Synchronous carcinoma breast with chronic myelogenous leukemia: A rare presentation. Indian J Cancer 2010;47:477-9
|How to cite this URL:|
Bahl A, Dhiman A, Talwar V, Doval D C. Synchronous carcinoma breast with chronic myelogenous leukemia: A rare presentation. Indian J Cancer [serial online] 2010 [cited 2019 Aug 26];47:477-9. Available from: http://www.indianjcancer.com/text.asp?2010/47/4/477/73558
A 45-year-old woman was diagnosed as a case of carcinoma (CA) left breast. She had a 5-cm lump in left breast; fine-needle aspiration cytology revealed infiltrating ductal carcinoma. On investigation, she was found to have leukocytosis of 105 Χ 10 9 /L with shift to left and blast 5%, peripheral smear was suggestive of myeloproliferative disorder. Further investigation by bone marrow aspiration was suggestive of chronic myelogenous leukemia (CML) [Figure 1], BCR-ABL by real-time reverse transcriptase polymerase chain reaction (RT-PCR) quantitative assay was positive, with 81.9% on fluorescence in situ hybridization analysis. She was finally diagnosed as synchronous CML and carcinoma breast [Figure 1].
|Figure 1 :Bone marrow aspiration suggestive of chronic myelogenous leukemia (H and E, ×10)|
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Subsequently, before surgery, cytoreduction was done with hydroxyurea followed by imatinib in the dose of 400 mg/d. Left modified radical mastectomy was performed and on HPE, the tumor was invasive ductal carcinoma grade II [Figure 2], pT2N3M0 with 21/26 lymph node positives at levels I-III with extracapsular extension. Breast prognostic profile was estrogen receptor 100% and progesterone receptor 80%, and HER2/neu score was not overexpressed [Figure 2].
|Figure 2 :Histopathology of the breast showing inflammatory duct carcinoma (H and E, ×100)|
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She was planned for adjuvant chemotherapy for intraductal breast concurrently with imatinib. She was continued on imatinib 400 mg once a day. TAC regimen (docetaxel, adriamycin, cyclophosphamide) was instituted and supported with granulocyte colony-stimulating factor, whenever required.
Imatinib was withheld whenever neutropenia was encountered, and G-CSF support was given. Chemotherapy was completed over a period of 22 weeks with an inadvertent delay of 4 weeks.
Subsequently, the patient was planned for adjuvant hormonal manipulation with tamoxifen 20 mg daily and radiation therapy while continuing with imatinib 400 mg once daily. After 6 months on imatinib, BCR-ABL was 3.01% with RT-PCR method. During the treatment duration, imatinib was withheld 3 times because of neutropenia and 1 episode of febrile neutropenia. BCR-ABL done after 12 months and 18 months with RT-PCR method was 0.0% and 0.03%, respectively. She has now completed 2 years of follow-up and is presently on imatinib and tamoxifen.
Although a number of case reports are in literature that leukemia either CML, acute lymphocytic leukemia, chronic myelomonocytic leukemia occurred after anthracycline-based therapy of CA breast or synchronously with adenocarcinoma stomach/hairy cell leukemia but simultaneous occurrence of CML and CA breast has not been reported in the literature. 
In general, a person with one malignancy is at an increased risk of developing another malignancy. Nineteen cases of second malignancies (CA prostate-4 cases, CA breast-1 case, adenocarcinoma stomach-1 case, lymphoma-1 case, CA ovary-2 cases, CA cervix 1 case, small cell lung cancer -1 case, CA rectum-1 case, basal cell cancer skin-1 case) in CML patients have been reported but only 1 case of synchronous CML with gastric adenocarcinoma.  Moertal et al reported 17 cases of CML occurring in association with a second malignancy. In one study with age- and sex-matched controls, patients who were 40-60 years old when CML was diagnosed had an approximately 10-fold higher frequency of other malignancies than did age-matched controls. Patients younger than 40 years did not have a second malignancy. 
Studies have shown that in CML, mutation at the stem level, that is, in ph chromosome, occurs around 6 years before the presentation of the disease, whereas carcinoma breast occurs many years prior to its presentation. 
In summary, our case of CA breast with CML is a rare presentation and it appears to be more of a coincidence than any association.
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[Figure 1], [Figure 2]