奥村 輝, 久保田 光博, 岡本 祐一, 斎藤 雄紀, 鈴木 育宏, 久下 壮一, 太田 正敏, 徳田 裕, 幕内 博康, 田島 知郎

Akira OKUMURA, Mitsuhiro KUBOTA, Yuichi OKAMOTO, Yuki SAITOH, Yasuhiro SUZUKI, Soichi KUGE, Masatoshi OHTA, Yutaka TOKUDA, Hiroyasu MAKUUCHI, Tomoo TAJIMA

東海大学医学部付属病院外科

Department of Surgery, Tokai University School of Medicine

キーワード :

The breast gland, a common site of primary malignant tumors, is rarely a site of metastasis from extramammary malignancies. We encountered a case of lymphoblastic leukemia with breast involvement as extramedullary relapse suggested by ultrasonography and diagnosed by fine needle aspiration cytology. The patient was a 16-year-old girl who had been diagnosed with acute lymphoblastic leukemia 18 months earlier and who had achieved complete remission after receiving chemotherapy and bone marrow transplantation. She was admitted again, however, when her peripheral blood test suggested relapse, and a rapidly growing tumor was found in her right breast gland at this time. The mammogram showed bilateral high-density areas, but there was no definitive evidence of tumor. Ultrasonic examination showed a low-density area (LDA) that measured 53×47×13 mm in her right breast. This LDA affected no changes in the surrounding tissues, and infiltration was limited to the breast. A high-density area was detected in the LDA, and high-density spots indicative of edema were present on the surface of the LDA. Further, the left breast showed the same findings. We considered these findings to be indicative of metastasis of extramammary malignancy, not benign tumor or typical malignant primary breast tumor, and, based on her history, we suspected breast involvement of lymphoblastic leukemia. The final diagnosis was made after fine needle aspiration cytology revealed leukemia cells. Only four cases of breast involvement with acute lymphoblastic leukemia appear in the literature.