Atypical Clinical Picture of Breast Cancer with Dominant Symptoms of Hematologic and Gastrointestinal Malignancies

Rybicka-Ramos Malwina,Kasiarz Grzegorz,Pluta Katarzyna,Pruszyński Jerzy,Ziółko Ewa,Wilczyński Tomasz

doi:10.23937/2469-5696/1410050

Abstract

Gastrointestinal malignancy was suspected in a 68-year-old woman with long-term anemia, thrombocytopenia, leukopenia, the presence of fecal occult blood and elevated levels of CEA and CA 19-9. However, malignancy was not confirmed. The patient was later hospitalized in the Department of Hematology where hematologic disease was excluded. Cervical and inguinal lymphadenopathy and atypical bone marrow cells collected by aspiration biopsy gave rise to the suspicion of bone marrow involvement by tumor cells of non-hematologic origin.

Highlights

Breast cancer is the most common malignancy in women
The results revealed bone marrow metastases of cancer of glandular origin with a phenotype corresponding to breast cancer
The results of immunohistochemical examination of the trepanobiopsy specimen showed bone marrow metastases of cancer of glandular origin (CK+, CK7+, CK20, GATA-3+, mammaglobin+, TTF-1, CD15+, WT-1-) with a phenotype corresponding to breast cancer without blast cells (CD34, CD117-) that would otherwise be characteristic of hematologic malignancy

Summary

Introduction

Breast cancer is the most common malignancy in women. It is the main cause of cancer-related death in females [1]. The suspicion of bone marrow infiltration with non-hematological cancer cells was raised and further immunohistochemical assessment of trepanobiopsy specimen was performed. The results of immunohistochemical examination of the trepanobiopsy specimen showed bone marrow metastases of cancer of glandular origin (CK+, CK7+, CK20-, GATA-3+, mammaglobin+, TTF-1-, CD15+, WT-1-) with a phenotype corresponding to breast cancer without blast cells (CD34-, CD117-) that would otherwise be characteristic of hematologic malignancy. Positron Emission Tomography (PET) revealed massive tumor spread from the left breast in the regions of the ribs, sternum, collarbones, shoulder blades, heads of the humerus, spine, pelvic bones, femurs, pleura, peritoneum, left axillary and anterior mediastinum lymph nodes. The patient did not report for further treatment at the Oncology Centre in Gliwice

Discussion

Findings

Conclusions