Breast involvement in patients with HTLV-1-associated adult T-cell leukemia/lymphoma (ATL)

Abstract

14009 Background: Adult T cell leukemia/lymphoma (ATL) is an aggressive lymphoproliferative disorder with a poor prognosis caused by human T cell lymphotrophic virus type 1 (HTLV-1). The aggressive subtypes of ATL are associated with high circulating peripheral leukemic cell counts or rapidly progressing lymphadenopathy, acute hepatosplenomegaly, hypercalcemia, rising serum LDH and infiltration of the skin, bones, lungs, eyes, G.I. tract, heart and CNS with malignant T cells. Clinical involvement of the breast has been reported only on one previous occasion in a male patient. We report four female patients that presented with or developed clinical breast involvement with ATL. Methods: Medical records and imaging study reports on female patients registered on NCI-IRB approved protocols for the treatment of HTLV-1-associated ATL including 96-C-0147 (yttrium-90 labeled daclizumab), 00-C-0030 (high-dose unlabeled daclizumab), and 03-C-0194 (alemtuzumab) accrued between 1996 and 2007 were reviewed with specific reference to diagnoses and information related to the presence of breast abnormalities, breast lymphoma, mammography, computerized tomography (CT) and breast biopsies. Mammograms and CT-scans were reviewed. Available pathology was reviewed. To meet the case definition, a subject demonstrated a palpable breast mass or abnormality, demonstrated lesion on mammography and/or CT scan that was positive for ATL on biopsy. Results: Four women, ages 37, 46, 55 and 56 years were identified that met these criteria. Three were of Jamaican origin and one was from Trinidad. Conclusions: A review of the literature found a single case of malignant gynecomastia occurring in a male with HTLV-1-associated ATL. The breast masses in two of our patients resolved with systemic treatment of their ATL. ATL may involve the female breast and is often seen in the setting of progressive diease. Lymphomatous involvement should be considered in the setting of a breast mass in patients with ATL. Patient Demographics Characteristic Patient No. Total Patients 4 Age Median (range years) 50.5 (37-56) Sex Male Female 0 4 Ethnicity Afro-Carribean 4 ATL Subtype Chronic Acute Leukemia Lymphomatous Smoldering 0 0 4 0 arnofsky Performance Status Median (range %) 90 (80-100) Prior Treatment Chemotherapy Monoclonal Antibody Therapy Radioimmunotherapy 3 3 2 1 No significant financial relationships to disclose.