J Breast Cancer.  2017 Jun;20(2):208-211. 10.4048/jbc.2017.20.2.208.

Chronic Myeloid Leukemia with a Complex Variant ‘Ph’ Translocation That Develops in Breast Carcinoma, Postchemotherapy: A Rare but Treatable Entity

• Tikku G
• Jain M
• Shukla P

• KMID: 2389760
• DOI: http://doi.org/10.4048/jbc.2017.20.2.208

Abstract

We report a case of chronic myeloid leukemia (CML) that developed after postoperative chemotherapy with cyclophosphamide, doxorubicin and 5-fluorouracil (CAF) for breast cancer. A 55-year-old woman was diagnosed with invasive ductal carcinoma which was treated with a modified radical mastectomy followed by six cycles of CAF chemotherapy. Nine years later, she developed CML and locoregional recurrence. Her breast recurrence showed strong estrogen receptor, weak progesterone receptor and strong human epidermal growth factor 2 (score 3+) expression. Her secondary CML in the chronic phase showed a complex variant translocation (CVT) involving chromosomes 9, 22, and 17. Considering that the HER2/neu gene is also located on chromosome 17, this secondary CML in chronic phase with CVT is indeed a rare occurrence. We discuss the associated genetic factors and the possible role of breast cancer chemo/radiotherapy in the development of such CML as well as its treatment and prognosis compared with de novo CML.

Keyword

Breast neoplasms; Chemotherapy; Chronic-phase myeloid leukemia

MeSH Terms

Breast Neoplasms*
Breast*
Carcinoma, Ductal
Chromosomes, Human, Pair 17
Cyclophosphamide
Doxorubicin
Drug Therapy
Epidermal Growth Factor
Estrogens
Female
Fluorouracil
Humans
Leukemia, Myelogenous, Chronic, BCR-ABL Positive*
Mastectomy, Modified Radical
Middle Aged
Prognosis
Receptors, Progesterone
Recurrence
Cyclophosphamide
Doxorubicin
Epidermal Growth Factor
Estrogens
Fluorouracil
Receptors, Progesterone

Figure

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  Figure 1 Microscopic findings and karyotyping. (A) Trucut biopsy sternal mass: recurrent duct carcinoma, breast (H&E stain, ×200). (B) Immunohistochemistry (IHC) for human epidermal growth factor receptor 2 (HER2), sternal mass shows 3+ positivity (IHC for HER2, ×400). (C) Bone marrow aspirate: chronic myeloid leukemia chronic phase, showing myeloid preponderance (May-Grünwald-Giemsa stain, ×400). (D) G-banded karyotyping: chronic myeloid leukemia with complex variant translocation involving chromosomes 9, 22, and 17.

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