Elm'hadi Choukri, Khmamouche Mohamed Reda, Tanz Rachid, Toreis Mehdi, Mahtat ElMehdi, Allaoui Mohammed, Oukabli Mohammed, Messaoudi Nezha, Errihani Hassan, Ichou Mohammed
Medical Oncology Department, Mohammed V Military Teaching Hospital of Rabat, Rabat, Morocco.
School of Medicine and Pharmacy, University Mohamed V, Souissi, Rabat, Morocco.
J Med Case Rep. 2017 Jan 10;11(1):10. doi: 10.1186/s13256-016-1180-4.
Survival is increasing after early breast cancer revealing frequent relapses and possibility of developing secondary malignancies. The concomitant occurrence of these two events is exceptionally disastrous and lethal. We report a case of a Moroccan woman who was successfully managed for synchronous recurrent breast carcinoma and chronic myelogenous leukemia.
A 42-year-old Moroccan woman was diagnosed with localized breast carcinoma in 2008. She received six cycles of an adjuvant chemotherapy regimen, radiation therapy and hormonal therapy by tamoxifen. After completion of 5 years of tamoxifen our patient reported asthenia; a physical examination found hepatomegaly, massive splenomegaly measuring 21 cm and supraclavicular lymphadenopathy. The staging showed lung and liver metastases. Morphology and immunohistochemical profile of this metastasis identified an adenocarcinoma of mammary origin. In parallel, the diagnosis of chronic myeloid leukemia was suspected because of the presence of a leukocytosis at 355 × 10/L, with circulating blasts of 4%. Chronic myeloid leukemia was confirmed by a bone marrow biopsy with the presence of Ph chromosome on cytogenetical analysis. Daily imatinib was ordered concurrently with chemotherapy-type docetaxel. The metastases were stable after nine courses of chemotherapy. Due to breast cancer progression 4 months later, bevacizumab and capecitabine were introduced. A major molecular response was achieved after 12 and 18 months. She has now completed 2 years of follow-up, still on a major molecular response, and is undergoing imatinib and capecitabine treatment.
Leukocytosis in breast cancer patients can reveal chronic myeloid leukemia. It may warrant a workup to find the underlying etiology, which could include a secondary hematological malignancy.
早期乳腺癌患者的生存率正在提高，但复发频繁且有发生继发性恶性肿瘤的可能。这两种情况同时出现极其严重且致命。我们报告一例摩洛哥女性患者，她同时患有复发性乳腺癌和慢性粒细胞白血病，经成功治疗后康复。
一名42岁的摩洛哥女性于2008年被诊断为局限性乳腺癌。她接受了六个周期的辅助化疗方案、放射治疗以及他莫昔芬激素治疗。在服用他莫昔芬5年后，患者出现乏力症状；体格检查发现肝脏肿大、脾脏巨大（长径21厘米）以及锁骨上淋巴结肿大。分期检查显示有肺和肝转移。对该转移灶的形态学和免疫组化分析确定为乳腺来源的腺癌。与此同时，由于白细胞计数为355× /L且循环原始细胞占4%，怀疑患有慢性髓性白血病。骨髓活检证实了慢性髓性白血病，细胞遗传学分析显示存在费城染色体。每日服用伊马替尼并同时进行多西他赛化疗。九个疗程的化疗后转移灶稳定。4个月后，由于乳腺癌进展，加用了贝伐单抗和卡培他滨。12个月和18个月后达到主要分子反应。她目前已完成2年随访，仍处于主要分子反应状态，正在接受伊马替尼和卡培他滨治疗。
乳腺癌患者的白细胞增多可能提示慢性髓性白血病。可能需要进行检查以找出潜在病因，这可能包括继发性血液系统恶性肿瘤。
