IS Case 258: Bilateral breast chloroma
Imaging Sciences URMC 2009
Publication Date: 2009-06-26
Bilateral CC mammogram demonstrate bilateral irregular masses without calcifications which correspond to the sites of palpable abnormality. Ultrasound (US) of the bilateral palpable breast abnormalities demonstrates bilateral large, solid heterogeneous masses. Doppler interrogation (not shown) demonstrated internal vascularity on both masses.
Chloroma, also known as extramedullary myeloblastoma or granulocytic sarcoma, is the name given to an extramedullary solid tumor associated with myelogenous leukemia. They are solid tumors composed of immature granulocyte precursor cells. Chloromas are uncommon manifestations of leukemia and rarely involve the breast. The term "chloroma" is derived from the Greek "chloros" meaning "green" - the tumors often have a green tint on gross inspection.
Chloromas may rarely occur during the disease course of chronic myelogenous leukemia (CML) or other myeloproliferative disorders including myelodysplastic syndrome, polycythemia vera, essential thrombocytosis and myelofibrosis. The presence of a chloroma signals transformation of these pre-malignant conditions into AML. Chloromas may also develop as the lone manifestation of disease recurrence after successful treatment of AML. This heralds imminent systemic relapse, typically within less than one year . Very rarely, a so called "primary chloroma" may occur, in which there is no history of previous myelogenous disease. In almost all reported cases, leukemia develops within a year .
Chloromas may occur in any tissue, but they are most commonly seen in the skin and gums. Other common locations include lymph nodes, small bowel, mediastinum, epidural space, uterus, and ovaries. Mammographically, breast chloromas are noncalcified, irregular masses with poorly defined "feathery" margins. Ultrasound typically shows a large malignant appearing mass with spiculations, angular margins, and hypoechoic areas.
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