Primary Granulocytic Sarcoma Of The Breast:a Report And Review Of Literature

Objective:Primary granulocytic sarcoma of the breast is a rare and poor-prognosis malignancy.Clinicians do not have enough knowledge of this disease and are often misdiagnosed as other soft tissue sarco mas or inflammation.This article reports on the recent diagnosis of a patient with primary myeloid sarcoma of the breast in our hospital.Combined with the recent literature review,the article discusses comprehensively the clinical,histopathological,immunohistochemical,genetic testing,treatment,and prognosis of the disease.To increase awareness of the disease.Methods:Report on a case of breast primary granulocytic sarcoma recently diagnosed at the Department of Breast Surgery,the Second Affiliated Hospital of Nanchang University,and a retrospective study of 32 cases of breast primary agranulosarcoma published in the pubmed database from 1970 to 2017.,Analysis of the main clinical manifestations,pathogenesis,laboratory examination,imaging characteristics,currently based on histopathology,immunohistochemical characteristics and molecular biology for its diagnosis and differential diagnosis,reduce misdiagnosis and mistreatment,guide treatment,estimation Prognosis.Results:Of the 33 patients with primary amelanocytic sarcoma of the breast,29 were females and 4 were males.The largest was 72 years old,and the youngest was 16 years old,with an average age of 42 years.All patients showed a rapid increase in recent breast masses without clinical signs of nipple discharge,nipple depression,and breast pain.Peripheral whole blood cell counts were not significantly abnormal.There was no obvious abnormality in the bone marrow puncture test.Ultrasound examination revealed that the mass in the breast gland was greater than or equal to 20 mm × 10 mm,irregular in shape,unclear in the edge,hypoechoic echo in the internal echo type,and echo attenuation in the posterior echo.There was no blood flow signal in the nodule.Breast mammography tips: mammary gland visible border is not clear,irregular shape,no calcification of the mass.Breast MRI Tip: T2-weighted coronal images may show multiple,indeterminate,non-uniform,high-signal masses of granulocytic sarcomas relative to breast tissue.O f the 33 cases,14 cases were misdiagnosed(including 7 cases of breast cancer,4 cases of lymphoma,1 case of phyllodesial sarcoma,1 case of mucosa-associated lymphoid tissue,1 case of fibroid),and the misdiagnosis rate was 42.4%.The pa thological immunohistochemical myeloperoxidase(MPO)positive rate was 92%.The most common chromosomal abnormalities in genetic tests were trisomy 8 and t(9;11).Conclusions:Primary granulocytic sarcoma of the breast is a rare extramedullary tumor consisting of immature medullary cells and has no apparent bone marrow abnormalities.It has no obvious clinical and imaging features in the early stage,and is easy to confuse with other malignant tumors,such as breast lobule cancer and lymphoma.The final diagnosis depends on histopathology and immunohistochemistry.Current treatments include surgical resection,radiotherapy,chemotherapy,and allogeneic hematopoietic stem cell transplantation.Allogeneic hematopoietic stem cell transplantation is more effect ive in prolonging the patients' tumor free survival rate,while chemotherapy is mostly for AML chemotherapy.