BREAST CANCER METASTASIS TO BONE MARROW, INITIALLY DIAGNOSED AS MYELOFIBROSIS S Righi MD, RVallejo-Calzada MD Department of Medicine, Ochsner Medical Center, New Orleans, LA
INTRODUCTION: Micrometastasis of breast cancer to bone marrow is not uncommon, however, development of symptoms secondary to bone marrow involvement is relatively rare. Additionally, patients with breast cancer treated with radiation and/or chemotherapy are at an increased risk for developing myelodysplastic syndromes (MDS).
CASE: A 58-year-old female with a history of hypertension, coronary artery disease, hypothyroid, and locally advanced hormone receptor-positive (ER+, PR+, HER2-) invasive lobular breast carcinoma presented to bone marrow transplant (BMT) clinic for evaluation of a stem cell transplant for the treatment of myelofibrosis. Her treatment for breast cancer consisted of bilateral mastectomy, chemotherapy, radiation, and adjuvant endocrine therapy. Her baseline hemoglobin had been around 14 g/dl, however, in the months prior to the BMT clinic visit her hemoglobin was consistently <10 g/dl with accompanying shortness of breath, fatigue, and weakness. Her symptomatic anemia was initially attributed to chronic blood loss anemia secondary to diverticular bleeds. Her mean corpuscular volume (MCV), however, was elevated (112 fL) with no clear etiology upon workup, which was concerning for a MDS, therefore, a bone marrow biopsy was obtained. The biopsy revealed hypercellular bone marrow with mild megakaryocytic hyperplasia and increased reticulin fibrosis. These bone marrow changes along with splenomegaly that was seen on recent Computed Tomography (CT) were consistent with a myeloproliferative neoplasm, favoring primary myelofibrosis. Before a final decision was made whether to pursue a stem cell transplant, the bone marrow biopsy was re-reviewed to confirm the diagnosis. Upon re-analysis of the bone marrow a new diagnosis of metastatic lobular carcinoma of the breast was made. DISCUSSION: Re-analysis of the bone marrow was pursued due to her myelofibrosis risk varying between high risk and low risk depending on which scoring system was used as in the bleeding patient, scoring systems may be unreliable (e.g., is she transfusion dependent). The metastasis of the breast cancer to the bone marrow may have led to the hypercellularity and increased megakaryocytes resulting in the initial diagnosis of myelofibrosis.
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