Case presentation:
The patient was a 62-year-old woman who presented with a right breast mass. The diagnosis was invasive ductal carcinoma in the biopsy of the mass with a positive lymph node in the ipsilateral axilla (figure1). The initial laboratory tests revealed pancytopenia, and in the abdominal sonography, she showed massive splenomegaly with 200 mm diameter and normal echo. BMB and flow cytometry was positive for CD103, CD30, and CD11 in favor of hairy cell leukemia (figure3). Given the severe symptoms of pancytopenia, the patient underwent splenectomy with the diagnosis of hairy cell leukemia; in the pathophysiology, metastatic carcinoma in favor of breast origin was seen. IHC was positive for PanCK, CK7, GATA3, and negative for CK20, TTF1, and CDX2(figure2). Pancytopenia was recovered after splenectomy.
In PET scan, after splenectomy, multiple FDJ avid metastases in the right axillary and subpectoral lymph nodes were reported without the involvement of other regions of the body. The patient underwent eight courses of chemotherapy (doxorubicin, cyclophosphamide, taxane, and trastuzumab) and then lumpectomy surgery. In the pathology, residual ductal carcinoma was reported with 4.5 mm size and grade 2 without positive lymph node findings. The patient underwent breast and right axilla radiotherapy.
At the end of radiotherapy, pancytopenia occurred. cladribine was administrated for a patient. Unfortunately, the Patient passed away because of severe pancytopenia and sepsis.