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.