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Chronic lymphocytic leukemia and breast cancer as synchronous primary in a male— a rare combination

A Resident Education Article

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Case Study

by Biswajit Dubashi, MD, DM

A 69-year-old man with no comorbidities and a family history of cancer presented with a right breast lump of 1 month’s duration. On examination, a 3×2-cm right breast lump with ulceration, fixed to the pectoralis major muscle, was noted. A right axillary hard mobile lymph node was also found. Investigations revealed hemoglobin 8.2 g/dL and total leucocytes 63×109/L, with a differential count of neutrophils 13%, lymphocytes 2%, abnormal cells 85%, and platelets 75×109/L. Bone marrow aspiration and biopsy revealed cll with CD5+ and CD23+. Trucut biopsy from the breast lump revealed an infiltrating ductal carcinoma positive for the estrogen receptor and negative for the progesterone receptor. Staging work-up was normal. The patient had renal dysfunction (creatinine clearance: 30 mL/min) with 13% elevation in uric acid and normal serum calcium and potassium, suggestive of tumour lysis syndrome. The final diagnosis was synchronous primary with carcinoma right breast T4bN1M0 and cll Rai stage iv.

 

Questions:

  1. What are the Malignancies associated with Chronic Lymphocytic Lymphoma?
  2. What are the various theories associated with development of second malignancies in patients?
  3. Which malignancy will you treat initially?
  4. Outline the management of breast cancer in the above patient.
  5. Outline the management of cll in the above patient.

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