Breast metastases in cases of leukemia are rare. We aimed to report the conventional-advanced magnetic resonance imaging (MRI) findings of unilateral breast involvement of acute lymphoblastic leukemia (ALL) and review the literature. A 32-year-old woman was first diagnosed with ALL in treated in 2004. She did not continue the follow-up after 2008. She was presented with a giant, progressive right breast palpable mass in 2010. Mass, contralateral breast tissue were evaluated with MRI, diffusion weighted imaging and MR spectroscopy. With MRI findings, lesion was evaluated as malignant, tru-cut biopsy revealed recurrence of ALL. Lymphoma, malignant melanoma, rhabdomyosarcoma are most common tumors metastase to breast. Breast metastases of leukemia are rare and occur primarily in patients with acute myeloid leukemia. Secondary ALL breast involvement is uncommon. In a patient with malignancy, any enlarging breast mass, even with benign radiologic appearance, should be investigated carefully and metastasis should not be forgotten.
Adult ; Biopsy ; Breast ; Diffusion Magnetic Resonance Imaging ; Female ; Follow-Up Studies ; Humans ; Leukemia ; Leukemia, Myeloid, Acute ; Lymphoma ; Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy ; Melanoma ; Neoplasm Metastasis ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Recurrence ; Rhabdomyosarcoma

INTRODUCTIONThe specificity of conventional magnetic resonance (MR) imaging is lower than its high sensitivity. Diffusion-weighted imaging (DWI), based on alterations in the microscopic motion of water molecules, promises improved specificity for breast MR imaging. In this study, we aimed to determine the diagnostic potential of DWI to differentiate between benign and malignant breast lesions and normal breast tissue.

METHODSDynamic contrast-enhanced breast MR imaging and DWI were applied to 108 women. Apparent diffusion coefficient (ADC) values were obtained for normal breast tissue (n = 183), benign lesions (n = 66) and malignant lesions (n = 58). The results were compared with the patients' final diagnoses.

RESULTSMean ADC values for benign and malignant breast lesions were 1.04 × 10-3 ± 0.29 × 10-3 mm2/s and 2.00 × 10-3 ± 0.55 × 10-3 mm2/s, respectively (p = 0.001, Student's t-test), while that for normal breast tissue was 1.78 × 10-3 ± 0.33 × 10-3 mm2/s. With a cut-off value of 1.46 × 10-3 mm2/s for ADC in receiver operating characteristic analysis, 95% sensitivity and 85% specificity were achieved for differentiating between benign and malignant lesions.

CONCLUSIONDWI of the breast can help differentiate benign and malignant breast lesions from normal breast tissue. DWI, which can be easily introduced into standard breast MR imaging protocols without increasing imaging times, promises to increase the accuracy of breast MR imaging without contrast media. However, its clinical value will depend on the standardisation of b-values and other technical parameters in larger future study series.

Adult ; Aged ; Breast ; pathology ; Breast Neoplasms ; diagnosis ; pathology ; Diffusion ; Diffusion Magnetic Resonance Imaging ; methods ; Female ; Humans ; Middle Aged ; Prospective Studies ; ROC Curve ; Sensitivity and Specificity ; Water ; chemistry ; Young Adult