CLINICAL HISTORY
A 13 year-old girl was admitted to our department with a mass in her left breast and inability to close her left eye. Her medical history revealed an operation for a lumbar mass in L5 vertebral corpus three years ago when she was diagnosed to have leukemia. Combined chemotherapy and local spinal radiotherapy provided remission for about one and a half years.

In the physical examination, a lobulated mass of 10x5cm in diameters in the left breast and left-sided facial paralysis were observed. In the blood analysis, hemoglobin 9,9 g/dl, leukocyte count 17.200/mm³ with 74% blast cells, platelet count 8.000/mm³ were found. Bone marrow aspirate revealed 100% blast cells, both myeloblasts and monoblasts (Figure 1). Cytochemistry studies showed both peroxidase and non-specific esterase positivity. Blast cells were positive for intracytoplasmic MPO, CD15, CD34 and HLA-DR. Cerebrospinal fluid examination was consistent with meningeal involvement. Computed axial tomography scan of the brain revealed a mass of 3,5 cm in diameter in the left temporal region (Figure 2). Ultrasonography showed a large mass in the left breast with lobulated contours and heterogenous echo texture. Magnetic resonance findings of the breast demonstrated a mass 9x4 cm in diameter in the left breast (Figure 3). The aspiration material, obtained from the breast mass, revealed myeloblasts and monoblasts (Figure 4). Cytogenetic analysis showed 46, XX, t (8;21). (q22, q22).

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PATHOLOGIC DIAGNOSIS
AML associated with extramedullary myeloid tumors (Myeloblastomas or granulocytic sarcomas)

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