title: Successful management of synchronous recurrent breast carcinoma with chronic myelogenous leukemia: a case report.
abstract: BACKGROUND
  Survival is increasing after early breast cancer revealing frequent relapses and possibility of developing secondary malignancies. The concomitant occurrence of these two events is exceptionally disastrous and lethal. We report a case of a Moroccan woman who was successfully managed for synchronous recurrent breast carcinoma and chronic myelogenous leukemia.
  
  
  METHODS
  A 42-year-old Moroccan woman was diagnosed with localized breast carcinoma in 2008. She received six cycles of an adjuvant chemotherapy regimen, radiation therapy and hormonal therapy by tamoxifen. After completion of 5 years of tamoxifen our patient reported asthenia; a physical examination found hepatomegaly, massive splenomegaly measuring 21 cm and supraclavicular lymphadenopathy. The staging showed lung and liver metastases. Morphology and immunohistochemical profile of this metastasis identified an adenocarcinoma of mammary origin. In parallel, the diagnosis of chronic myeloid leukemia was suspected because of the presence of a leukocytosis at 355 × 109/L, with circulating blasts of 4%. Chronic myeloid leukemia was confirmed by a bone marrow biopsy with the presence of Ph chromosome on cytogenetical analysis. Daily imatinib was ordered concurrently with chemotherapy-type docetaxel. The metastases were stable after nine courses of chemotherapy. Due to breast cancer progression 4 months later, bevacizumab and capecitabine were introduced. A major molecular response was achieved after 12 and 18 months. She has now completed 2 years of follow-up, still on a major molecular response, and is undergoing imatinib and capecitabine treatment.
  
  
  CONCLUSIONS
  Leukocytosis in breast cancer patients can reveal chronic myeloid leukemia. It may warrant a workup to find the underlying etiology, which could include a secondary hematological malignancy.
authors.affiliation: Medical Oncology Department, Mohammed V Military Teaching Hospital of Rabat, Rabat, Morocco. dr.choukrielmhadi@hotmail.com.|School of Medicine and Pharmacy, University Mohamed V, Souissi, Rabat, Morocco. dr.choukrielmhadi@hotmail.com.
authors.forename: Choukri
authors.initials: C
authors.lastname: Elm'hadi
authors.affiliation: Medical Oncology Department, Mohammed V Military Teaching Hospital of Rabat, Rabat, Morocco.
authors.forename: Mohamed Reda
authors.initials: MR
authors.lastname: Khmamouche
authors.affiliation: Medical Oncology Department, Mohammed V Military Teaching Hospital of Rabat, Rabat, Morocco.
authors.forename: Rachid
authors.initials: R
authors.lastname: Tanz
authors.affiliation: Medical Oncology Department, Mohammed V Military Teaching Hospital of Rabat, Rabat, Morocco.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Toreis
authors.affiliation: Clinical Hematology Department, Mohammed V Military Teaching Hospital of Rabat, Rabat, Morocco.
authors.forename: ElMehdi
authors.initials: E
authors.lastname: Mahtat
authors.affiliation: Department of Pathology, Mohammed V Military Teaching Hospital of Rabat, Rabat, Morocco.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Allaoui
authors.affiliation: Department of Pathology, Mohammed V Military Teaching Hospital of Rabat, Rabat, Morocco.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Oukabli
authors.affiliation: Laboratory of Hematology, Mohammed V Military Teaching Hospital of Rabat, Rabat, Morocco.
authors.forename: Nezha
authors.initials: N
authors.lastname: Messaoudi
authors.affiliation: Medical Oncology Department, National Institute of Oncology Sidi Mohamed Ben Abdellah, Rabat, Morocco.
authors.forename: Hassan
authors.initials: H
authors.lastname: Errihani
authors.affiliation: Medical Oncology Department, Mohammed V Military Teaching Hospital of Rabat, Rabat, Morocco.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Ichou
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols; D001943:Breast Neoplasms / Q000150:complications* / Q000188:drug therapy* / Q000473:pathology; D000069287:Capecitabine / Q000008:administration & dosage; D017024:Chemotherapy, Adjuvant; D000077143:Docetaxel; D005260:Female; D006801:Humans; D000068877:Imatinib Mesylate / Q000008:administration & dosage; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000150:complications* / Q000188:drug therapy*; D009364:Neoplasm Recurrence, Local / Q000150:complications* / Q000188:drug therapy* / Q000473:pathology; D043823:Taxoids / Q000008:administration & dosage; D016896:Treatment Outcome
chemical_list: D043823:Taxoids; D000077143:Docetaxel; D000069287:Capecitabine; D000068877:Imatinib Mesylate
keywords: Breast cancer; Chronic myeloid leukemia; Management; Relapse