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Objectives. We present an extremely rare case of breast cancer with metastasis to the bone marrow, which was also simultaneously diagnosed with chronic lymphocytic leukemia (CLL). Case Presentation. A 56-year-old female with a history of routine blood transfusions presented with chronic fatigue and recurrent right upper quadrant abdominal pain due to cholecystitis. Additionally, nodules were palpable in both breasts, which were subsequently detected as suspicious calcified lesions on ultrasound. Leukocytosis and bi-cytopenia were found. Cholecystectomy was performed and biopsies from some tissues were conducted. Gall bladder and subcutaneous tissue from the umbilical area showed neoplastic cells suggestive of breast carcinoma. Bone marrow biopsy showed CLL and non-hematopoietic cells identical to the previously detected neoplastic cells. Immunohistochemistry revealed that the breast carcinoma was ER-positive, PR-positive, and HER2negative. Outcome. After a thorough investigation, the bone marrow depression was proven to result from a metastatic bone marrow lesion from breast cancer diagnosed concurrently with CLL. Conclusions. This circumstance obliged clinicians to be more considerate of the diagnostic approach and treatment of patients with neoplasm presenting with cytopenia. It is to avoid underdiagnosis and ensure that every pathology in the bone marrow is investigated and managed accordingly.

Background: Breast cancer is one of the most common gynecologic malignancies in women and the main cause of death in 25% of all cases. The main cause of death from breast cancer is metastases, it is estimated that 5-10% of breast cancers have metastasized at the time of early diagnosis with an advanced stage. Purpose: To analyze the risk factors that influence the incidence of metastases in patients with advanced breast cancer. Methods: This study is an analytic observational study with a cross-sectional design, the number of samples in the study was 120 patients. The inclusion criteria of the study sample were breast cancer patients with advanced stages III and IV in the last five years. Exclusion criteria were incomplete patient medical records. The sampling technique in this study was consecutive sampling. This research was conducted at Ibnu Sina Hospital, Makassar City. The variables analyzed in this study were type 2 diabetes mellitus, anemia, and hypertension which were tested with the chi-square test. Results: The results of this study showed that diabetes mellitus type 2 (p=0.00; Prevalence Rate [PR]=1.79; 95% CI=1.32-2.42) and anemia (p=0.03; Prevalence Rate [PR] = 1.82; 95% CI = 1.61-2.86) is a risk factor that affects the incidence of metastases in patients with advanced breast cancer. While the risk factor that has no effect is hypertension. Conclusion: Type 2 diabetes mellitus and anemia are risk factors that influence the incidence of metastases in breast cancer patients.

Objectives. We present an extremely rare case of breast cancer with metastasis to the bone marrow, which was also simultaneously diagnosed with chronic lymphocytic leukemia (CLL). Case Presentation. A 56-year-old female with a history of routine blood transfusions presented with chronic fatigue and recurrent right upper quadrant abdominal pain due to cholecystitis. Additionally, nodules were palpable in both breasts, which were subsequently detected as suspicious calcified lesions on ultrasound. Leukocytosis and bi-cytopenia were found. Cholecystectomy was performed and biopsies from some tissues were conducted. Gall bladder and subcutaneous tissue from the umbilical area showed neoplastic cells suggestive of breast carcinoma. Bone marrow biopsy showed CLL and non-hematopoietic cells identical to the previously detected neoplastic cells. Immunohistochemistry revealed that the breast carcinoma was ER-positive, PR-positive, and HER2negative. Outcome. After a thorough investigation, the bone marrow depression was proven to result from a metastatic bone marrow lesion from breast cancer diagnosed concurrently with CLL. Conclusions. This circumstance obliged clinicians to be more considerate of the diagnostic approach and treatment of patients with neoplasm presenting with cytopenia. It is to avoid underdiagnosis and ensure that every pathology in the bone marrow is investigated and managed accordingly. [ABSTRACT FROM AUTHOR]

We report here a color-coded imaging model in which metastatic niches in the lung and liver of breast cancer can be identified. The transgenic green fluorescent protein (GFP)-expressing nude mouse was used as the host. The GFP nude mouse expresses GFP in all organs. However, GFP expression is dim in the liver parenchymal cells. Mouse mammary tumor cells (MMT 060562) (MMT), expressing red fluorescent protein (RFP), were injected in the tail vein of GFP nude mice to produce experimental lung metastasis and in the spleen of GFP nude mice to establish a liver metastasis model. Niche formation in the lung and liver metastasis was observed using very high resolution imaging systems. In the lung, GFP host-mouse cells accumulated around as few as a single MMT-RFP cell. In addition, GFP host cells were observed to form circle-shaped niches in the lung even without RFP cancer cells, which was possibly a niche in which future metastasis could be formed. In the liver, as with the lung, GFP host cells could form circle-shaped niches. Liver and lung metastases were removed surgically and cultured in vitro. MMT-RFP cells and GFP host cells resembling cancer-associated fibroblasts (CAFs) were observed interacting, suggesting that CAFs could serve as a metastatic niche.