J Med Cases

Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Med Cases and Elmer Press Inc

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Case Report

Volume 16, Number 9, September 2025, pages 360-365

Radiotherapy for Isolated Breast Myeloid Sarcoma

↓ **Table 1.** Recent Case Reports of Breast Myeloid Sarcoma (2014 - 2025): Clinical, Imaging, and Treatment Features
References	Patient age (yrs)/gender	Presentation/symptoms	Past hematologic disease	Imaging findings	Histopathology/IHC	Systemic/surgical treatment	Radiotherapy	Outcome/follow-up
F: female; yrs: years; US: ultrasound; WBC: white blood cell; post-op: postoperative; CT: computed tomography; 3D: three-dimensional; CBC: complete blood count; MRI: magnetic resonance imaging; BM: bone marrow; BMT: bone marrow transplantation; LN: lymph node; allo-HSCT: allogeneic hematopoietic stem cell transplant; MPO: myeloperoxidase; IHC: immunohistochemistry; CXR: chest X-ray; RT: radiotherapy; fx: fractions; ara-C: cytarabine; SLNB: sentinel lymph node biopsy; AML: acute myeloid leukemia; N/A: not available/not applicable; IL: interleukin; FLAG-IDA: fludarabine, cytarabine (ara-C), granulocyte colony-stimulating factor (G-CSF), and idarubicin; HDAC: high-dose cytarabine; Chemo: chemotherapy; MUD: matched unrelated donor; BuCyATG: busulfan, cyclophosphamide, and anti-thymocyte globulin; MTX: methotrexate; GVHD: graft-vs-host disease; PET-CT: positron emission tomography-computed tomography; FDG: fluorodeoxyglucose; ITD: internal tandem duplications.
Goncalves et al, 2014 [4]	35/F	Tender left breast nodule, 25 mm, upper outer quadrant	N/A	US/mammography: solid heterogeneous nodule about 22 mm, small ipsilateral axillary LN; MRI post-chemo: persistent lesion about 60 mm, later resolved	Myeloid sarcoma: MPO⁺, CD45⁺, CD68⁺, CD34⁺, CD31⁺, CD43⁺, Cam5.2^-, CD117^-, CD3^-, CD20^-, TdT^-, CD10^-	Tumorectomy; chemo: idarubicin + ara-C, consolidation 4 × ara-C	30 Gy/15 fx, 3D conformal	26-month follow-up: asymptomatic, no relapse
Huang et al, 2015 [12]	58/F	Painless, palpable left breast mass (4 × 3 cm), 1-year duration	AML-M6 diagnosed 2 years prior; treated with 5 cycles idarubicin + ara-C	Mammography: single irregular, poorly defined mass, no calcification; MRI T2: ill-defined in homogeneous hyperintense mass	Myeloid sarcoma: small-sized cells, hyperchromatic nuclei, scant cytoplasm; MPO⁺, CD68⁺ ER^-, PR^- HER2^-, p120^-	Excisional biopsy; post-op chemo: 3 cycles ara-C + idarubicin	N/A	Complete remission; follow-up every 3 months with US, CXR, BM aspiration
Ozsoy et al, 2016 [13]	21/F	Bilateral painless palpable masses (largest 4.5 cm), lower quadrants, for 4 months	N/A (normal BM, peripheral smear)	US: multiple lobulated, hypoechoic solid masses, circumscribed contours, largest 4.5 × 2.7 cm	Myeloid sarcoma: CD34⁺, CD43⁺, CD99⁺, TdT⁺, Bcl-2⁺, CD79a & CD117 weak-moderate, MPO focal, CD68 variable	Excisional biopsy; chemo: high-dose ara-C + idarubicin	N/A	Disease-free during 2-year follow-up
Sharma et al, 2018 [14]	52/F	Painless right breast lump, 8 × 6 cm, skin changes, nipple retraction	N/A (normal CBC, BM biopsy)	US: homogeneous hypoechoic mass, well-defined margins	Myeloid sarcoma: MPO⁺, CD34⁺, CD117⁺; ER^-, PR^-, HER2^-, CK^-	Lumpectomy; consolidation chemo: 3 cycles ara-C + idarubicin	N/A	Complete remission; disease-free at 1-year follow-up
Zhai et al, 2018 [15]	34/F	Palpable right breast mass (about 2.6 × 3.5 cm, superior lateral quadrant), painless	AML-M2, 3 years prior	Mammogram: 2.5 × 2.4 cm, well-defined, irregular margins; 2nd mass 1.4 × 1.1 cm; US: hypoechoic 3.7 × 2.6 cm, another 1.8 × 1.1 cm, axillary LN 1.8 cm	Myeloid sarcoma: MPO⁺, CD43⁺, LCA⁺; weakly CD20⁺, kappa/lambda, PR⁺; negative for CD79α, CD3, CD10, CD5, CD56, AE1/AE3, ER, C-erbB2	Lumpectomy; post-op consolidation chemo: 4 cycles idarubicin + ara-C	N/A	Remission; disease-free at 1.5-year follow-up
Gomaa et al, 2018 [16]	29/F	Left breast lump for 3 months	N/A	US: well-defined mass; mammography: possible hamartoma; MRI: suggested hamartoma	Sheets/cords of pleomorphic neoplastic cells infiltrating parenchyma, sparing ducts/lobules IHC: LCA⁺, MPO⁺, CD68⁺, focal CD34⁺, CD117⁺	Surgery + chemo	Yes, but no description available	6 months: BM biopsies negative, normal WBC, no blasts
Wu et al, 2019 [2]	42/F	Palpable right breast mass (4 months), mobile right axillary LN	N/A (normal BM, no AML)	US: irregular 2 × 1.8 cm lesion, axillary LN about 2 × 0.7 cm; mammography: mass, no calcification; MRI: right breast mass with axillary LN, bilateral dotted lesions; CT: proliferative lesion in right lung	Myeloid sarcoma: MPO⁺, LCA⁺, BCL-2⁺, C-myc⁺, Ki-67 ∼60%	Modified radical mastectomy + SLNB; chemo: 2 cycles IA (inhibition + cytosine arabinoside), then HA (homoharringtonine and cytosine arabinoside)	N/A	Complete remission; disease-free at 1-year follow-up
Khoshnaw et al, 2019 [17]	30/F	Bilateral breast pain and tenderness (2 weeks), post-AML remission	AML-M1, post-induction/consolidation/high-dose ara-C	US: oval heterogeneous masses right: 41 × 26 mm, left: 22 × 14 mm; MRI: multiple round-shaped masses bilaterally, irregular outlines, largest 45 × 40 mm	Myeloid sarcoma: medium-sized blastic cells, perivascular arrangement, frequent mitoses; IHC: CD117⁺, CD45⁺, Ki67⁺, CD34^-, ER^-, PR^-, HER2^-	FLAG-IDA chemo	N/A	Patient died due to disease progression
Kim et al, 2019 [18]	24/F	Hard, painless right breast lump (2 days), upper outer quadrant	AML (18 months prior), multiple extramedullary relapses, haploidentical stem cell transplant 6 months prior	US: 4.3 cm, indistinct, oval, heterogeneous-echoic mass with posterior enhancement, increased vascularity, stiff on elastography	Myeloid sarcoma: hypercellular sheets of immature mononuclear cells, MPO focal positivity	Core needle biopsy; ongoing chemo for relapsed AML	N/A	N/A
Huang et al, 2021 [19]	34/F	Bilateral breast masses (left 3.0 × 1.2 cm, right 2.3 × 1.64 cm), rapid growth	AML-M4, post-allo-HSCT (mother donor), partial response after multiple chemo regimens	US/MRI: multiple well-defined hypoechoic oval lesions, axillary nodules; enhanced masses with small fluid necrosis	Myeloid sarcoma: medium-sized malignant cells, MPO⁺⁺, CD34⁺⁺⁺, CD43⁺⁺⁺, CD68⁺, CD117⁺, Ki67 40%; FLT3-ITD mutation positive	Chemo: multiple regimens (IL-2 + decitabine + thalidomide, azacitidine + ara-C + IL-2, MTX, MTX + venetoclax)	N/A	Patient died March 2021 due to AML cranial invasion
Amiraian et al, 2022 [20]	63/F	Rapidly enlarging bilateral breast masses (2 weeks)	AML (relapsed), history of ovarian cancer	Mammography: multiple high-density masses (left breast), single right breast mass; US: complex hypoechoic central portion, hyperechoic halo bilaterally	Myeloid sarcoma: medium-large myeloid blasts, MPO^-, lysozyme^-, pan-CK^-, CD33⁺, CD43⁺, CD34⁺; FISH: monosomy 7	Core biopsy; planned salvage chemo and future allo-HSCT	N/A	Patient died shortly after diagnosis
Mahfouz et al, 2025 [21]	20/F	Painless left breast mass (55 × 33 mm), slow onset; additional nodules (face, axilla, under eyes)	N/A	US: central retroareolar large hypoechoic mass, moderate vascularity; smaller area in right breast; suspicious bilateral axillary and left infraclavicular nodes; mild skin thickening/edema; PET-CT: FDG-avid bilateral masses	Myeloid sarcoma: diffuse infiltration of small-medium neoplastic cells, MPO⁺, CD34⁺ LCA⁺; CD117 focal⁺, ERG⁺; Ki67 high; CD20, CD3, CD79a negative	Core needle biopsy; chemo: CHOP protocol (cyclophosphamide + doxorubicin + vincristine + prednisolone) followed with 4 cycles of high-dose ara-C	N/A	Complete metabolic and morphologic response; awaiting BMT.
Current case	33/F	Right breast lump (October 2013)	N/A	US: recurrent mass 1.6 × 1.1 cm (2014)	Myeloid sarcoma (IHC consistent with MS)	Chemo: 7 + 3 (ara-C + daunorubicin), 2 × HDAC → remission; allo-HSCT (MUD, BuCyATG conditioning, tacrolimus + MTX GVHD prophylaxis)	25 Gy/10 fx, conformal tangents	> 8 years post-RT: no local recurrence or systemic relapse

↓ Table 1. Recent Case Reports of Breast Myeloid Sarcoma (2014 - 2025): Clinical, Imaging, and Treatment Features

References

Patient age (yrs)/gender

Presentation/symptoms

Past hematologic disease

Imaging findings

Histopathology/IHC

Systemic/surgical treatment

Radiotherapy

Outcome/follow-up

F: female; yrs: years; US: ultrasound; WBC: white blood cell; post-op: postoperative; CT: computed tomography; 3D: three-dimensional; CBC: complete blood count; MRI: magnetic resonance imaging; BM: bone marrow; BMT: bone marrow transplantation; LN: lymph node; allo-HSCT: allogeneic hematopoietic stem cell transplant; MPO: myeloperoxidase; IHC: immunohistochemistry; CXR: chest X-ray; RT: radiotherapy; fx: fractions; ara-C: cytarabine; SLNB: sentinel lymph node biopsy; AML: acute myeloid leukemia; N/A: not available/not applicable; IL: interleukin; FLAG-IDA: fludarabine, cytarabine (ara-C), granulocyte colony-stimulating factor (G-CSF), and idarubicin; HDAC: high-dose cytarabine; Chemo: chemotherapy; MUD: matched unrelated donor; BuCyATG: busulfan, cyclophosphamide, and anti-thymocyte globulin; MTX: methotrexate; GVHD: graft-vs-host disease; PET-CT: positron emission tomography-computed tomography; FDG: fluorodeoxyglucose; ITD: internal tandem duplications.

Goncalves et al, 2014 [4]

35/F

Tender left breast nodule, 25 mm, upper outer quadrant

N/A

US/mammography: solid heterogeneous nodule about 22 mm, small ipsilateral axillary LN; MRI post-chemo: persistent lesion about 60 mm, later resolved

Myeloid sarcoma: MPO⁺, CD45⁺, CD68⁺, CD34⁺, CD31⁺, CD43⁺, Cam5.2^-, CD117^-, CD3^-, CD20^-, TdT^-, CD10^-

Tumorectomy; chemo: idarubicin + ara-C, consolidation 4 × ara-C

30 Gy/15 fx, 3D conformal

26-month follow-up: asymptomatic, no relapse

Huang et al, 2015 [12]

58/F

Painless, palpable left breast mass (4 × 3 cm), 1-year duration

AML-M6 diagnosed 2 years prior; treated with 5 cycles idarubicin + ara-C

Mammography: single irregular, poorly defined mass, no calcification; MRI T2: ill-defined in homogeneous hyperintense mass

Myeloid sarcoma: small-sized cells, hyperchromatic nuclei, scant cytoplasm; MPO⁺, CD68⁺ ER^-, PR^- HER2^-, p120^-

Excisional biopsy; post-op chemo: 3 cycles ara-C + idarubicin

N/A

Complete remission; follow-up every 3 months with US, CXR, BM aspiration

Ozsoy et al, 2016 [13]

21/F

Bilateral painless palpable masses (largest 4.5 cm), lower quadrants, for 4 months

N/A (normal BM, peripheral smear)

US: multiple lobulated, hypoechoic solid masses, circumscribed contours, largest 4.5 × 2.7 cm

Myeloid sarcoma: CD34⁺, CD43⁺, CD99⁺, TdT⁺, Bcl-2⁺, CD79a & CD117 weak-moderate, MPO focal, CD68 variable

Excisional biopsy; chemo: high-dose ara-C + idarubicin

N/A

Disease-free during 2-year follow-up

Sharma et al, 2018 [14]

52/F

Painless right breast lump, 8 × 6 cm, skin changes, nipple retraction

N/A (normal CBC, BM biopsy)

US: homogeneous hypoechoic mass, well-defined margins

Myeloid sarcoma: MPO⁺, CD34⁺, CD117⁺; ER^-, PR^-, HER2^-, CK^-

Lumpectomy; consolidation chemo: 3 cycles ara-C + idarubicin

N/A

Complete remission; disease-free at 1-year follow-up

Zhai et al, 2018 [15]

34/F

Palpable right breast mass (about 2.6 × 3.5 cm, superior lateral quadrant), painless

AML-M2, 3 years prior

Mammogram: 2.5 × 2.4 cm, well-defined, irregular margins; 2nd mass 1.4 × 1.1 cm; US: hypoechoic 3.7 × 2.6 cm, another 1.8 × 1.1 cm, axillary LN 1.8 cm

Myeloid sarcoma: MPO⁺, CD43⁺, LCA⁺; weakly CD20⁺, kappa/lambda, PR⁺; negative for CD79α, CD3, CD10, CD5, CD56, AE1/AE3, ER, C-erbB2

Lumpectomy; post-op consolidation chemo: 4 cycles idarubicin + ara-C

N/A

Remission; disease-free at 1.5-year follow-up

Gomaa et al, 2018 [16]

29/F

Left breast lump for 3 months

N/A

US: well-defined mass; mammography: possible hamartoma; MRI: suggested hamartoma

Sheets/cords of pleomorphic neoplastic cells infiltrating parenchyma, sparing ducts/lobules IHC: LCA⁺, MPO⁺, CD68⁺, focal CD34⁺, CD117⁺

Surgery + chemo

Yes, but no description available

6 months: BM biopsies negative, normal WBC, no blasts

Wu et al, 2019 [2]

42/F

Palpable right breast mass (4 months), mobile right axillary LN

N/A (normal BM, no AML)

US: irregular 2 × 1.8 cm lesion, axillary LN about 2 × 0.7 cm; mammography: mass, no calcification; MRI: right breast mass with axillary LN, bilateral dotted lesions; CT: proliferative lesion in right lung

Myeloid sarcoma: MPO⁺, LCA⁺, BCL-2⁺, C-myc⁺, Ki-67 ∼60%

Modified radical mastectomy + SLNB; chemo: 2 cycles IA (inhibition + cytosine arabinoside), then HA (homoharringtonine and cytosine arabinoside)

N/A

Complete remission; disease-free at 1-year follow-up

Khoshnaw et al, 2019 [17]

30/F

Bilateral breast pain and tenderness (2 weeks), post-AML remission

AML-M1, post-induction/consolidation/high-dose ara-C

US: oval heterogeneous masses right: 41 × 26 mm, left: 22 × 14 mm; MRI: multiple round-shaped masses bilaterally, irregular outlines, largest 45 × 40 mm

Myeloid sarcoma: medium-sized blastic cells, perivascular arrangement, frequent mitoses; IHC: CD117⁺, CD45⁺, Ki67⁺, CD34^-, ER^-, PR^-, HER2^-

FLAG-IDA chemo

N/A

Patient died due to disease progression

Kim et al, 2019 [18]

24/F

Hard, painless right breast lump (2 days), upper outer quadrant

AML (18 months prior), multiple extramedullary relapses, haploidentical stem cell transplant 6 months prior

US: 4.3 cm, indistinct, oval, heterogeneous-echoic mass with posterior enhancement, increased vascularity, stiff on elastography

Myeloid sarcoma: hypercellular sheets of immature mononuclear cells, MPO focal positivity

Core needle biopsy; ongoing chemo for relapsed AML

N/A

Huang et al, 2021 [19]

34/F

Bilateral breast masses (left 3.0 × 1.2 cm, right 2.3 × 1.64 cm), rapid growth

AML-M4, post-allo-HSCT (mother donor), partial response after multiple chemo regimens

US/MRI: multiple well-defined hypoechoic oval lesions, axillary nodules; enhanced masses with small fluid necrosis

Myeloid sarcoma: medium-sized malignant cells, MPO⁺⁺, CD34⁺⁺⁺, CD43⁺⁺⁺, CD68⁺, CD117⁺, Ki67 40%; FLT3-ITD mutation positive

Chemo: multiple regimens (IL-2 + decitabine + thalidomide, azacitidine + ara-C + IL-2, MTX, MTX + venetoclax)

N/A

Patient died March 2021 due to AML cranial invasion

Amiraian et al, 2022 [20]

63/F

Rapidly enlarging bilateral breast masses (2 weeks)

AML (relapsed), history of ovarian cancer

Mammography: multiple high-density masses (left breast), single right breast mass; US: complex hypoechoic central portion, hyperechoic halo bilaterally

Myeloid sarcoma: medium-large myeloid blasts, MPO^-, lysozyme^-, pan-CK^-, CD33⁺, CD43⁺, CD34⁺; FISH: monosomy 7

Core biopsy; planned salvage chemo and future allo-HSCT

N/A

Patient died shortly after diagnosis

Mahfouz et al, 2025 [21]

20/F

Painless left breast mass (55 × 33 mm), slow onset; additional nodules (face, axilla, under eyes)

N/A

US: central retroareolar large hypoechoic mass, moderate vascularity; smaller area in right breast; suspicious bilateral axillary and left infraclavicular nodes; mild skin thickening/edema; PET-CT: FDG-avid bilateral masses

Myeloid sarcoma: diffuse infiltration of small-medium neoplastic cells, MPO⁺, CD34⁺ LCA⁺; CD117 focal⁺, ERG⁺; Ki67 high; CD20, CD3, CD79a negative

Core needle biopsy; chemo: CHOP protocol (cyclophosphamide + doxorubicin + vincristine + prednisolone) followed with 4 cycles of high-dose ara-C

N/A

Complete metabolic and morphologic response; awaiting BMT.

Current case

33/F

Right breast lump (October 2013)

N/A

US: recurrent mass 1.6 × 1.1 cm (2014)

Myeloid sarcoma (IHC consistent with MS)

Chemo: 7 + 3 (ara-C + daunorubicin), 2 × HDAC → remission; allo-HSCT (MUD, BuCyATG conditioning, tacrolimus + MTX GVHD prophylaxis)

25 Gy/10 fx, conformal tangents

> 8 years post-RT: no local recurrence or systemic relapse