Granulocytic sarcoma of breast: an aleukemic presentation.

Granulocytic sarcoma is a rare extramedullary tumor composed of immature myeloid cells. It is usually associated with leukemia or other myeloproliferative disorders but can also occur without overt hematologic diseases. The breast is an uncommon site of presentation and requires a high index of suspicion for diagnosis. We report such a case in a 45-year-old female, who presented with nontender left breast lump of 6 months' duration. A peripheral smear and bone marrow examination at that time was normal. A lumpectomy was done. An H and E diagnosis of lobular carcinoma vs. non-Hodgkin's lymphoma was entertained. Immunostains, however, revealed myeloperoxidase, naphthol AS-D chloroacetate esterase and CD43 positivity, indicating a diagnosis of granulocytic sarcoma. It appears that early initiation of systemic AML-type chemotherapy is beneficial and may delay or avert the development of AML in bone marrow and blood. Eight months later, the patient presented with an orbital mass; bone marrow and peripheral smear involvement by AML.

Choroidal melanoma metastatizing to the biliary system: A diagnostic dilemma.

Metastatic melanoma to the gall bladder is extremely rare and is associated with a very poor prognosis. We report a case of choroidal melanoma metastatizing to the hepatobiliary system, with an unusual presentation. Our patient presenting with obstructive jaundice was misdiagnosed as having carcinoma of the gall-bladder, but the diagnosis of metastatic melanoma to the gallbladder was confirmed by ultrasonography guided fine needle aspiration cytology (USG-FNAC). On reviewing the past history, the patient had a history of enucleation for choroidal melanoma. Even though the liver 'is' a common site for metastasis of choroid melanoma, the patient presenting with a suspected gall bladder mass 'is' a rare presentation. Hence, gastrointestinal symptoms and a history of melanoma should be investigated for the presence of gastrointestinal or liver metastases, even if the original primary malignancy was diagnosed years before the patient's presentation.

Primary aneurysmal cyst: bone type in the breast.

A 60-year-old women presented with one month's history of a large breast lump. On examination she had irregular hard mass occupying the central and outer quadrants of the right breast with no palpable lymph nodes. Fine needle aspiration cytology (FNAC) diagnosis was a benign stromal lesion. In view of the large size, a simple mastectomy was performed. We are reporting this case of primary extrasseous aneurysmal cyst of the bone in the breast as the first case described in the literature.