Acute lymphoblastic leukemia in relapse presenting as a breast lump: a case report.

A 26-year-old assistant nurse was referred .from the Sungei Buloh District Hospital for investigation of anaemia in December 1980. On admission, she had marked pallor and hepatosplenomegaly. Her peripheral blood showed pancytopenia with 80% of white cells being blast cells. These blast cells were rather homogeneous in size and shape, with single poorly-defined nucleolus. Cytochemical study showed that these blast cells were negative for peroxidase, non-specific esterases and acid phosphatase. They were however strongly positive for periodic-acid-Schiff reagent. Bone marrow aspirate revealed that 95% of nucleated cells were blast cells. She was diagnosed to have acute lymphoblastic leukemia.