lymphoma , malign melanoma and rhabdomyosarcoma are the most common tumors that metastasize to the breast tissue .
breast metastases in cases of leukemia are very rare and occur primarily in patients with acute myeloid leukemia .
we report the conventional and advanced magnetic resonance imaging ( mri ) findings of unilateral breast involvement of all and review the literature .
a 32-year - old woman with all under remission was admitted to the department of internal medicine in our institution .
this patient was first diagnosed with all in june 2004 and was treated between june and december 2004 .
the giant mass , involving the whole right breast at the time of presentation grew progressively in a period of 3 months .
the mass and contralateral breast tissue was further evaluated with mri , diffusion weighted imaging ( dwi ) and mr spectroscopy .
mri was done with a 1.5 tesla mr device ( signa hdx ; general electric , milwaukee , usa ) .
the routine sequences were axial short ti inversion recovery ( stir ) , sagittal fast spin echo ( fse ) , fat saturated t2w , sagittal 3d vibrant ( postcontrast fat saturated t1w ) .
we added dwi with b=0 and b=600 values and brease ( single voxel mr spectroscopy ) sequence .
the giant right breast mass was hyperintense - isointense on precontrast fat saturated t1w images ( figure 1a ) and heterogeneously hypointense - hyperintense on stir and fat saturated t2w images ( figure 1b and 1c ) .
in the vibrant sequence , there was a prominent enhancement of the solid components ( figure 1d and 1e ) .
time - signal intensity curves obtained by post - processing were classified as type 2 ( figure 1f ) .
the lesion was hyperintense on dwi ( figure 1 g ) , and hypointense in apparent coefficient diffusion ( adc ) maps ( figure 1h ) .
the adc value was extremely low ( 3.1210 mm / sec ) representing prominent restricted diffusion .
a prominent choline peak compatible with malignancy was detected at 3.2 ppm in the brease sequence ( figure 1i ) .
there was no sign of chest wall invasion and the other breast was normal . with these findings
cd34 ( + ) , tdt ( + ) , cd20 ( - ) , cd3 ( - ) , cd79 ( - ) , mpo ( - ) were found in immunhistochemical analysis .
a new chemotherapy regimen was started , but unfortunately the treatment was not successful and the patient died .
metastases to the breast from extramammary malignant neoplasms are unusual and were described first in 1903 .
metastatic cancer to the breast is often discovered as a superficial solitary mass ( 85% ) , located in the upper outer quadrant ( 66% ) .
metastases are frequently multiple and bilateral , but they are more commonly large , solitary tumors .
metastatic breast leukemia is very rare and occurs primarily in patients with acute myeloid leukemia .
the explanation of this ring - enhancement is reported due to the central necrosis and peripheral angiogenesis in the literature .
malignant tumors , show attenuated diffusion on dwi , and the adc values are low secondary to high cellular density .
choline takes part in cellular membrane turn - over and is a marker of cellular proliferation . in malignancy ,
the choline concentration increases as a result of both intracellular phosphocholine and high cellular density of the lesion .
moreover , it was reported that high choline content was compatible with the increase of angiogenetic activity . in our case
the extremely rare involvement of the breast in cases of leukemia can be the only complaint at initial presentation or seen as relapse .
moreover , radiotherapy performed for breast malignancies can also cause acute leukemia in breast tissue . in a patient with a known malignancy ,
any enlarging breast mass , even one with a reassuring benign sonographic appearance must be investigated promptly , initially with fine - needle aspiration or core needle biopsy .
breast metastases are usually associated with disease originating elsewhere , and the prognosis is generally poor .
 breast metastases in cases of leukemia are rare . we aimed to report the conventional - advanced magnetic resonance imaging ( mri ) findings of unilateral breast involvement of acute lymphoblastic leukemia ( all ) and review the literature . 
 a 32-year - old woman was first diagnosed with all in treated in 2004 . 
 she did not continue the follow - up after 2008 . 
 she was presented with a giant , progressive right breast palpable mass in 2010 . 
 mass , contralateral breast tissue were evaluated with mri , diffusion weighted imaging and mr spectroscopy . with mri findings , 
 lesion was evaluated as malignant , tru - cut biopsy revealed recurrence of all . 
 lymphoma , malignant melanoma , rhabdomyosarcoma are most common tumors metastase to breast . 
 breast metastases of leukemia are rare and occur primarily in patients with acute myeloid leukemia . 
 secondary all breast involvement is uncommon . in a patient with malignancy , 
 any enlarging breast mass , even with benign radiologic appearance , should be investigated carefully and metastasis should not be forgotten . 
INTRODUCTION
CASE REPORT
DISCUSSION