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Backache and breast cancer

Backache and breast cancer
#00013038
Author: Neil Abramson
Category: Laboratory Hematology > Non-hematopoietic malignancies involving the blood or bone marrow
Published Date: 08/06/2012

A 46-year-old woman developed mild backache during her usual aerobic exercises. The pain disappeared in several days with an anti-inflammatory drug. She was in her fourth year of follow-up for breast cancer (stage III, ER positive) that was treated with adriamycin and cyclophosphamide followed by tamoxifen. Several weeks after this episode, she visited her oncologist for routine follow-up. Nothing was found on physical examination. However, after the oncologist reviewed the peripheral smear (see left image) and noted red cell deformities, he questioned the woman again about any problems, at which time she recalled the backache. Laboratory work revealed mild anemia and an elevation of the alkaline phosphatase. A bone scan showed 3 to 4 areas of activity, including the region of the previous backache. A bone marrow aspirate and biopsy were performed. A section of the marrow (see right image) illustrates numerous foci of extraneous cells, consistent with metastatic adenocarcinoma.