Imatinib‑induced gynecomastia: A case report

Abstract

Chronic myeloid leukemia is a myeloproliferative neoplasm characterized by the unregulated and abnormal proliferation of both mature and immature granulocytes, which results in the proliferation of peripheral blood leukocytes. Imatinib, a tyrosine kinase inhibitor, is the first-line treatment for patients diagnosed with chronic myeloid leukemia. However, despite its favorable safety profile, imatinib use is associated with a number of side effects. Gynecomastia is a rare adverse effect of imatinib treatment and may be associated with an imbalance in sex hormones. The present study reports the case of a patient with chronic myeloid leukemia diagnosed with gynecomastia after imatinib treatment. The aim of the present report was to highlight to clinicians this adverse reaction to imatinib treatment and investigate a treatment strategy with fewer side effects.

Keywords: chronic myeloid leukemia; gynecomastia; imatinib.

Figure 1

Abdominal color ultrasound performed in March 2016. The ultrasound demonstrated an enlarged spleen measuring ~164 mm in length and ~52 mm in thickness. Left panel, liver; right panel, spleen.

Figure 2

Bone marrow smear results indicating hyperactive bone marrow hyperplasia. Neutrophilic myelocytes exhibited hyperplasia, with 5% acidophils (red arrow) and 3% alkalophils (black arrow). Magnification, x100.

Figure 3

Bone marrow biopsy showing active bone marrow hyperplasia, increased proportion of erythroid lines, granular hyperplasia, predominance of mature cells and acidophilic granulocytes. Magnification, x40.

Figure 4

Bone marrow cell chromosome analysis demonstrating the presence of the Philadelphia chromosome (arrow).

Figure 5

Fluorescence in situ hybridization of bone marrow samples showing positive expression of the BCR activator of RhoGEF and GTPase-ABL proto-oncogene fusion gene. Magnification, x1,000.

Figure 6

Color ultrasound of breast tissue performed in January 2017. The right breast tissue had a size of 27x29x8 mm. The hierarchy of the right breast was clear, the skin surface was smooth and the echo of the gland layer was uniform. The left mammary gland had a discoid echo and was ~14x13x6 mm in size. Left panel, left breast; right panel, right breast.

Figure 7

Color ultrasound of breast tissue performed in April 2017. The right breast tissue had a size of 34x27x11 mm. The right breast had clear layers and low echogenicity. The left gland layer was uniform, with no obvious dilated ductal echo. The left mammary gland had a discoid echo and was ~14x13x6 mm in size. Left panel, right breast; right panel, left breast.

Figure 8

Abdominal color ultrasound performed in April 2024 showing normal liver, gallbladder and splenic function. Left panel, portal vein blood flow chart; middle panel, right kidney exhibited hydronephrosis; right panel, the right ureter was dilated, and stones can be seen in the upper section.