Breast Implant-Associated Anaplastic Large Cell Lymphoma (ALCL): A Case Report

Abstract

BACKGROUND Anaplastic large cell lymphomas (ALCL) are a rare type of primary breast lymphoma. The association between breast implants and ALCL was first described in 1997 and since then 34-173 cases have been presented. The annual incidence of breast implant-associated ALCL (BI-ALCL) is 0.1-0.3 per 100 000 women who undergo breast reconstruction, and cases are often underreported due to the rarity of these tumors. BI-ALCL arises from the inflammatory T cells surrounding the fibrous capsule, and most tumors are in situ. CASE REPORT Here, we present the case of a 51-year-old woman with ALCL following bilateral silicone breast implants. The patient presented with breast enlargement and tenderness 9 years following reconstructive surgery. Imagining studies showed fluid collection surrounding the affected breast implant. Staging studies and histocytopathology examination confirmed the presence BI-ALCL without capsular invasion or metastasis. Complete surgical excision was performed. The patient continues to be in complete remission. CONCLUSIONS Due to the rarity of these tumors, establishing the diagnosis of BI-ALCL can be challenging and requires a multidisciplinary approach. Clinicians should be aware of the relationship between breast implants and BI-ALCL.

Figure 1.

Imaging studies. Evaluation studies included breast mammography, ultrasound, magnetic resonance imaging (MRI), computed tomography (CT), and positron emission tomography (PET). (A) Mammogram. MLO and CC views demonstrated a smooth soft tissue density area completely surrounding the silicone breast implant. (B) Ultrasonography of the left breast showed an anechoic fluid collection. (C) MRI of the breasts. Sagittal view T2W sequence demonstrated the bright signal intensity fluid-like collection surrounding the dark signal intensity central silicone breast implant. This was not enhancing, as seen on the axial post contrast (colored image) subtraction vibrant sequences. (D) PET/CT study. No FDG uptake was observed in the left breast fluid density (white arrows CT) surrounding the implant. The right breast implant is unremarkable.

Figure 2.

Histology and Immunohistochemical (IHC) studies. (A) Cell block stained with hematoxylin and eosin (40×) showing atypical lymphocytes with enlarged nuclei and prominent nucleoli (inset, 100× magnification of an atypical large cell). (B) CD30 stains the majority of the cells (40×). (C) EMA stains a subset of cells, mainly the most atypical enlarged cells (40×). (D) CD3 stains most of the cells (40×).

Figure 3.

Gross anatomical representation of the case. (A) Photograph of the breast status after bilateral augmentation depicts asymmetry in the patient’s left breast prior to surgery. (B) En bloc removal of the breast implant, the inner surface of smooth glistening implant capsule with no distinctive lesions.