Case Report: Early Breast Cancer Recurrence Mimicking BIA-ALCL in a Patient With Multiple Breast Procedures

Abstract

Breast reconstruction plays a fundamental role in the therapeutic process of breast cancer treatment and breast implants represents the leading breast reconstruction strategy. Breast Implant Associated-Anaplastic Large Cell Lymphoma (BIA-ALCL), locoregional recurrence in the skin flap, and skin flap necrosis are well-known complications following mastectomy and immediate breast reconstruction (IBR). We report a case of locoregional cancer recurrence in the mastectomy flap mimicking BIA-ALCL, in a patient who underwent 6 breast procedures in four facilities across 15 years including immediate breast reconstruction with macrotextured breast implants. Despite the rate and onset of the disease, clinicians should be aware of BIA-ALCL. Due to the risk of false negative results of fine needle aspiration, clinical suspicion of BIA-ALCL should drive clinicians' choices, aside from cytological results. In the present case, surgical capsulectomy of the abnormal periprosthesic tissue revealed locoregional recurrence.

Keywords: breast cancer; breast implant associated-anaplastic large cell lymphoma; breast seroma; case report; immediate breast reconstruction; locoregional recurrence; macro textured breast implants; residual breast tissue.

Figure 1

Immunohistochemical (IHC) study of periprothestic staining. CD30 negative staining on periprosthetic capsule (original magnification 10×).

Figure 2

(a) One mm-wide invasive ductal carcinoma in the fibroadipose tissue surrounding the periprosthetic capsule, whose inner surface can be recognized in the upper left of the panel (hematoxylin eosin, original magnification 2×). (b) Higher magnification highlights the invasive ductal carcinoma shown in (a) (hematoxylin eosin, original magnification 10×). (c) Another section of the fibroadipose tissue surrounding the periprosthetic capsule showing a second focus of invasive ductal carcinoma 2 millimeters-wide. The insert shows the absence of myoepithelial layer in the ductal structures (hematoxylin eosin, original magnification 2×; immunostaining for p63, clone Leica, 10× in the insert). (d) Higher magnification of invasive ductal carcinoma showed in (c) (hematoxylin eosin, original magnification 4×).