A Case Report of Breast Implant–Associated Anaplastic Large-Cell Lymphoma in a PALB2 Mutation–Positive Woman

Abstract

Breast implant–associated anaplastic large-cell lymphoma (BIA-ALCL) is a rare peripheral T-cell lymphoma composed of anaplastic pleomorphic T cells. The first case was reported in 1997 but was not recognized until 2016 by the World Health Organization. The exact incidence is unknown but is estimated to be 0.1 to 0.3 per 100,000 women with implants. Almost every case has been found in women with textured breast implants. The median time of onset after implantation is 10.7 years. Patients presenting with localized disease, most commonly manifesting as breast enlargement, can be managed solely with surgical resection and have a 100% survival rate. This report describes a PALB2 mutation–positive woman with a strong family history of breast cancer who underwent prophylactic bilateral nipple-sparing mastectomy with textured silicone implant placement. She was diagnosed with BIA-ALCL less than 4 years later after seroma aspiration. She was treated with implant removal and capsulectomy; but, surprisingly, final surgical pathology did not show any malignancy.

BIA-ALCL in patients with genetic predisposition for breast cancer: our experience and a review of the literature

“…Finally, a case of BIA-ALCL in a patient carrying a pathogenic mutation of PALB2 was described by Bonev et al (2021). It was a 72-year-old patient who underwent bilateral prophylactic mastectomy due to a strong family history of breast cancer and the known pathogenic mutation and was reconstructed with textured silicone implants.…”

“…From the Dutch nationwide Pathology Database, a population of 49 women affected by BIA-ALCL was identified (De Boer et al ., 2020), in which six patients had germline BRCA1 and BRCA2 mutations with a prevalence of 12.2% (95% CI, 4.6–24.8). Among these patients, 32 women received breast implants for aesthetic purposes, 15 patients for reconstruction after breast cancer, and the remaining two after risk-reducing surgery in high-risk patients.…”

“…Unfortunately, few data exist in the literature about BIA-ALCL in this subgroup of women (Table 1), and genetic predisposition for breast cancer has not been investigated or reported in the majority of medical reports regarding BIA-ALCL. Current data (De Boer et al ., 2020) on BIA-ALCL risk in women with germline mutations need to be validated in more and larger series.…”

“…Lastly, germline mutation of PALB2 was described by Bonev et al (2021) in a BIA-ALCL patient. This gene is a known partner and localizer of BRCA2, which is vital for homologous recombination (HR) repair in response to DNA double-strand breaks (DSBs).…”

“…In this light, de Boer et al . (2020) identified from the Dutch nationwide Pathology Database 15 BIA-ALCL occurring after reconstruction for breast cancer of which 26.6% (4/15) were diagnosed in BRCA1 or BRCA2 mutation carriers.…”