Anaplastic Large Cell Lymphoma Associated with Double-Lumen Breast Implants: A Case Report and Review of the Literature

Abstract

T he association between breast implants and primary lymphoma of the breast has garnered growing concern since 1995 (1). Primary lymphoma of the breast only constitutes 0.4% to 0.5% of all breast malignancies (2-4). Anaplastic large cell lymphoma (ALCL) is a T cell lymphoma with an incidence of three per 100 million per year in the United States (4-7). The first reported case linking ALCL to textured saline implants dates back to 1997 (8-10). Approximately 91 cases of breast-implant associated ALCL have been documented since that time and, in contrast, it is believed that five to 10 million breast implants have been placed for reconstructive or aesthetic purposes worldwide (3). The pathogenesis of breastimplant associated ALCL remains elusive. Breast implant-associated ALCL presents as a site-specific lymphoma associated with devices of varying size, surface characteristics and pocket location. The median time between breast implant placement and diagnosis of ALCL is eight years, with a range from one to 23 years (11). In 2011, the United States Food and Drug administration alerted the public that women with breast implants have a very low but increased risk for developing ALCL (2,3). However, to date, no case JS Wang, BR DeGeorge Jr, SL Showwalter, RF Morgan. Anaplastic large cell lymphoma associated with double-lumen breast implants: A case report and review of the literature. Plast Surg Case Studies 2016;2(2):20-22. BACkGRounD: Breast implant-associated anaplastic large cell lymphoma (ALCL) is commonly associated with diagnostic delay due to the insidious nature of presentation with late periprosthetic fluid collection, mass or locoregional adenopathy. CASe PReSentAtion: A 75-year-old woman with a remote history of right breast cancer treated with modified radical mastectomy and immediate reconstruction with a double-lumen silicone implant presented 13 years later with volume asymmetry. The implant was removed and a saline implant was placed. Five years later, she presented with acute onset of right breast enlargement and pain. Ultrasound revealed an associated periprosthetic fluid accumulation. Cytology showed anaplastic lymphoma kinasenegative, CD30-positive ALCL without associated systemic disease. The patient was treated with implant removal and total capsulectomy. ConCLuSion: Due to the insidious presentation of ALCL, a high index of clinical suspicion must be maintained when evaluating patients for delayed presentation of volumetric discrepancy. Treatment typically entails implant removal. Indications for additional systemic treatment include extracapsular spread of ALCL or presence of a periprosthetic tumour.

Linfoma anaplásico de células grandes asociado a implantes mamarios diagnosticado mediante punción por aguja fina. Caso clínico

“…Se ha descrito que el LACG-AIM ocurre con más frecuencia cuando se han utilizado implantes con superficies texturizadas en lugar de aquellos con superficies lisas 4 .…”