Breast Implant–Associated Anaplastic Large Cell Lymphoma: A Case Report and Review of the Literature

Abstract

Breast implant–associated anaplastic large T-cell lymphoma has recently been recognized as an entity, with few reports describing the two common subtypes: in situ (indolent) and infiltrative. Recently, the infiltrative subtypes have been shown to be more aggressive requiring adjuvant chemotherapy. We report a rare case of breast implant–associated anaplastic large cell lymphoma (BIA-ALCL) in a 65-year-old Caucasian female following silicone breast implantation and multiple capsulectomies. We discuss the rare presentation of this disease, histopathologic features of the indolent and infiltrative subtypes of ALCL, and their clinical significance. We also review the literature for up-to-date information on the diagnosis and clinical management. Treatment modalities including targeted therapy are also discussed. Although BIA-ALCL is rare, it should always be considered as part of the differential diagnosis especially in women with breast implants. Given the increasing rate of breast reconstruction and cosmetic surgeries, we anticipate a continuous rise in incidence rates of this rare disease; thus, caution must be taken to avoid misdiagnosis.

Breast implant‐associated anaplastic large cell lymphoma: A rare case report of lymphoma in the form of a pericapsular solid formation

“…Primary breast lymphomas are a rarity; they represent approximately 0.7% of all lymphomas and less than 1% of all breast cancer. The majority of these non‐Hodgkin's lymphomas (NHL) that affect the breast derive from B‐cell origin and <10% from T‐cell origin …”

“…It may represent a new entity with less aggressive behavior. This may be similar to the less aggressive primary cutaneous form of ALK‐ negative ALCL, rather than the more aggressive systemic form …”

“…Patients with a distinct mass adjacent to their implant may have a more aggressive clinical course that may become systemic as this often indicates the infiltrative subtype of ALCL and require aggressive treatment including chemotherapy and radiation therapy …”

“…The majority of these non-Hodgkin's lymphomas (NHL) that affect the breast derive from B-cell origin and <10% from T-cell origin. 6,7 Anaplastic large cell lymphomas are a subset of T-cell lymphomas histologically characterized by large and highly pleomorphic T-cells with anaplastic morphology. [12][13][14] Since 1997, many studies have suggested a possible association, without causation, between breast implants and ALCL.…”

“…Breast implant associated‐ anaplastic large cell Lymphoma is ALK negative, and it is characterized by anaplastic T‐cells with eccentric, horseshoe‐shaped nuclei. BI‐ALCL is distinct from primary breast lymphoma, which is composed of B cells and originates from the breast parenchyma …”