Cytological diagnostic features of late breast implant seromas: From reactive to anaplastic large cell lymphoma

Abstract

Late breast implant seroma may be the presentation of a breast implant-associated anaplastic large cell lymphoma (BI-ALCL), which claims for a prompt recognition. However, BI-ALCL diagnosis on fine-needle aspiration (FNA) might be challenging for pathologists lacking experience with peri-implant breast effusions. Sixty-seven late breast implant seromas collected by FNA from 50 patients were evaluated by Papanicolaou smear stain and immunocytochemistry on cell blocks. A diagnostic algorithm based on the cellular composition, cell morphology and percentage of CD30+ cells was developed. Histological evaluation of the corresponding peri-prosthetic capsules was also performed. Most of the effusions (91% of the samples) were classified as reactive and 9% as BI-ALCL. In the BI-ALCL cases, medium-to-large atypical cells expressing CD30 represented more than 70% of the cellularity, whereas in in the reactive effusions CD30+ elements were extremely rare (<5%) and consisted of non-atypical elements. The reactive effusions were categorized into three patterns: i) acute infiltrate with prominent neutrophilic component (33% of the samples); ii) mixed infiltrate characterized by a variable number of neutrophils, lymphocytes and macrophages (30% of the samples); iii) chronic infiltrate composed predominantly of T lymphocytes or macrophages with only sporadic granulocytes (37% of the samples). The inflammatory cytological patterns were consistent with the histology of the corresponding capsules. Our results indicate that cytological analysis of late breast implant effusions, supported by the knowledge of the heterogeneous cytomorphological spectrum of late seromas, is a valuable approach for the early recognition of BI-ALCL.

Diagnosis of anaplastic large cell lymphoma on late peri‐implant breast seroma: Management of cytological sample by an integrated approach

“…This is important for lymphoma diagnosis and classification but also to exclude a possible neoplastic recurrence during breast cancer follow‐up. It also allows for molecular studies, as ALK rearrangement by FISH and TRG rearrangement by PCR have been reported as discussed above and in other studies …”

“…BI‐ALCL cells are CD30 positive; T‐cell differentiation markers (CD3, CD2, CD7, CD4, CD8, CD5) and CD43 may be variably positive . Few CD30‐positive large cells may be present in reactive PBS . These cells are usually immunoblasts, confirmed by CD20 positivity.…”

“…Indeed Di Napoli et al. have recently described a recent series of 67 late PBS from 50 patients in which BI‐ALCL represented 9% of the samples . The increase of BI‐ALCL cases is probably due to the widespread awareness of the neoplasm.…”

“…Late peri‐implant breast seroma (PBS) is a rare tardive clinical complication of breast device surgical implantation . It occurs in <1% of cases and consists of an accumulation of serous fluid between the implant and the surrounding fibrous capsule, after at least 1 year from the placement of the breast implant . The large majority of PBS is due to benign conditions including mechanical shearing, infections and implant rupture .…”

“…Indeed Di Napoli et al have recently described a recent series of 67 late PBS from 50 patients in which BI-ALCL represented 9% of the samples. 1 The increase of BI-ALCL cases is probably due to the widespread awareness of the neoplasm. Indeed, the knowledge that this neoplasm can be diagnosed by the cytological examination of the seroma determined a more accurate management of the sample.…”