Recurrent Systemic Anaplastic Lymphoma Kinase–Negative Anaplastic Large Cell Lymphoma Presenting as a Breast Implant–Associated Lesion

Abstract

A woman aged 48 years presented with fevers, chills, weight loss, and night sweats. She had significant lymphadenopathy of the left neck as well as the left axilla. Her history was significant for bilateral breast augmentation with textured silicone implants more than 25 years ago. Excisional biopsy of a cervical lymph node revealed large, atypical cells positive for CD4 and CD30 and negative for Epstein-Barr virus-encoded ribonucleic acid, CD2, CD3, CD5, CD7, CD8, CD15, CD20, pan-keratin, S100, anaplastic lymphoma kinase (ALK), and paired box 5. These findings were consistent with Ann Arbor stage IIIB ALK-anaplastic large cell lymphoma (ALCL). The patient was started on 6 cycles of cyclophosphamide, doxorubicin, vincristine, and prednisone. She initially had no signs or symptoms of breast involvement; however, after developing seroma during the clinical course, the patient underwent capsulectomy and removal of the intact, textured silicone implants. Pathological evaluation demonstrated ALK-ALCL in the left breast capsule with cells displaying a significant degree of pleomorphism with binucleated forms and numerous mitoses. Fluorescence in situ hybridization confirmed the tumor was negative for t(2;5). She presented 8 weeks later showing evidence of recurrent systemic disease.

Breast Implant–Associated Anaplastic Large-Cell Lymphoma: Current Understanding and Recommendations for Management

“…Notably, complete remission has been achieved in patients with visceral disease with use of brentuximab vedotin. 78 Additionally, the drug has been successful in the neoadjuvant setting for reducing chest wall invasion. 79 Timely diagnosis, implant and capsule removal, and chemotherapy (when necessary) are essential in the management of BIA-ALCL.…”

Breast implant–associated anaplastic large cell lymphoma, a systematic review and in‐depth evaluation of the current understanding

“…The average age of patients documented was 53.6 years. The majority of cases presented with unilateral breast swelling (including enlargement and tenderness), lymphadenopathy, skin manifestations, and B symptoms (fever, chills, weight loss, night sweats, etc) . Imaging done showed a pericapsular fluid collection in the majority of patients, with masses and superficial lesions presenting much more rarely .…”

“…The average implant life before presentation was 9.9 years, with the shortest implant duration being 2 months in a patient who had undergone exchange of old implants . After diagnosis, four patients who did not undergo immediate removal of the implants developed recurrent BIA‐ALCL; of these, three achieved remission upon explantation but the fourth expired . Data surrounding the indication for implants, volume, type, brand, and laterality were inconsistently recorded.…”

Screening of a Novel Upregulated lncRNA, A2M-AS1, That Promotes Invasion and Migration and Signifies Poor Prognosis in Breast Cancer

“…CD2 and SELL participate in the leukocyte transendothelial migration pathway. CD2, which is regarded as an immune response molecule, has been documented to be involved in breast cancer recurrence and metastasis and to play a vital role as a prognostic factor for patients with breast cancer [31][32][33]. SELL is a cell surface adhesion molecule.…”