Background: Primary anaplastic large-cell lymphoma (ALCL) occurring in women with breast implants is very rare. It is usually described as tumor cells infiltrating the periprosthetic capsule. These are most often revealed by a periprosthetic recurrent isolated effusion (seroma cavity), occurring late after implantation of the prosthesis. ALCL is more rarely a tumor or periprosthetic capsular contracture. Case: We report a 66-year-old woman, initially diagnosed by cytological examination of breast effusion, in whom ALCL appeared two and a half months after the removal of a ruptured implant. Repeated biopsies of the periprosthetic capsule performed in parallel showed fibrous tissue, without tumor proliferation. Only meticulous histological examination of the total capsulectomy identified tumor cells as a thin and discontinuous layer along the inner surface of the capsule without capsular invasion. Conclusion: Awareness of the histological pattern of this new clinical entity is important. A total capsulectomy with a good sampling for microscopic examination should be conducted for any suspicion of breast implant-associated ALCL. Cytology-histology correlation is essential.

1.
Talwalkar SS, Miranda RN, Valbuena JR, Routbort MJ, Martin AW, Medeiros LJ: Lymphomas involving the breast: a study of 106 cases comparing localized and disseminated neoplasms. Am J Surg Pathol 2008;32:1299-1309.
2.
Story SK, Schowalter MK, Geskin LJ: Breast implant-associated ALCL: a unique entity in the spectrum of CD30+ lymphoproliferative disorders. Oncologist 2013;18:301-307.
3.
Taylor CR, Siddiqi IN, Brody GS: Anaplastic large cell lymphoma occurring in association with breast implants: review of pathologic and immunohistochemical features in 103 cases. Appl Immunohistochem Mol Morphol 2013;21:13-20.
4.
Centre for Devices and Radiological Health US Food and Drug Administration: Anaplastic large cell lymphoma (ALCL) in women with breast implants: preliminary FDA findings and analyses. http://www fda gov/downloads/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/BreastImplants/UCM240003 (pdf 2011).
5.
Kenkel JM: Discussion: Anaplastic large cell lymphoma and breast implants: a systematic review. Plast Reconstr Surg 2011;127:2151-2153.
6.
Aladily TN, Medeiros LJ, Amin MB, Haideri N, Ye D, Azevedo SJ, Jorgensen JL, de Peralta-Venturina M, Mustafa EB, Young KH, You MJ, Fayad LE, Blenc AM, Miranda RN: Anaplastic large cell lymphoma associated with breast implants: a report of 13 cases. Am J Surg Pathol 2012;36:1000-1008.
7.
Lechner MG, Lade S, Liebertz DJ, Prince HM, Brody GS, Webster HR, Epstein AL: Breast implant-associated, ALK-negative, T-cell, anaplastic, large-cell lymphoma: establishment and characterization of a model cell line (TLBR-1) for this newly emerging clinical entity. Cancer 2011;117:1478-1489.
8.
Thompson PA, Lade S, Webster H, Ryan G, Prince HM: Effusion-associated anaplastic large cell lymphoma of the breast: time for it to be defined as a distinct clinico-pathological entity. Haematologica 2010;95:1977-1979.
9.
Lazzeri D, Agostini T, Bocci G, Giannotti G, Fanelli G, Naccarato AG, Danesi R, Tuccori M, Pantaloni M, D'Aniello C: ALK-1-negative anaplastic large cell lymphoma associated with breast implants: a new clinical entity. Clin Breast Cancer 2011;11:283-296.
10.
Kim B, Roth C, Chung KC, Young VL, van BK, Schnyer C, Mattke S: Anaplastic large cell lymphoma and breast implants: a systematic review. Plast Reconstr Surg 2011;127:2141-2150.
11.
Wong AK, Lopategui J, Clancy S, Kulber D, Bose S: Anaplastic large cell lymphoma associated with a breast implant capsule: a case report and review of the literature. Am J Surg Pathol 2008;32:1265-1268.
12.
Kim B, Roth C, Young VL, Chung KC, van BK, Schnyer C, Mattke S: Anaplastic large cell lymphoma and breast implants: results from a structured expert consultation process. Plast Reconstr Surg 2011;128:629-639.
13.
Brody GS: Brief recommendations for dealing with a new case of anaplastic large T-cell lymphoma. Plast Reconstr Surg 2012;129:871e-872e.
14.
Revised CAP guidelines for prosthetic breast implants. CAP Today 1995;9:58.
15.
Swerdlow SH, Campo E, Harris NL, Jaffe ES, Pileri SA, Stein H, et al: WHO Classification of Tumours of Hematopoietic and Lymphoid Tissues, ed 4. Lyon, International Agency for Research on Cancer, 2008.
16.
Popplewell L, Thomas SH, Huang Q, Chang KL, Forman SJ: Primary anaplastic large-cell lymphoma associated with breast implants. Leuk Lymphoma 2011;52:1481-1487.
17.
Lechner MG, Megiel C, Church CH, Angell TE, Russell SM, Sevell RB, Jang JK, Brody GS, Epstein AL: Survival signals and targets for therapy in breast implant-associated ALK-anaplastic large cell lymphoma. Clin Cancer Res 2012;18:4549-4559.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.