Breast Implant-Associated Anaplastic Large Cell Lymphoma: A Case Report

The Food and Drug Administration (FDA) released a statement in the beginning of 2017 regarding a rare cancer, Anaplastic Large Cell Lymphoma (ALCL) that has been related to textured breast implants and resulted in nine deaths. The first case of Breast Implant-Associated ALCL (BIA-ALCL) was published in 1997. This entity is more recently recognized and has been provisionally classified in the 2016 revision of the World Health Organization classification of lymphoid neoplasms. Here we report a case of a 58 year old woman with history of sub glandular silicone implants for bilateral breast augmentation 25 years ago, with complaints of bilateral breast pain and found to have bilateral Baker Grade III capsular contracture, and a suspicious chest wall lesion on imaging. Patient underwent removal of bilateral breast implants and total capsulectomies. The capsule and all associated abnormal lesions were sent for excisional biopsy. Microscopic examination revealed breast implantassociated anaplastic large cell lymphoma on the left side. On immunohistochemistry the lymphoma cells were positive for CD3 (subset), CD4, CD7, CD30, and CD43, and negative for CD2, CD5, CD8, CD68 and ALK1; supporting the diagnosis of breast implant-associated anaplastic large cell lymphoma. No lymphoma cells were identified in the submitted sections of right breast capsule which was confirmed by CD30 stain. This diagnostic workup proves it to be a Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) which is an uncommon peripheral Tcell lymphoma arising around textured-surface breast implants.