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Skin involvement as the first manifestation of breast implant‐associated anaplastic large cell lymphoma
Author(s) -
Alcalá Rebeca,
Llombart Beatriz,
Lavernia Javier,
Traves Víctor,
Guillén Carlos,
Sanmartín Onofre
Publication year - 2016
Publication title -
journal of cutaneous pathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.597
H-Index - 75
eISSN - 1600-0560
pISSN - 0303-6987
DOI - 10.1111/cup.12697
Subject(s) - anaplastic large cell lymphoma , medicine , pathology , cd30 , breast implant , cd15 , breast cancer , lymphoma , metastasis , large cell , epithelioid cell , immunohistochemistry , implant , adenocarcinoma , cancer , biology , stem cell , cd34 , surgery , genetics
Breast implant‐associated anaplastic large cell lymphoma ( ALCL ) is a newly described clinical and pathologic entity that typically presents as seroma in the fibrous scar around the implant. Less frequently, it presents as a solid peri‐implant mass, and there have been no reports to date of cutaneous lesions as the presenting manifestation. We report the case of a 56‐year‐old woman with a history of bilateral breast reconstruction following breast cancer of the right breast who consulted with several papules on the right breast suggestive of metastasis. Histopathology showed a proliferation of large epithelioid lymphocytes with highly pleomorphic cells and nuclei. The neoplastic cells were CD15 and CD30 positive and ALK ‐1 negative. The epithelial markers were all negative except for epithelial membrane antigen ( EMA ), which was weakly positive. Molecular analysis showed monoclonal T‐cell receptor γ gene rearrangement, confirming a diagnosis of breast implant‐associated ALCL . The non‐specific morphology of the skin lesions, the epithelioid nature of the neoplastic cells and the expression of EMA can lead to an erroneous diagnosis of skin metastases from a poorly differentiated adenocarcinoma of the breast. We recommend immunohistochemical staining for CD30 and ALK ‐1 for patients with breast implants who develop anaplastic lesions.