Demystifying Systemic Anaplastic Large Cell Lymphoma After Breast Augmentation: Separating Fact From Fiction
Jocellie Marquez, MD, MBA, Feras Yamin, MD, Kanad Ghosh, BA, Duc Bui, MD.
Stony Brook Medicine, Stony Brook, NY, USA.
PURPOSE: Breast implant associated anaplastic large cell lymphoma (BIA-ALCL) has been a major concern in patients with history of breast augmentation. Rarely is peri-implant breast swelling, pain and lymphadenopathy associated with other types of ALCL. Here we describe a unique case of systemic CD30 positive ALK-1 negative anaplastic large cell lymphoma (ALCL) causing pain and swelling around a textured breast implant
METHODS: The clinical course and diagnosis of a patient presenting with right axilla, breast pain and swelling 16 years post-bilateral breast augmentation.
RESULTS: We present the case of a 44-year-old female with past medical history significant for bilateral submuscular breast augmentation with textured anatomic saline implants performed in 2002. She presented with late onset peri-implant seroma formation, right breast mass, upper extremity swelling, supra-clavicular, mediastinal and mammary lymphadenopathy and pectoralis muscle swelling. Lymph node biopsy was notable for CD30 positive ALK-1 negative ALCL. Brentuximab vedotin in combination with cyclophosphamide, doxorubicin, and prednisone (Bv-CHP) and brentuximabchemotherapy was initiated. Cytology from the bilateral capsulectomies and removal of saline implants were negative for BIA-ALCL markers.
CONCLUSION: To our knowledge, this is the first documented case report of non-BIA-ALCL systemic ALCL involving a breast implant. Systemic ALCL likely triggered an inflammatory response heightened by the presence of the textured material.Plastic surgeons should be aware of various ways breast implants may be involved in a malignant process. Multi-disciplinary management with chemotherapy and implant removal is recommended. Any reconstruction should be delayed until systemic ALCL has been addressed.
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