Sunday, October 8, 2006

Anaplastic Large Cell Lymphoma Arising in a Saline Breast Implant Capsule after Tissue Expander Breast Reconstruction

Brian Olack, MD, Raavi Gupta, MD, and Glen S. Brooks, MD.

Background: Primary non-Hodgkin lymphoma of the breast represents less than 0.5% of all breast cancers, and the majority are of B-cell origin. Anaplastic large cell lymphoma, T-cell phenotype, arising in the setting of a breast prosthetic capsule is sufficiently rare in that only five cases have been previously reported.

Report of Case: In May 1997, a then 56 year-old female underwent mastectomy, axillary lymph node dissection, and tissue expander reconstruction of the right breast for multifocal ductal carcinoma. The expander was sequentially filled without difficulty, and in February 1998, she underwent replacement of the expander with a 650cc saline implant. In June 2005, the 64 year-old female presented with an enlarged right breast. An ultrasound with aspiration of the seroma was performed and the cytology revealed high grade malignant cells which were suspicious for a recurrence of ductal carcinoma. An MRI showed a large peri-implant collection without suspicious enhancement, and a PET scan showed no metastasis. In July 2005, the patient underwent removal of the right breast implant and radical resection of the implant capsule and pectoral muscle. The final pathology revealed anaplastic large cell lymphoma, T-cell phenotype, ALK-1 negative. A PortaCath was placed for administration of CHOP chemotherapy followed by local radiation.

Discussion: Anaplastic large cell lymphoma, T-cell phenotype has been previously reported in proximity to both silicone and saline breast implants. However, this is only the second reported case arising in the capsule of a breast implant placed for reconstruction after a previous breast malignancy. Although rare, this is a diagnosis that is easily missed and should be considered in the evaluation of breast swelling after previous implant placement.

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