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Anaplastic giant cell lymphoma (ALCG) associated with breast implants
Authors:
González Lafuente, Elena; García Ramos, Mateo; Sal de Rellán Arango, Seila; Bulnes Vázquez, Verónica; Budiño Torres, Sara.
Central University Hospital of Asturias, Oviedo, Asturias. SPAIN
Figure 2C & 2D. C and D: Post-contrast sequences with fat suppression (axial and sagittal respectively). Bilateral retropectoral prostheses. A significant amount of periprosthetic fluid at the level of the left breast is striking (yellow asterisks). It causes a significant mass effect, displacing the prosthesis (red asterisks) posteriorly and superiorly (image D). The fluid is encapsulated with a cover that enhances after the administration of contrast (purple arrows).
1Clinical History
An asymptomatic 35-year-old woman who comes for a periodic review of her breast prostheses, placed five years previously.
2Image Findings
Breast sonography was performed, observing the retropectoral breast prosthesis surrounded by a moderate amount of periprosthetic fluid with septations inside that caused an increase in breast volume (Fig.1)
3Diagnosis
Given these findings, more than a year after the placement of the prosthesis, a possible anaplastic giant cell lymphoma associated with the prosthesis was suspected. It was decided to perform an FNA that confirmed the suspected diagnosis (Fig.3).
4Discussion
BACKGROUND:
Anaplastic giant cell lymphoma (ALCG) associated with breast prostheses is a rare type of non-Hodgkin T-cell lymphoma that affects a large variety of tissues, including the breast in those women who have breast implants. It develops from the lymphocytes involved in a fibrous capsule which is formed around the implant, as a consequence of a foreign body reaction. It is a rare and relatively new entity. Its pathogenesis is still unknown although it is currently postulated that it has a multifactorial origin and may be related mainly to three factors: type of implants (more common in surface implants textured than with smooth surface implants), genetic basis, and contamination. It is considered a late complication since it usually appears approximately ten years after the implantation. However, a new periprosthetic leak that appears more than one year after implantation should raise suspicion of ALCL.
CLINICAL PERSPECTIVE:
It usually has an indolent clinical course and in many cases is an incidental finding in periodic check-ups. In some cases, it may present with an increase in breast volume as the main clinical sign.
THERAPEUTIC APPROACH:
The therapeutic option of choice is early removal of the prosthesis.
OUTCOME & PROGNOSIS:
In the case of our patient, she underwent surgery with early removal of the prosthetic material with adequate clinical evolution in subsequent controls.
It usually has a benign clinical course with adequate and early treatment, although cases of death secondary to said disease have been reported.
Anaplastic giant cell lymphoma (ALCG) associated with breast prostheses is a rare type of non-Hodgkin T-cell lymphoma that affects a large variety of tissues, including the breast in those women who have breast implants. It develops from the lymphocytes involved in a fibrous capsule which is formed around the implant, as a consequence of a foreign body reaction. It is a rare and relatively new entity. Its pathogenesis is still unknown although it is currently postulated that it has a multifactorial origin and may be related mainly to three factors: type of implants (more common in surface implants textured than with smooth surface implants), genetic basis, and contamination. It is considered a late complication since it usually appears approximately ten years after the implantation. However, a new periprosthetic leak that appears more than one year after implantation should raise suspicion of ALCL.
CLINICAL PERSPECTIVE:
It usually has an indolent clinical course and in many cases is an incidental finding in periodic check-ups. In some cases, it may present with an increase in breast volume as the main clinical sign.
THERAPEUTIC APPROACH:
The therapeutic option of choice is early removal of the prosthesis.
OUTCOME & PROGNOSIS:
In the case of our patient, she underwent surgery with early removal of the prosthetic material with adequate clinical evolution in subsequent controls.
It usually has a benign clinical course with adequate and early treatment, although cases of death secondary to said disease have been reported.
5Teaching Points
Anaplastic giant cell lymphoma associated with breast prostheses is a rare but potentially serious entity, so early diagnosis is vital. If periprosthetic ffuid appears more than a year after placement of the prosthesis, it must be suspected. In these cases, ultrasound-guided FNA is indicated for correct diagnosis and early treatment by prosthesis removal.
6References
1. Noreña-Rengifo BD, Sanín-Ramírez MP, Adrada BE, Luengas AB, Martínez de Vega V, Guirguis MS, et al. MRI for evaluation of complications of breast augmentation. Radiographics 2002;42(4):S2S–4c.
2. Middleton MS, McNamara MP Jr. Breast implant classification with MR imaging correlation. Radiographics 2000 ;20(3):e1e1.
3. Shah M, Tanna N, Margolies L. Magnetic resonance imaging of breast implants. Top Magn Reson Imaging 2014;23(c):345–53.
4. Sardanelli F, Boetes C, Borisch B, Decker T, Federico M, Gilbert FJ, et al. Magnetic resonance imaging of the breast: Recommendations from the EUSOMA working group. Eur J Cancer .2010 ;4c(8):12Sc– 31c.
2. Middleton MS, McNamara MP Jr. Breast implant classification with MR imaging correlation. Radiographics 2000 ;20(3):e1e1.
3. Shah M, Tanna N, Margolies L. Magnetic resonance imaging of breast implants. Top Magn Reson Imaging 2014;23(c):345–53.
4. Sardanelli F, Boetes C, Borisch B, Decker T, Federico M, Gilbert FJ, et al. Magnetic resonance imaging of the breast: Recommendations from the EUSOMA working group. Eur J Cancer .2010 ;4c(8):12Sc– 31c.
