JAOCR at the Viewbox: Breast Implant-Associated Anaplastic Large Cell Lymphoma

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A 65-year-old woman with bilateral breast implants complained of increased right breast swelling. The patient had textured breast implants placed 14 years earlier, and approximately 10 years after surgery she began to have right breast swelling. Bilateral diagnostic mammograms (A) demonstrate a curvilinear focal asymmetry (star) surrounding the right breast implant, asymmetric from the left, suggestive of peri-implant fluid. Ultrasound (B) confirmed a moderate amount of homogeneous peri-implant fluid (star). This patient underwent surgical removal of bilateral implants and bilateral capsulectomies with pathology demonstrating breast-implant associated anaplastic large cell lymphoma (BIA-ALCL).

BIA-ALCL is a rare T-cell lymphoma typically occurring in the setting of a late-onset (defined as >1 year after surgery) fluid collection around a textured breast implant.1 The most common clinical presentation is swelling of the affected breast related to the periprosthetic effusion.1 Less commonly, the condition presents as a palpable mass.1 The late-onset large spontaneous periprosthetic fluid collection occurs on average 8 to 10 years following implantation with a textured surface breast implant.2 Mammography generally demonstrates nonspecific findings while ultrasound has high sensitivity to detect a peri-implant fluid collection or a mass.1 When an effusion is present, fine-needle aspiration is indicated with at least 50 mL of fluid sent to pathology.1 Indicating suspicion for BIA-ALCL is important for the pathologist because specific immunophenotyping markers must be tested to confirm the diagnosis.1 When BIA-ALCL presents as a periprosthetic mass in the affected breast, percutaneous needle biopsy or surgical excisional biopsy can be performed to establish the diagnosis.1 When ultrasound yields indeterminate results, breast MRI is the second imaging test of choice that can evaluate for capsule integrity, presence of effusion, and masses.1,2 Although the majority of cases may be treated with surgery alone, extent of disease and/or lymph node involvement may also necessitate radiation and/or systemic therapy.2

References

  1. Sharma B, Jurgensen-Rauch A, Pace E, et al. Breast implant-associated anaplastic large cell lymphoma: review and multiparametric imaging paradigms. RadioGraphics 2020;40(3):609-628.
  2. Clemens, M, Horwitz SM. NCCN Consensus Guidelines for the Diagnosis and Management of Breast Implant-Associated Anaplastic Large Cell Lymphoma. Aesthet Surg J 2017;37(3):285-289.
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Kapoor MM, Whitman GJ.  JAOCR at the Viewbox: Breast Implant-Associated Anaplastic Large Cell Lymphoma.  J Am Osteopath Coll Radiol.  2021;10(1):40.

About the Author

Megha M. Kapoor, M.D., Gary J. Whitman, M.D.

Megha M. Kapoor, M.D., Gary J. Whitman, M.D.

Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX


 

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