Presentation
Textured breast implant after mastectomy for breast cancer. She presents after 5 years with enlargement and tenderness of the right breast.
Patient Data
there is a right periprosthetic fluid collection hypointense on T1 and hyperintense on T2, with a high signal on suppressed silicone sequence.
discontinuous regular thickening of the outer shell of the implant (corresponding to periprosthetic adherent fibrin) best seen in the posteromedial border, mimicking a rupture (but there is no silicone leak outside of the prosthesis: there is a clear difference between silicone and seroma signal on T1 and T2 weighted images)
fibrin and debris adherent to the capsule
no enhancement of the fibrous capsule or the periprosthetic fibrin
the patient was referred for a follow-up of the left breast
there is no mass nor pathological enhancement in the left breast
the right breast implant is unremarkable.
The patient went on and had a puncture-aspiration of the seroma.
FINE NEEDLE ASPIRATION CYTOLOGY REPORT (synopsis):
Few large cells with abundant micro vacuolated basophilic cytoplasm and a bulky nucleus with irregular outlines, and fine and nucleolated chromatin.
The background shows cellular debris within an alcianophilic background moderately rich in red blood cells.
Immunohistochemical study :
The large cells are lymphomatous: CD30+, ALK1-, EMA-, CD3+/-, CD2 +/-, CD5-/+, CD4+, TiA1+, CD20-. KPAN: absence of marking.
In situ hybridization with the EBER probe: no labeling of the lymphomatous cells.
moderate FDG uptake (SUV max =2.46) around the right periprosthetic seroma
heterogeneous FDG uptake of the anterior lateral aspect of the spleen (SUV max = 3,9)
there is no hypermetabolic lymphadenopathy
left ovarian avid focus (SUV max = 6,65). and moderate FDG uptake of the right ovary (SUV max = 3,9)
The patient was operated on and had a total capsulectomy with the removal of the breast implant.
PATHOLOGY REPORT (synopsis):
Regular thickening of the capsule, which is lined on its internal aspect with a few adherent foci of fibrin.
There are many large lymphoma cells within the fibrin. The capsule consists of a fibrous shell with abundant and diffuse lymphoid infiltrate.
Immunohistochemical study :
There is CD30 labeling of the lymphoma cells located in the fibrin adherent to the capsule and the periprosthetic fibrin.
The cells are CD30 + 100%, EMA+/- (20%), ALK 1-, CA9 +, CD3 -, CD2 -, CD5 -, CD4 + 100%, TIA1 +++ >90%, CD79 a -
Case Discussion
Breast implant-associated anaplastic large T-cell lymphoma revealed by a late periprosthetic seroma after five years of the initial breast reconstruction.
The patient was referred for a total capsulectomy and removal of the breast implant that revealed lymphoma T-cells in the fibrin adherent to the capsule and in the periprosthetic fibrin with no mass that could be seen on MRI or PET scan.
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