Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL)
Róża Poźniak-Balicka, Dawid Murawa
Abstract
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) has recently been recognised, and so far approximately 200 cases have been described worldwide. From a histopathological and molecular perspective, it does not differ from classical breast anaplastic large cell lymphoma without ALK kinase expression. However, it has a different clinical course and prognosis, with a five-year survival rate about 92% as compared to 20–50% in patients with the classic form. A 60-year-old female patient had undergone bilateral mastectomy at the age of 45 years due to fibrocystic mastopathy and frequent breast cancer in her family history. Her implants were changed twice due to rupture. In 2018 the patient noticed a growing swelling of the right breast and fluid accumulation in the implant pouch; in September 2018 both implants were removed together, with the pouch also thoroughly removed during the procedure, and other PolyTech implants were inserted. Histological examination revealed the following: breast implant-associated anaplastic large cell lymphoma, immunophenotype: CD30+, ALK–, CD68, PGM–, CKAE1/AE3–, Ki 67 in 90% of cell nuclei. The patient was in very good general condition and without abnormalities in haematological tests. In PET-CT with 18F-FDG (13/12/2018), areas of slightly increased 18F-FDG activity were found in the vicinity of the implants on the right side (SUV max = 1.9) and on the left side (SUV max = 2.3), in addition to left axillary lymph node 12 × 7 × 8 mm (SUV max = 2.0). The patient did not decide to go ahead with the proposed removal of the implants, and a suspicious node was taken for examination — no cancer architecture was found. A control PET-CT test was performed after four months, the result of which was comparable to the previous one. The patient is under observation.