Baylor University Medical Center Proceedings October 2017 - 441

Breast implant-associated anaplastic large cell lymphoma
Lindsay Keith, MD, William Herlihy, MD, Houston Holmes, MD, and Paul Pin, MD

Anaplastic large cell lymphoma is a rare
disease associated with breast implants.
We present the case of a woman who had
had breast augmentation and multiple
revisions over a period of 13 years and
presented with recurrent fluid collections.
The cause was determined to be anaplastic large cell lymphoma, which required
removal of the implants, capsulectomy,
and evaluation by a medical oncologist.
The patient was not found to have meta- Figure 1. (a) Front view of the patient at presentation. (b) Side view of the patient at presentation.
static disease on imaging studies. Breast
implant-associated anaplastic large cell lymphoma is a poorly understood
surgeon performed further workup for this ﬂuid accumulation
prior to performing another revision of her augmentation. A
disease entity, and optimal treatment is unclear.

reast implant-associated anaplastic lymphoma kinase
(ALK)-negative large cell lymphoma (BIA-ALCL) is a
rare clinical entity, with fewer than 400 reported cases
in the literature, most of which are case reports. It was
ﬁrst described in 1997 (1) and has a suspected incidence of
0.3% per 100,000 women per year (2). This may be a gross
underestimation, given the number of breast augmentation
and reconstructive procedures performed worldwide, and could
reﬂect the diﬃculty in establishing a diagnosis. This case report
describes a 60-year-old woman with BIA-ALCL.

CASE STUDY
A 60-year-old white woman with no signiﬁcant past medical
history presented to her plastic surgeon with a grossly distorted, swollen, and enlarged left breast without evidence of a mass
(Figure 1). There was no history of trauma or systemic symptoms.
She previously had breast augmentation with multiple revisions;
the ﬁrst procedure took place when she was 43 years old. The
procedure used polyurethane implants in the subglandular location. The patient subsequently had three further revisions of her
augmentation secondary to recurrent ﬂuid accumulation on the
left breast.
At age 59, the patient began to have increasing ﬁrmness
and tenderness of the left breast, which was associated with yet
another ﬂuid collection requiring implant exchange. The plastic
Proc (Bayl Univ Med Cent) 2017;30(4):441-442

diagnostic mammogram and ultrasound revealed only a small
amount of ﬂuid around the left implant in the 12 o'clock position. A computed tomography scan of the chest without contrast
revealed an asymmetric undulating contour of the left breast
prosthesis with mass eﬀect from ﬂuid of variable densities, with
no evidence of implant rupture, but an inﬂammatory, infectious,
or lymphoma etiology could not be ruled out. A discussion ensued with the patient concerning these ﬁndings; ultimately, she
elected to have her implants removed without replacement until
the etiology could be identiﬁed. The patient underwent bilateral
implant removal with capsulectomies, which was uneventful on
the right side. Fluid was evacuated on the left side and revealed
a capsule that was thickened with a plaque-like mass and mucoid material associated with capsule posteriorly. This could not
be entirely resected, as it adhered to the underlying chest wall
beneath the pectoralis major muscle. The remaining mass was
debrided with a scratch pad, drains were placed, and the wounds
were closed. The patient healed well postoperatively.
Final pathology of the capsules revealed atypical inﬁltrate
consistent with ALK-negative ALCL associated with a breast
implant. Hematoxylin and eosin studies (Figure 2a) were
From the Departments of Breast Oncology Surgery (Keith), Pathology (Herlihy),
Oncology (Holmes), and Plastic Surgery (Pin), Baylor University Medical Center at
Dallas and Baylor Charles A. Sammons Cancer Center, Dallas, Texas.
Corresponding author: Lindsay Keith, MD, 3500 Gaston Avenue, Dallas, TX
75246 (e-mail: lindsaykeith928@gmail.com).
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Table of Contents for the Digital Edition of Baylor University Medical Center Proceedings October 2017