PRIMARY T-CELL ANAPLASTIC LYMPHOMA ASSOCIATED TO A BREAST IMPLANT: CASE REPORT
P. Mora, A.C. Melo, G.L.S. Amorim, A.A. Scheliga
Background. Breast Non-Hodgkin lymphomas are rare, with approximately 0.04-0.5% of all malignant breast tumors, and the vast majority are B-cell lymphomas. In contrast, T-cell phenotype has been rarely reported and some of these lymphomas are associated to breast implants. The neoplastic cells with T-cell phenotype are CD30+, express cytotoxic granule-associated proteins, EMA and clusterin, and are anaplastic lymphoma kinase-1-negative. Design and Methods. We present a case of a woman who recently changed silicone breast prostheses, with a fast growing mass along one implant. Results. A 56-year-old white female patient had a recent history of plastic surgery to change old breast implants, with a normal mammogram one month before the procedure. Nearly two months after the surgery, she noticed a firm nodule in right breast, located at superior limit of the implant. The MRI described a lobulated nodule with 36 x 33 x 24 mm, with early peripheral enhancement, classified as BIRADS V. A right mastectomy with sentinel lymph-node mapping was carried out. The cryosection suggested sarcoma histology. Further pathological analysis (H&E stain) showed undifferentiated carcinoma, with negative axilar lymph node, and the immunohistochemical staining was performed. The neoplastic cells express CD30, CD45, granzyme B, clusterin, CD43 (weak) and TIA-1. They do not express ALK, CD3, CD2, CD5, CD7, CD20, CD15, ER/PR, AE1/AE3, OSCAR, p63, keratin 903, S-100 or EMA. The morpoholgy and immunoperoxidase stains support a diagnosis of anaplastic large cell lymphoma, T-cell phenotype, ALK negative. A postoperative chest and abdominal scan was performed and showed no other sites of disease. She had no laboratory abnormalities and her HIV and HTLV testing were negative. Conclusions. This case is unique for its unusual presentation; similar cases have been reported in the literature. Although an increased risk of breast lymphomas in patients with silicone prostheses has been speculated, no studies have been conducted so far.