96 A Rare Case of Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL)?

Abstract

Abstract Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare subtype of T-cell lymphoma that develops around breast implants and was first described in 1997. To date, the estimated risk of BIA-ALCL in UK is reported to be 1 in 24000, but as yet appears to have a substantial variation of incidence around the world. The aetiology of this recognised clinical entity remained widely unknown. A 72-year-old woman in remission for systemic anaplastic lymphoma kinase (ALK)-positive ALCL of right axilla, presented with a discoloured lump at the medial mastectomy scar following a progressive enlargement of right breast, 20 years after silicone breast implant reconstruction. Imaging studies showed fluid collection and herniation of the affected breast implant. Subsequently, the discoloured lump burst and patient then had tissue biopsy and removal of her right breast implant in together with intravenous antibiotic. Histocytopathological examination confirmed the presence of BIA-ALCL without capsular invasion and the growth of Gram-negative bacteria were noted in fluid culture. Total capsulectomy was performed and patient continues to be in remission with no local or systemic therapy. We reported a rare yet interesting case of the coexistence of BIA-ALCL and systemic ALK-positive ALCL in an elderly patient. This case has further strengthened the causal relationship of composition and/or textured implant, and the presence of a theoretical association of a select group of pathogens maybe a trigger and contributes to the pathogenesis of BIA-ALCL. Due to the rarity of this disease, diagnosis can be challenging and requires a multidisciplinary approach.