Abstract
IntroductionAn estimated 30.000 breast implants are placed in the Netherlands annually. An increasing amount of reports have linked implants to the rare anaplastic large cell lymphoma (ALCL). Other implant-related lymphomas, such as those of B-cell lineage, are much rarer. Presentation of caseA 62-year-old female presented with pain and Baker grade III capsular contraction of the right breast. Subpectorally placed textured anatomical implants had been in situ for 26 years after cosmetic augmentation. Magnetic Resonance Imaging (MRI) showed bilateral implant leakage. Explantation of both implants confirmed bilateral leakage after which symptoms went into remission. Three months later our patient noticed an erythematous area, scar swelling and serous fluid leakage on the lateral side of the inframammary fold of the right breast. Siliconomas were excised bilaterally together with a partial capsulectomy on the left. Histopathology and immunohistochemical analysis showed monotonous small cell B-lymphocytic infiltration (CD20+, CD5+, CD23+, ALK-) in both capsules, highly suggestive for chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL). DiscussionCLL/SLL are classified as nearly the same disease. The primary difference is the localization; CLL is found the bone marrow and blood whereas SLL is predominantly in the lymph nodes and spleen. There are no previous descriptions of bilateral CLL/SLL found in periprosthetic capsules. ConclusionBreast implants are increasingly linked to various malignancies. In most cases, including our patient, implant explantation together with long-term follow-up suffices. MRI yields additional value in early stage diagnosis. More research is required to further optimize multidisciplinary care and improve patient outcomes.
Highlights
IntroductionAn increasing amount of reports have linked implants to the rare anaplastic large cell lymphoma (ALCL)
An estimated 30.000 breast implants are placed in the Netherlands annually
This breast implant associated anaplastic large cell lymphoma (BIA-ALCL) is extremely rare, it has been suggested that some relationship exists [2]
Summary
An increasing amount of reports have linked implants to the rare anaplastic large cell lymphoma (ALCL). Since the 1990’s, an increasing amount of reports have linked a rare type of T-cell lymphoma to breast implants. This breast implant associated anaplastic large cell lymphoma (BIA-ALCL) is extremely rare, it has been suggested that some relationship exists [2]. The fourth edition of the World Health Organization Classification of Tumours of Haematopoietic and Lymphoid Tissues classifies chronic lymphocytic leukemia (CLL) as almost the same disease as small lymphocytic lymphoma (SLL) [3] Both are nonHodgkin’s lymphoma subtypes originating from the B-cell lineage. This study was exempted of ethical approval by the hospital’s medical ethics committee
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