Abstract
We report a case of a 55-year-old woman with left breast cosmetic augmentation performed 5 years earlier, showing at ultrasound a left small amount of peri-implant effusion suspicious for an anaplastic large cell lymphoma localization. The final diagnosis was obtained by cytology using a small amount of fluid (6 ml). Subsequently, hybrid 18F-FDG PET/MRI was used for pre-operative staging and follow-up. An appropriate management of BIA-ALCL could be obtained even in cases of a small amount of peri-implant effusion, using a comprehensive approach of clinical and imaging evaluation, including PET/MRI as useful and innovative staging imaging technique.
Highlights
Peri-implant breast seroma is a common complication of augmentation mammoplasty and breast prosthetic reconstruction, which clinically appears as a notable breast swelling, asymmetry or with breast pain [1]
BIA-ALCL is a rare primary non-Hodgkin T-cell lymphoma and it has been recently included within the group of anaplastic lymphoma kinase (ALK) negative ALCLs [5]
As previously shown by Quesada et al [7], the peri-implant effusion developing in BIA-ALCL does not correspond to a seroma, since it is composed of dense liquid derived from necrotic tumoral cells
Summary
Peri-implant breast seroma is a common complication of augmentation mammoplasty and breast prosthetic reconstruction, which clinically appears as a notable breast swelling, asymmetry or with breast pain [1]. BIA-ALCL is a rare primary non-Hodgkin T-cell lymphoma and it has been recently included within the group of anaplastic lymphoma kinase (ALK) negative ALCLs [5] It could arise as a solid mass attached to the prosthetic capsule and soft tissue or, more frequently, as a late peri-implant seroma within which tumour cells are enclosed [6]. We hereby describe a rare case of a woman evaluated in our institution for a late breast implant effusion representing the only sign of BIA-ALCL, with the final diagnosis reached by a cytological sampling of a small amount of fluid; this case highlights the role of advanced imaging techniques such as hybrid 18F-FDG PET/MRI, in the diagnostic workup of this rare condition. Prior to PET/MRI, unenhanced PET/CT scan was performed showing a small volume effusion surrounding the left breast implant with mild tracer uptake on PET/CT fused images (Fig. 3a, b). The patient did not undergo chemotherapy nor radiotherapy and she is currently on clinical follow-up
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