Primary Anaplastic Large Cell Lymphoma of the Breast Occurring in Patients with Silicone Breast Implants.

Abstract

Primary breast lymphoma (PBL) accounts for up to 1% of all primary breast tumors, and 2.2% of all extranodal lymphomas. The vast majority of PBL are of B-cell origin, most commonly of the diffuse large cell histology. Fewer than 20 cases of T-cell PBL have been reported. We report 6 cases of T-lineage PBL occuring in patients who had previously received silicone breast implants for purposes of breast augmentation. None of the patients had a previous diagnosis of malignancy or unrelated prior breast surgery. In each case, the implants had been placed between 5 and 20 years previously. In each case, lymphoma was confined to breast by staging, and met previously defined criteria for PBL. In 5 cases, the lymphoma was identified as a solid mass involving the breast tissue. In one case, lymphoma cells were identified by flow cytometry in a fluid collection surrounding the implant. The implant was replaced, and the patient has subsequently treated with systemic chemotherapy despite negative PET scan. Thus far, reaccumulation of fluid has not occurred several months following replacement of the implant. In patients for whom follow-up information is available, two recurred following initial therapy and received autologous stem cell transplantation in second complete remission, and remain disease free at 2 years post-transplantation. Since 1995, six cases of PBL associated with breast implants have been reported in the literature, all of which are of T-cell lineage. The majority are of anaplastic large cell type. None of these cases have been previously reported, and this is the largest collection of such reported from a single institution. While previous reports have discounted any link between breast implants and lymphoma, this appears to be a specific association of an unusual lymphoma subtype occuring after a significant time period. Given the increasing number of silicone implant procedures recorded each year in the U.S., this represents an environmental association ripe for further investigation. Establishment of a national database would be appropriate to monitor any potential trends in this entity.PBL Anaplastic Lymphoma, ImmunohistochemistryAge at DiagnosisALK-1CD2CD3CD20CD30CD43CD4532−+−++41++++40−+−−+−54−−−−++−49+−+++62−−−+−+31+−−−+−+