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A Rare Case of Breast Implant-Associated Diffuse Large B-Cell Lymphoma

A Rare Case of Breast Implant-Associated Diffuse Large B-Cell Lymphoma Hindawi Case Reports in Oncological Medicine Volume 2019, Article ID 1801942, 4 pages https://doi.org/10.1155/2019/1801942 Case Report A Rare Case of Breast Implant-Associated Diffuse Large B-Cell Lymphoma Christopher Larrimore and Annmarie Jaghab Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, USA Correspondence should be addressed to Christopher Larrimore; cl1398@mynsu.nova.edu Received 28 May 2019; Accepted 12 September 2019; Published 27 November 2019 Academic Editor: Katsuhiro Tanaka Copyright © 2019 Christopher Larrimore and Annmarie Jaghab. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. This is a case of an elderly female who presented for follow-up ultrasound of the right breast after routine mammogram revealed a small benign mass. A subsequent ultrasound detected a small nodular mass that was described as benign in appearance. Although the patient was asymptomatic, a fine-needle biopsy was performed to rule out malignancy. Results from immunohistochemistry and FISH studies of the biopsy were positive for diffuse large B-cell lymphoma (DLBCL). The patient underwent surgery for lumpectomy and removal of breast implants. Intraoperative tissue samples were analyzed by pathology using both flow cytometry and microscopy, and results confirmed DLBCL. With total tumor resection and implant removal completed, the patient did not require additional treatments as the prognosis of DLBCL status post implant removal is excellent. She returned for follow-up six months later and has since had no signs of reoccurrence. 1. Introduction 2. Case Report Primary breast lymphoma has a low rate of occurrence com- A 70-year-old female without significant past medical history presented to the clinic after the results of a routine mammo- prising an estimated 0.5% of breast malignancies [1, 2]. Even rarer are lymphomas associated with breast implants with the gram revealed the continued presence of a small mass in her majority of the documented cases being T-cell lymphomas. right breast. A mammogram dated 3 years prior detected this Worldwide, over 500 cases of anaplastic large cell lymphoma mass and reported it as small and benign, located inferior to associated with breast implants have been documented [3], an implant of her right breast. The more recent mammogram including 4 cases of cutaneous T-cell lymphoma [1]. How- findings reported no change in size. The patient was asymp- ever, to date, only 5 cases of diffuse large B-cell lymphoma tomatic and denied previous history of cancer and no family (DLBCL) associated with breast implants have been reported history of breast cancer, or other malignancies. She denied [1, 2, 4]. Because lymphomas associated with breast implants weight loss, fever, night sweats, or change in appetite. How- have been reported as well localized, implant removal and ever, she did report mild discomfort with self-palpation to mass resection have proven to be satisfactory treatment. her lower right breast. Her breast implants were placed 28 However, without many cases documented within the litera- years ago in Argentina for cosmetic reasons and have not ture and without long-term outcome studies, it is difficult to since been revised. Additionally, she reported a long history know if additional treatments are required. In this case report, of smoking tobacco daily. a patient with a newly diagnosed DLBCL is described. In the To rule out malignancy, an ultrasound was performed report, her clinical presentation, diagnostic studies, and out- and confirmed the presence of an elongated nodular density come after surgery will be discussed. benign in appearance. The mass had multiple areas of 2 Case Reports in Oncological Medicine Figure 1: Ultrasound of the right breast before fine-needle biopsy shows a nodular density with multiple areas of hyperechoic densities within it. hyperechoic densities within it and was located at the one-time dose of cefazolin 1 gm IV and hydrocodone for pain 8o’clock position 10 cm from the right nipple. The size was management. She was discharged 2 days later with a com- measured to be 3:4×1:3×3:2 cm, with no evidence of plaint of moderate breast pain that was being managed well shadowing or implant rupture reported (Figure 1). The with hydrocodone. impression of the ultrasound was the presence of a hamar- Intraoperative tissue samples were sent to pathology. The toma, a benign lesion of the breast that corresponded with breast lesion was noted to be well circumscribed and con- previous mammogram results. Despite recommendations sisted of monomorphous cells with large lymphocytic fea- for a follow-up mammogram at a later date, the patient was tures. No evidence of invasion from the calcified capsule was found. The cells had pleomorphic ovoid to round nuclei referred by her primary care provider for fine-needle biopsy and samples were sent for evaluation. with occasional atypical mitotic figures. Atypical cells, as well Biopsy samples were sent to pathology for analysis using as foamy macrophages, were present in the touch prep. Atyp- histology, immunohistochemistry, and FISH studies. Histo- ical lymphoid cells with anaplastic nuclear features were logic sections of the core biopsy fragments showed malignant noted to infiltrate into collagenized-sclerotic stroma and at times adjacent fatty lobules. Immunohistochemistry was lymphoma of diffuse pattern. The tumor cells were large in size with anaplastic and focally spindled morphology. Addi- positive for CD45, BCL2, BCL6, CD43, CD79A, MUM1, tionally, there were increased mitotic figures and cellular and PAX5. Flow cytometry results, in addition to the histo- apoptosis. Immunohistochemistry revealed lymphoma cells logic and immunohistochemistry staining, confirmed the positive for CD20, PAX5, BCL2, BCL6, and vimentin and diagnosis of DLBCL. The tumor was ultimately measured as 2:3×1:3 cm in maximal dimension, and the benign scle- negative for CD3, CD5, CD10, cyclin D1, smooth muscle myosin, S100, CD31, CD20, E-cadherin, and keratin. It was rotic capsule tissue provided evidence of the chronic rupture determined that the neoplasm had a nongerminal center of implants. phenotype with a proliferative index of 80-90%. FISH stud- The patient returned to the clinic 2 weeks after surgery ies were completed to determine the presence of MYC, and had well-healing scars without signs of infection. She returned again 6 months later and reported no pain at the BCL2, or BCL6 gene rearrangements. All were negative; however, an abnormal signal pattern suggestive of gains of surgical sites. Physical exam did not find any lymphadenop- BCL2 was detected. Overall, testing of the fine-needle biopsy athy or mass with palpation. She continues to remain in confirmed DLBCL. good health. The patient underwent surgery for lumpectomy of the right breast, as well as bilateral breast implant removal. During the operation, the presence of a calcified capsule sur- 3. Discussion rounding each nontextured implant was noted. Found within the capsules was silicone. It was unclear if the nontextured In this report, a rare case of DLBCL associated with breast implants had ruptured prior to surgery or if there was a rup- implants is presented. The mass was first detected 3 years ture during the procedure. Both capsules were removed, and prior during routine mammogram. Findings reported the silicone was irrigated and aspirated from the sites. The tumor mass to be benign in appearance, which resulted in no addi- was found to be in direct contact with the calcified capsule tional work-up. Three years later, routine mammogram but without evidence of capsule invasion into the tumor. reported no change in size or appearance. While the patient The tumor was also widely excised with ample samples sent continued to be asymptomatic, it was decided to order to pathology for further testing. The patient was given a additional testing to rule out any potential malignancy. Case Reports in Oncological Medicine 3 histochemistry of both the fine-needle biopsy and the intra- Table 1: A listing of DLBCL diagnostic markers [4, 6]. operative tissue samples was completed. Laboratory testing Biomarker expression/genetic was consistently positive for CD45, BCL2, BCL6, CD43, Percentage of cases alterations CD79A, MUM1, and PAX5. All of these are markers that Pan B-cell antigens, strongly correlate with DLBCL [2, 5, 7]. Further reinforcing CD19, CD20, CD22, CD79A, CD45 highly expressed the diagnosis was the lack of T-cell markers that would be CD30 25% (anaplastic variant) present in ALCL. This included CD3 and CD5. While DLBCL is an aggressive cancer and rapidly fatal if BCL2 25-80% left untreated, DLBCL associated with breast implants has a BCL6 70% far better prognosis and is often less aggressive. Nonbreast CD10 30-60% implant-associated DLBCL requires a treatment combination MUM1/IRF4 35-65% of cyclophosphamide, doxorubicin, vincristine, and predni- Uncommon, aggressive sone (CHOP). Adding rituximab, a chimeric monoclonal CD5 disease antibody against CD20, has proven to increase survival rates (14;18) translocation 30% [8]. Breast implant-associated DLBCL, if localized, requires MYC gene rearranged 5-15% no CHOP regimen. Instead, treatment is the complete resec- tion of malignant tissue and removal of breast implants. If Fine-needle biopsy with ultrasound guidance was performed, malignancy has invaded the lymph nodes, a treatment regi- men should be considered. and pathology results revealed the diagnosis of DLBCL. DLBCL is a non-Hodgkin lymphoma (NHL). It is the In this case, a 70-year-old female with 28-year-old non- most common type of lymphoid malignancy in adults and textured silicone breast implants developed a slow-growing is B-cell in origin [1, 2]. In western countries, DLBCL mass in the right breast later identified as DLBCL. While accounts for 31% of NHLs [2]. While DLBCL does have a symptomatology is dependent upon the severity of the dis- ease, the common clinical presentation for DLBCL is breast higher rate of occurrence in adults, its association with breast implants is extremely rare. With only 0.5% of breast malig- swelling and tenderness. This patient was asymptomatic with nancy being comprised of primary breast lymphomas [1], benign mammogram findings. Because tumors associated only 5 cases of DLBCL have been reported [1, 2, 4, 7]. The with breast implants can be aggressive and are sometime more frequent primary breast lymphoma is anaplastic large associated with squamous cell tumors, additional testing was ordered that ultimately revealed the malignancy. Within cell lymphoma (ALCL). This lymphoma is T-cell in origin, is associated most commonly with textured implants, and 6 months from diagnosis, the patient underwent complete has been reported in over 500 cases worldwide [2, 3]. tumor resection and implant removal. There were no Regardless, both forms of primary breast lymphomas are reported intraoperative or postoperative complications. Sub- rarely documented in the medical literature resulting in sequent follow-up appointments at 2 weeks, 6 months, and 1 year were highly suggestive of a successful treatment as no the pathogenesis being poorly understood. NHLs are characterized by the abnormal growth of new mass was noted and the patient remained asymptomatic. lymphocytes. In ALCL, the expression of T-cell markers CD4 and CD43 occurs in 82% and 77% of the cases, respec- Conflicts of Interest tively [2]. Also present is a typical expression of CD30 and a characteristic horseshoe-shaped nucleus [2, 3]. While ALCL The authors declare that there is no conflict of interest can be further divided into two groups based upon the regarding the publication of this paper. presence of anaplastic lymphoma kinase (ALK), implant- associated ALCL is primarily ALK-negative [2, 3]. In con- References trast, DLBCL is heterogeneous in respect to morphology and biomarker expression. Based upon gene expression [1] A. Messer, H. Jenkinson, W. Wang, and M. Duvic, “New B-cell studies, DLBCL has been subdivided into separate molecular lymphomas in the setting of a previous rare breast implant– subtypes that arise at different stages of B-cell differentiation associated B-cell lymphoma,” Plastic and Reconstruction [5]. Although there is diversity in marker expression as out- Surgery, vol. 4, no. 11, article e1148, 2016. lined in Table 1, the more common diagnostic markers for [2] A. Rupani, J. D. Frame, and D. Kamel, “Lymphomas associated DLBCL include BCL2, BCL6, c-MYC, and PAX5 [2, 5, 6]. with breast implants: a review of the literature,” Aesthetic With the detection of these cellular markers and the presence Surgery Journal, vol. 35, no. 5, pp. 533–544, 2015. of specific morphologic changes, ALCL and DLBCL can be [3] F. Fitzal, S. Turner, and L. Kenner, “Is breast implant-associated properly identified. anaplastic large cell lymphoma a hazard of breast implant In this patient, the microscopy of the tissue samples from surgery?,” Open Biology, vol. 9, no. 4, article 190006, 2019. the fine-needle biopsy showed malignant lymphoma in a dif- [4] B. K. Smith and S. S. Gray, “Large B-cell lymphoma occurring in fuse pattern. The tumor cells present were large in size and a breast implant capsule,” Plastic and Reconstructive Surgery, with an anaplastic morphology. DLBCL morphology can be vol. 134, no. 4, pp. 670e-671e, 2014. diverse with variants that include centroblastic, immunoblas- [5] H. Nogai, B. Dorken, and G. Lenz, “Pathogenesis of non- tic, T-cell/histiocyte rich, or anaplastic [2]. To confirm the Hodgkin’s lymphoma,” Journal of Clinical Oncology, vol. 29, diagnosis, testing that included flow cytometry and immuno- no. 14, pp. 1803–1811, 2011. 4 Case Reports in Oncological Medicine [6] N. Johri, S. C. Patne, M. Tewari, and M. Kumar, “Diagnostic utility of PAX5 in Hodgkin and non-Hodgkin lymphoma: a study from northern India,” Journal of Clinical Diagnostic Research, vol. 10, no. 8, pp. XC04–XC07, 2016. [7] A. S. Freedman and J. C. Aster, Epidemiology, clinical mani- festations, pathologic features, and diagnosis of large B cell lymphoma, UpToDate, 2018. [8] B. Coiffier, E. Lepage, J. Brière et al., “CHOP chemotherapy plus rituximab compared with CHOP alone in elderly patients with diffuse large-B-cell lymphoma,” The New England Journal of Medicine, vol. 346, no. 4, pp. 235–242, 2002. MEDIATORS of INFLAMMATION The Scientific Gastroenterology Journal of World Journal Research and Practice Diabetes Research Disease Markers Hindawi Hindawi Publishing Corporation Hindawi Hindawi Hindawi Hindawi www.hindawi.com Volume 2018 http://www www.hindawi.com .hindawi.com V Volume 2018 olume 2013 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 International Journal of Journal of Immunology Research Endocrinology Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 Submit your manuscripts at www.hindawi.com BioMed PPAR Research Research International Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 Journal of Obesity Evidence-Based Journal of Journal of Stem Cells Complementary and Ophthalmology International Alternative Medicine Oncology Hindawi Hindawi Hindawi Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2013 Parkinson’s Disease Computational and Behavioural Mathematical Methods AIDS Oxidative Medicine and in Medicine Neurology Research and Treatment Cellular Longevity Hindawi Hindawi Hindawi Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Case Reports in Oncological Medicine Hindawi Publishing Corporation

A Rare Case of Breast Implant-Associated Diffuse Large B-Cell Lymphoma

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Hindawi Publishing Corporation
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Copyright © 2019 Christopher Larrimore and Annmarie Jaghab. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Abstract

Hindawi Case Reports in Oncological Medicine Volume 2019, Article ID 1801942, 4 pages https://doi.org/10.1155/2019/1801942 Case Report A Rare Case of Breast Implant-Associated Diffuse Large B-Cell Lymphoma Christopher Larrimore and Annmarie Jaghab Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, USA Correspondence should be addressed to Christopher Larrimore; cl1398@mynsu.nova.edu Received 28 May 2019; Accepted 12 September 2019; Published 27 November 2019 Academic Editor: Katsuhiro Tanaka Copyright © 2019 Christopher Larrimore and Annmarie Jaghab. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. This is a case of an elderly female who presented for follow-up ultrasound of the right breast after routine mammogram revealed a small benign mass. A subsequent ultrasound detected a small nodular mass that was described as benign in appearance. Although the patient was asymptomatic, a fine-needle biopsy was performed to rule out malignancy. Results from immunohistochemistry and FISH studies of the biopsy were positive for diffuse large B-cell lymphoma (DLBCL). The patient underwent surgery for lumpectomy and removal of breast implants. Intraoperative tissue samples were analyzed by pathology using both flow cytometry and microscopy, and results confirmed DLBCL. With total tumor resection and implant removal completed, the patient did not require additional treatments as the prognosis of DLBCL status post implant removal is excellent. She returned for follow-up six months later and has since had no signs of reoccurrence. 1. Introduction 2. Case Report Primary breast lymphoma has a low rate of occurrence com- A 70-year-old female without significant past medical history presented to the clinic after the results of a routine mammo- prising an estimated 0.5% of breast malignancies [1, 2]. Even rarer are lymphomas associated with breast implants with the gram revealed the continued presence of a small mass in her majority of the documented cases being T-cell lymphomas. right breast. A mammogram dated 3 years prior detected this Worldwide, over 500 cases of anaplastic large cell lymphoma mass and reported it as small and benign, located inferior to associated with breast implants have been documented [3], an implant of her right breast. The more recent mammogram including 4 cases of cutaneous T-cell lymphoma [1]. How- findings reported no change in size. The patient was asymp- ever, to date, only 5 cases of diffuse large B-cell lymphoma tomatic and denied previous history of cancer and no family (DLBCL) associated with breast implants have been reported history of breast cancer, or other malignancies. She denied [1, 2, 4]. Because lymphomas associated with breast implants weight loss, fever, night sweats, or change in appetite. How- have been reported as well localized, implant removal and ever, she did report mild discomfort with self-palpation to mass resection have proven to be satisfactory treatment. her lower right breast. Her breast implants were placed 28 However, without many cases documented within the litera- years ago in Argentina for cosmetic reasons and have not ture and without long-term outcome studies, it is difficult to since been revised. Additionally, she reported a long history know if additional treatments are required. In this case report, of smoking tobacco daily. a patient with a newly diagnosed DLBCL is described. In the To rule out malignancy, an ultrasound was performed report, her clinical presentation, diagnostic studies, and out- and confirmed the presence of an elongated nodular density come after surgery will be discussed. benign in appearance. The mass had multiple areas of 2 Case Reports in Oncological Medicine Figure 1: Ultrasound of the right breast before fine-needle biopsy shows a nodular density with multiple areas of hyperechoic densities within it. hyperechoic densities within it and was located at the one-time dose of cefazolin 1 gm IV and hydrocodone for pain 8o’clock position 10 cm from the right nipple. The size was management. She was discharged 2 days later with a com- measured to be 3:4×1:3×3:2 cm, with no evidence of plaint of moderate breast pain that was being managed well shadowing or implant rupture reported (Figure 1). The with hydrocodone. impression of the ultrasound was the presence of a hamar- Intraoperative tissue samples were sent to pathology. The toma, a benign lesion of the breast that corresponded with breast lesion was noted to be well circumscribed and con- previous mammogram results. Despite recommendations sisted of monomorphous cells with large lymphocytic fea- for a follow-up mammogram at a later date, the patient was tures. No evidence of invasion from the calcified capsule was found. The cells had pleomorphic ovoid to round nuclei referred by her primary care provider for fine-needle biopsy and samples were sent for evaluation. with occasional atypical mitotic figures. Atypical cells, as well Biopsy samples were sent to pathology for analysis using as foamy macrophages, were present in the touch prep. Atyp- histology, immunohistochemistry, and FISH studies. Histo- ical lymphoid cells with anaplastic nuclear features were logic sections of the core biopsy fragments showed malignant noted to infiltrate into collagenized-sclerotic stroma and at times adjacent fatty lobules. Immunohistochemistry was lymphoma of diffuse pattern. The tumor cells were large in size with anaplastic and focally spindled morphology. Addi- positive for CD45, BCL2, BCL6, CD43, CD79A, MUM1, tionally, there were increased mitotic figures and cellular and PAX5. Flow cytometry results, in addition to the histo- apoptosis. Immunohistochemistry revealed lymphoma cells logic and immunohistochemistry staining, confirmed the positive for CD20, PAX5, BCL2, BCL6, and vimentin and diagnosis of DLBCL. The tumor was ultimately measured as 2:3×1:3 cm in maximal dimension, and the benign scle- negative for CD3, CD5, CD10, cyclin D1, smooth muscle myosin, S100, CD31, CD20, E-cadherin, and keratin. It was rotic capsule tissue provided evidence of the chronic rupture determined that the neoplasm had a nongerminal center of implants. phenotype with a proliferative index of 80-90%. FISH stud- The patient returned to the clinic 2 weeks after surgery ies were completed to determine the presence of MYC, and had well-healing scars without signs of infection. She returned again 6 months later and reported no pain at the BCL2, or BCL6 gene rearrangements. All were negative; however, an abnormal signal pattern suggestive of gains of surgical sites. Physical exam did not find any lymphadenop- BCL2 was detected. Overall, testing of the fine-needle biopsy athy or mass with palpation. She continues to remain in confirmed DLBCL. good health. The patient underwent surgery for lumpectomy of the right breast, as well as bilateral breast implant removal. During the operation, the presence of a calcified capsule sur- 3. Discussion rounding each nontextured implant was noted. Found within the capsules was silicone. It was unclear if the nontextured In this report, a rare case of DLBCL associated with breast implants had ruptured prior to surgery or if there was a rup- implants is presented. The mass was first detected 3 years ture during the procedure. Both capsules were removed, and prior during routine mammogram. Findings reported the silicone was irrigated and aspirated from the sites. The tumor mass to be benign in appearance, which resulted in no addi- was found to be in direct contact with the calcified capsule tional work-up. Three years later, routine mammogram but without evidence of capsule invasion into the tumor. reported no change in size or appearance. While the patient The tumor was also widely excised with ample samples sent continued to be asymptomatic, it was decided to order to pathology for further testing. The patient was given a additional testing to rule out any potential malignancy. Case Reports in Oncological Medicine 3 histochemistry of both the fine-needle biopsy and the intra- Table 1: A listing of DLBCL diagnostic markers [4, 6]. operative tissue samples was completed. Laboratory testing Biomarker expression/genetic was consistently positive for CD45, BCL2, BCL6, CD43, Percentage of cases alterations CD79A, MUM1, and PAX5. All of these are markers that Pan B-cell antigens, strongly correlate with DLBCL [2, 5, 7]. Further reinforcing CD19, CD20, CD22, CD79A, CD45 highly expressed the diagnosis was the lack of T-cell markers that would be CD30 25% (anaplastic variant) present in ALCL. This included CD3 and CD5. While DLBCL is an aggressive cancer and rapidly fatal if BCL2 25-80% left untreated, DLBCL associated with breast implants has a BCL6 70% far better prognosis and is often less aggressive. Nonbreast CD10 30-60% implant-associated DLBCL requires a treatment combination MUM1/IRF4 35-65% of cyclophosphamide, doxorubicin, vincristine, and predni- Uncommon, aggressive sone (CHOP). Adding rituximab, a chimeric monoclonal CD5 disease antibody against CD20, has proven to increase survival rates (14;18) translocation 30% [8]. Breast implant-associated DLBCL, if localized, requires MYC gene rearranged 5-15% no CHOP regimen. Instead, treatment is the complete resec- tion of malignant tissue and removal of breast implants. If Fine-needle biopsy with ultrasound guidance was performed, malignancy has invaded the lymph nodes, a treatment regi- men should be considered. and pathology results revealed the diagnosis of DLBCL. DLBCL is a non-Hodgkin lymphoma (NHL). It is the In this case, a 70-year-old female with 28-year-old non- most common type of lymphoid malignancy in adults and textured silicone breast implants developed a slow-growing is B-cell in origin [1, 2]. In western countries, DLBCL mass in the right breast later identified as DLBCL. While accounts for 31% of NHLs [2]. While DLBCL does have a symptomatology is dependent upon the severity of the dis- ease, the common clinical presentation for DLBCL is breast higher rate of occurrence in adults, its association with breast implants is extremely rare. With only 0.5% of breast malig- swelling and tenderness. This patient was asymptomatic with nancy being comprised of primary breast lymphomas [1], benign mammogram findings. Because tumors associated only 5 cases of DLBCL have been reported [1, 2, 4, 7]. The with breast implants can be aggressive and are sometime more frequent primary breast lymphoma is anaplastic large associated with squamous cell tumors, additional testing was ordered that ultimately revealed the malignancy. Within cell lymphoma (ALCL). This lymphoma is T-cell in origin, is associated most commonly with textured implants, and 6 months from diagnosis, the patient underwent complete has been reported in over 500 cases worldwide [2, 3]. tumor resection and implant removal. There were no Regardless, both forms of primary breast lymphomas are reported intraoperative or postoperative complications. Sub- rarely documented in the medical literature resulting in sequent follow-up appointments at 2 weeks, 6 months, and 1 year were highly suggestive of a successful treatment as no the pathogenesis being poorly understood. NHLs are characterized by the abnormal growth of new mass was noted and the patient remained asymptomatic. lymphocytes. In ALCL, the expression of T-cell markers CD4 and CD43 occurs in 82% and 77% of the cases, respec- Conflicts of Interest tively [2]. Also present is a typical expression of CD30 and a characteristic horseshoe-shaped nucleus [2, 3]. While ALCL The authors declare that there is no conflict of interest can be further divided into two groups based upon the regarding the publication of this paper. presence of anaplastic lymphoma kinase (ALK), implant- associated ALCL is primarily ALK-negative [2, 3]. In con- References trast, DLBCL is heterogeneous in respect to morphology and biomarker expression. Based upon gene expression [1] A. Messer, H. Jenkinson, W. Wang, and M. Duvic, “New B-cell studies, DLBCL has been subdivided into separate molecular lymphomas in the setting of a previous rare breast implant– subtypes that arise at different stages of B-cell differentiation associated B-cell lymphoma,” Plastic and Reconstruction [5]. Although there is diversity in marker expression as out- Surgery, vol. 4, no. 11, article e1148, 2016. lined in Table 1, the more common diagnostic markers for [2] A. Rupani, J. D. Frame, and D. Kamel, “Lymphomas associated DLBCL include BCL2, BCL6, c-MYC, and PAX5 [2, 5, 6]. with breast implants: a review of the literature,” Aesthetic With the detection of these cellular markers and the presence Surgery Journal, vol. 35, no. 5, pp. 533–544, 2015. of specific morphologic changes, ALCL and DLBCL can be [3] F. Fitzal, S. Turner, and L. Kenner, “Is breast implant-associated properly identified. anaplastic large cell lymphoma a hazard of breast implant In this patient, the microscopy of the tissue samples from surgery?,” Open Biology, vol. 9, no. 4, article 190006, 2019. the fine-needle biopsy showed malignant lymphoma in a dif- [4] B. K. Smith and S. S. Gray, “Large B-cell lymphoma occurring in fuse pattern. The tumor cells present were large in size and a breast implant capsule,” Plastic and Reconstructive Surgery, with an anaplastic morphology. DLBCL morphology can be vol. 134, no. 4, pp. 670e-671e, 2014. diverse with variants that include centroblastic, immunoblas- [5] H. Nogai, B. Dorken, and G. Lenz, “Pathogenesis of non- tic, T-cell/histiocyte rich, or anaplastic [2]. To confirm the Hodgkin’s lymphoma,” Journal of Clinical Oncology, vol. 29, diagnosis, testing that included flow cytometry and immuno- no. 14, pp. 1803–1811, 2011. 4 Case Reports in Oncological Medicine [6] N. Johri, S. C. Patne, M. Tewari, and M. Kumar, “Diagnostic utility of PAX5 in Hodgkin and non-Hodgkin lymphoma: a study from northern India,” Journal of Clinical Diagnostic Research, vol. 10, no. 8, pp. XC04–XC07, 2016. [7] A. S. Freedman and J. C. Aster, Epidemiology, clinical mani- festations, pathologic features, and diagnosis of large B cell lymphoma, UpToDate, 2018. [8] B. Coiffier, E. Lepage, J. Brière et al., “CHOP chemotherapy plus rituximab compared with CHOP alone in elderly patients with diffuse large-B-cell lymphoma,” The New England Journal of Medicine, vol. 346, no. 4, pp. 235–242, 2002. MEDIATORS of INFLAMMATION The Scientific Gastroenterology Journal of World Journal Research and Practice Diabetes Research Disease Markers Hindawi Hindawi Publishing Corporation Hindawi Hindawi Hindawi Hindawi www.hindawi.com Volume 2018 http://www www.hindawi.com .hindawi.com V Volume 2018 olume 2013 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 International Journal of Journal of Immunology Research Endocrinology Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 Submit your manuscripts at www.hindawi.com BioMed PPAR Research Research International Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 Journal of Obesity Evidence-Based Journal of Journal of Stem Cells Complementary and Ophthalmology International Alternative Medicine Oncology Hindawi Hindawi Hindawi Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2013 Parkinson’s Disease Computational and Behavioural Mathematical Methods AIDS Oxidative Medicine and in Medicine Neurology Research and Treatment Cellular Longevity Hindawi Hindawi Hindawi Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018

Journal

Case Reports in Oncological Medicine – Hindawi Publishing Corporation

Published: Nov 27, 2019

References

  • New B-cell lymphomas in the setting of a previous rare breast implant–associated B-cell lymphoma,
    A. Messer, H. Jenkinson, W. Wang, and M. Duvic
  • Lymphomas associated with breast implants: a review of the literature,
    A. Rupani, J. D. Frame, and D. Kamel
  • Is breast implant-associated anaplastic large cell lymphoma a hazard of breast implant surgery?
    F. Fitzal, S. Turner, and L. Kenner
  • Large B-cell lymphoma occurring in a breast implant capsule,
    B. K. Smith and S. S. Gray
  • Pathogenesis of non-Hodgkin’s lymphoma,
    H. Nogai, B. Dorken, and G. Lenz
  • Diagnostic utility of PAX5 in Hodgkin and non-Hodgkin lymphoma: a study from northern India,
    N. Johri, S. C. Patne, M. Tewari, and M. Kumar
  • CHOP chemotherapy plus rituximab compared with CHOP alone in elderly patients with diffuse large-B-cell lymphoma,
    B. Coiffier, E. Lepage, J. Brière et al.