Case Study: 50-Year-Old Woman with Fibrous Capsule after Breast Augmentation
A board-style question with an explanation and a link to a relevant article is a recurring feature of TraineE-News. The goal of the case studies is to clarify specific and timely teaching points in the field of hematology. The following case study focuses on a 50-year-old woman whose medical history shows a breast augmentation with saline implants 10 years ago for cosmetic preference. She developed swelling and pain in her right breast following which an MRI revealed a fibrous capsule with an effusion surrounding the implant. She was subsequently seen by her plastic surgeon and underwent implant removal and capsulectomy. No masses were seen on the MRI or at the time of surgery.
Pathologic review is significant for a CD30(+) lymphoma confined within the capsule.
What is the most likely diagnosis?
- Classic Hodgkin lymphoma
- CD30(+) diffuse large B-cell lymphoma
- Anaplastic large-cell lymphoma
- Mediastinal B-cell lymphoma
Answer
- Anaplastic large-cell lymphoma
Explanation
The most likely diagnosis is breast-implant associated anaplastic large-cell lymphoma (ALCL). There are more than 60 reported cases of ALCL associated with both silicone and saline breast implants. Two distinct presentations of this entity have been described. The first includes the presence of a fibrous capsule with an effusion and without a mass (as presented in the case). The second presentation includes the development of a mass within the fibrous capsule surrounding the breast. From a recent review of 60 published cases, the latter presentation appears to have a worse prognosis. Based on limited case report data, treatment options include capsulectomy and implant removal followed by observation, chemotherapy, or radiotherapy.
References
- Miranda RN, Aladily TN, Prince HM, et al. Breast implant-associated anaplastic large-cell lymphoma: long-term follow-up of 60 patients. J Clin Oncol. 2014; 32:114-20.
Case study submitted by Deborah Siegal, MD, Division of Hematology and Thromboembolism, McMaster University, Hamilton, ON.
