Anaplastic Large Cell Lymphoma Related to Breast Implant Presenting as a Solid mass: A Case Report.

Introduction: Breast implant associated anaplastic large cell lymphoma (BIA-ALCL) is an uncommon form of non-Hodgkin's T-cell lymphoma associated with textured breast implants and tissue expanders. Case Presentation: A 46-year-old female presented with a 1-week history of a firm lump in the upper inner quadrant of her right breast. She had a history of augmentation mammoplasty with textured implants 8 years prior. Ultrasound guided biopsy of the 15 mm × 18 mm mass confirmed a diagnosis of BIA-ALCL on histopathology. Pre-operative staging with PET CT showed a peri-implant nodule with avid nodules within and deep to the pectoralis muscle with no evidence of distant metastases. Bilateral en bloc removal of the breast implants, capsulectomy (including palpably involved pectoralis major and minor muscles) and right axillary dissection were performed. Final histopathology confirmed BIA-ALCL, pT4N0, with clear margins. Post-operative PET-CT demonstrated complete excision of local disease, however, a new FDG-avid right internal mammary node was identified, which increased in size and avidity on follow up imaging. Mediastinoscopy with core biopsy were performed and histopathological features were consistent with metastatic cells (BIA-ALCL). Patient subsequently completed six cycles of adjuvant chemotherapy with evidence of interval response on imaging. To date, patient remains in complete clinical and radiological remission and the expected duration of follow up is 5 years. Conclusions: BIA-ALCL poses a significant challenge due to increasing use of implants for reconstructive and cosmetic procedures. Patients most commonly present with peri-implant fluid collections but palpable masses, capsular contracture and lymphadenopathy are also commonly seen. Diagnosis involves ultrasound and histopathological analysis of fluid or tissue with CD30 immunohistochemistry and staging with PET-CT. Patient education and a multidisciplinary team approach allow for timely diagnosis and complete surgical excision, which are key for a good prognosis. Clinical and radiological surveillance detect early recurrence and assess need for adjuvant therapy.