[Breast implant-associated anaplastic large cell lymphoma that developed 20 years after breast reconstruction and was successfully treated with chemotherapy].

Abstract

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a type of anaplastic large cell lymphoma, that was first described in the revised 4th edition of the WHO Classification of Tumors released in 2017. The textured implants are thought to form bacterial biofilm and cause chronic inflammation, which may be associated with tumorigenesis. We present a 50-year-old woman who had a past medical history of breast reconstruction with the implant 20 years ago. She presented with abdominal distension caused by intraperitoneal lymphadenopathy. She was diagnosed with suspicion of idiopathic multicentric Castleman disease and received pulse therapy with corticosteroid and eight courses of tocilizumab, which resulted in progression of the disease. Positron emission tomography-computed tomography showed new masses in liver and an effusion around the breast implant, and BIA-ALCL was suspected. Pathological examination of the liver tumor and cell blocks made from fluid collected around the implant confirmed the diagnosis of ALCL. Six cycles of brentuximab vedotin in combination with cyclophosphamide, doxorubicin and prednisolone (BV-CHP) led to complete remission. Her implant was subsequently removed. It is important to keep in mind the possibility of BIA-ALCL when lymphadenopathy is observed in patients with a history of breast reconstruction with textured implants.