PET positive tattoo lymphadenopathy: a case report and review of the literature

We present a case of positron emission tomography (PET)–avid internal mammary lymphadenopathy, prompting open excisional biopsy of the lymph node in the setting of concern about breast-implant associated anaplastic large cell lymphoma (BIA-ALCL) or breast cancer recurrence. Histopathological examination revealed reactive lymphadenopathy with tattoo ink and no malignancy. We undertook a review of the literature to investigate the frequency of tattoo ink related PET-avid lymphadenopathy, and false positive PET scan results from tattooing. Lymphadenopathy related to tattoo ink has been reported previously, however this is the only case of benign PET positive tattoo lymphadenopathy resulting in unnecessary invasive surgery reported to date.