Enhancement to effusion: Breast implant-associated anaplastic large cell lymphoma

This case is a rare presentation of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), where malignant pericardial effusion (MPE) served as the primary manifestation. A 58-year-old woman, post-breast implant removal, presented with pleuritic chest pain, fever, and chills. Clinical evaluation revealed jugular venous distention, muffled heart sounds, and hemodynamic instability. Echocardiogram with Doppler confirmed large pericardial effusion with tamponade physiology. Following a multidisciplinary discussion, a diagnostic and therapeutic pericardiocentesis was performed, resulting in immediate symptomatic relief.

Cytology studies of the pericardial fluid revealed CD30+, ALK-ALCL, confirming BIA-ALCL. Prompt initiation of brentuximab-cyclophosphamide, doxorubicin, and prednisolone therapy ensued. This case underscores the rarity of MPE as an initial presentation of BIA-ALCL and highlights the significance of early recognition and consideration of rare lymphomas in patients with breast implants.

Learning objective

Recognize the importance of considering breast implant-associated anaplastic large cell lymphoma in the differential diagnoses of malignant pericardial effusion.