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Int J Clin Exp Pathol 2013;6(8):1631-1642

Case Report
Breast implant-associated ALK-negative anaplastic large cell lymphoma: a case report
and discussion of possible pathogenesis

Eva V George, John Pharm, Courtney Houston, Semar Al-Quran, Grey Brian, Huijia Dong, Wang Hai, Westley Reeves, Li-Jun Yang

Departments of Pathology, Immunology, Laboratory Medicine, Medicine, University of Florida College of Medicine, Gainesville, FL 32607;
Departments of Pathology and Surgery, John D Archbold Memorial Hospital, Thomasville, GA 31799, USA

Received May 14, 2013; Accepted July 1, 2013; Epub July 15, 2013; Published August 1, 2013

Abstract: Breast implant associated anaplastic large cell lymphoma (BIA-ALCL) is a recently recognized clinical entity, with only 39
well-documented cases reported worldwide, including 3 fatalities. Because of its rarity, the clinical and pathologic features of this malignancy
have yet to be fully defined. Moreover, the pathogenesis of ALCL in association with textured silicone gel breast implants is poorly understood.
Here we report a case of BIA-ALCL arising in a 67-year-old woman with a mastectomy due to breast cancer followed by implantation of textured
silicone gel breast prosthesis. The patient presented with breast enlargement and tenderness 8 years following reconstructive surgery. MRI
revealed a fluid collection surrounding the affected breast implant. Pathologic examination confirmed the presence of malignant ALCL T cells
that were CD30+, CD8+, CD15+, HLA-DR+, CD25+ ALK- and p53. A diagnosis of indolent BIA-ALCL was made since tumor cells were not
found outside of the capsule. Interestingly, an extensive mixed lymphocytic infiltrate and ectopic lymphoid tissue (lymphoid neogenesis)
adjacent to the fibrous implant capsule were present. The patient was treated with capsulectomy and implantation of new breast prostheses.
Six months later, the patient was found to have BIA-ALCL involvement of an axillary lymph node with cytogenetic evolutionof the tumor. To our
knowledge, this is the sixth reported case of aggressive BIA-ALCL. Unique features of this case include the association with lymphoid
neogenesis and the in vivo cytogenetic progression of the tumor. This case provides insight into the potential role of chronic inflammation and
genetic instability in the pathogenesis of BIA-ALCL. (IJCEP1305019).

Keywords: Anaplastic large cell lymphoma (ALCL), breast implant, ectopic lymphoid aggregates, pathogenesis, ALK-negative

Address correspondence to: Dr. Li-Jun Yang, Department of Pathology, Immunology, Laboratory Medicine, Dental Science Building Rm
D6-28, University of Florida, Gainesville, FL 32607. Phone: 352-392-0005; E-mail: yanglj@pathology.ufl.edu