Anaplastic Large-Cell Lymphoma Associated with Breast Implants: A Case Report of a Transgender Female

Abstract

Breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) is a rare peripheral T cell lymphoma. BIA-ALCL is a disease of the fibrous capsule surrounding the implant and occurs in patients after both breast reconstruction and augmentation. More than 300 cases have been reported so far, including two in a transgender patient. Here we describe BIA-ALCL presented with a mass in a transgender patient and the first case of BIA-ALCL in the Czech Republic. In 2007, a 33-year-old transgender male to female underwent bilateral breast augmentation as a part of his transformation to female. In June 2014, the patient developed a 5-cm tumorous mass in her left breast. Magnetic resonance imaging of the chest revealed a ruptured implant and a tumorous mass penetrating into the capsule and infiltrating the pectoral muscle. An R0 surgery was indicated-the implant, silicone gel and capsule were removed, and the tumorous mass was resected together with a part of the pectoral muscle. Histology revealed anaplastic large-cell lymphoma. The patient underwent standard staging procedures for lymphoma including a bone marrow trephine biopsy, which confirmed stage IE. The patient was treated with the standard chemotherapy for systemic ALCL-6 cycles of CHOP-21. The patient was tumor-free at the 2-year follow-up. BIA-ALCL has been reported mostly in women who received implants for either reconstructive or aesthetic augmentation. This is the third report of BIA-ALCL in a transgender person, the first in the Czech Republic. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Epidemiologic Characteristics and Postoperative Complications following Augmentation Mammaplasty: Comparison of Transgender and Cisgender Females

“…Regarding incidence of breast adenocarcinoma in the transfeminine population, Brown and Jones 62 and Gooren et al 63 found no difference when compared with age-standardized samples of natal males. Despite reports of breast implant-associated anaplastic large cell lymphoma, 64,65 there does not seem to be any increased risk in the transgender population. However, similar to natal females, continued mammographic and clinical screening for breast cancer is recommended in the transfeminine population.…”

How I treat breast implant–associated anaplastic large cell lymphoma

“…21 Three male to female transgender patients with BIA-ALCL have also been reported, including 1 unpublished case. 22,23 Although the pathogenesis of BIA-ALCL remains unclear, there are a number of hypotheses regarding the risks of developing this malignancy. Textured implants appear to elicit a marked local T-cell immune response (both helper and cytotoxic) in comparison with smooth implants.…”

Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) in axillary lymph nodes – a case report and review of 29 other cases from world literature

“…This may be due to the fact that females decide to undergo breast augmentation surgery because of aesthetic reasons and those surgeries are performed mainly in private clinics, therefore, the medical documentation can be difficult to access. The use of textured breast implants seems to be the most crucial and clinically important risk factor of BIA-ALC [23]. The research results of a clinical trial by Broody et al showed that up to 171 of 173 BIA-ALCL cases were related to the textured structure of the breast implant [29].…”