Extranodal NK/T-cell Lymphoma, Nasal Type, Arising in Association With Saline Breast Implant

Abstract

Extranodal NK/T-cell lymphoma, nasal type, is a rare type of non-Hodgkin lymphoma that is most common in Asia and is driven by Epstein-Barr virus infection. These tumors usually arise in the nasal region; in rare cases they can involve extranasal sites, most often skin, with involvement of the breast being rare. Lymphomas arising adjacent to breast implants are rare, and most cases reported to date have been anaplastic lymphoma kinase (ALK)-negative anaplastic large cell lymphoma. Here we report a 41-year-old white woman with bilateral saline breast implants placed for cosmetic reasons who almost 9 years later developed painful swelling at the right-breast implant site. Excisional biopsy revealed lymphoma composed of monomorphic large cells associated with necrosis and angioinvasion. Immunohistochemical analysis showed an aberrant, NK/T-cell immunophenotype with the lymphoma cells being CD2+, CD3+, CD56+, partial CD30+, granzyme B, TIA-1+, CD4+, CD5+, CD7+, and CD8+. In situ hybridization analysis showed Epstein-Barr virus-encoded RNA within the neoplastic cells. Polymerase chain reaction analysis showed monoclonal T-cell receptor-γ chain gene rearrangement. These findings support the diagnosis of extranodal NK/T-cell lymphoma, nasal type. On the basis of our review of the literature, this case is unique. In addition, we believe this case is important to report, because it expands the spectrum of T-cell lymphomas that can be associated with breast implants and may be a forerunner of additional cases to follow.

Diagnosis of anaplastic large cell lymphoma on late peri‐implant breast seroma: Management of cytological sample by an integrated approach

“…It is a rare disease representing 2%‐3% of all non‐Hodgkin's lymphomas in adults and 0.5% of all breast cancers . BI‐ALCL is not the only breast implant‐associated lymphoma: other histotypes have been described in association with reconstructive surgery or cosmetic augmentation mammoplasty with breast implants . The association between breast implants and ALCL was first described in 1997 .…”

“…9 BI-ALCL is not the only breast implant-associated lymphoma: other histotypes have been described in association with reconstructive surgery or cosmetic augmentation mammoplasty with breast implants. 10 The association between breast implants and ALCL was first described in 1997. 11 Although it is a rare disease, the scientific community has recently turned its attention to this lymphoma and several cases have been reported in literature in recent years, because the association between breast implant and lymphoma occurrence has a worrying social impact.…”

Extranodal NK/T-Cell Lymphoma, Nasal Type, Presenting as a Breast Mass

“…One reported case involved the breast as a part of the disseminated disease in an immunosuppressed woman who had undergone heart transplantation five years earlier [ 7 ]. Two cases were also reported in patients that previously received breast implants [ 8 - 9 ].…”

Flow cytometry of ALK-negative anaplastic large cell lymphoma of breast implant-associated effusion and capsular tissue

“…Of non‐T‐cell lymphomas, subsets with B‐cell immunophenotype have also been reported and classified either as follicular lymphoma , lymphoplasmacytic lymphoma , or primary effusion lymphoma . Most recently, a report has also described tumor cells with an immunophenotype of extranodal NK‐T cell lymphoma , broadening the lineage of lymphomas that may be observed with breast implants. Whether these disparate lymphomas represent the varied spectrum of or the end result of a common pathogenic process induced by a breast prosthetic implant is not known and requires further inquiry.…”