Rare lymphoid malignancies of the breast: a report of two cases illustrating potential diagnostic pitfalls

Abstract

Breast involvement by lymphoma is uncommon and poses challenges in diagnosis. Lymphomas may clinically, radiologically, and morphologically mimic both benign and neoplastic conditions. We describe two cases of lymphoid malignancies predominantly involving the breast, both presenting diagnostic dilemmas. The first case, ALK-negative anaplastic large-cell lymphoma involving a seroma associated with a breast implant, is an emerging clinicopathologic entity. Anaplastic large-cell lymphoma has been identified in association with breast implants and seroma formation relatively recently. The second case, hairy cell leukemia involving the breast and ipsilateral axillary sentinel lymph node, is, to our knowledge, the first reported case of hairy cell leukemia involving the breast at the time of diagnosis. While a localized bone lesion was present at time of diagnosis, bone marrow involvement was relatively mild in comparison to that seen in the breast and lymph node. In the first case, lymphoma occurred in a clinical setting where malignancy was unsuspected, highlighting the importance of careful morphologic evaluation of paucicellular samples, as well as awareness of rare clinicopathologic entities, in avoiding a misdiagnosis of a benign inflammatory infiltrate. In the second case, the lymphoid neoplasm exhibited classic morphologic and immunophenotypic features, but presented at an unusual site of involvement. Knowledge of the patient's concurrent diagnosis of hairy cell leukemia involving the bone marrow and bone helped avoid a misdiagnosis of carcinoma rather than lymphoma.

A Patient Death Attributable to Implant-Related Primary Anaplastic Large Cell Lymphoma of the Breast

“…Most affected patients reported in the literature have had a good response, with nearly all demonstrating complete remission of the disease process on limited follow-up. 14,24 This generally positive prognosis has led some to declare implant-related primary ALCL of the breast to be a less aggressive form of ALCL; as reported by Roden et al, "Our series and other reported cases suggest that primary anaplastic largecell lymphoma adjacent to breast implants is an indolent T-cell lymphoproliferative disorder." 18 To our knowledge, our case report represents the first confirmed death attributable to implantrelated primary ALCL of the breast.…”

“…16,24,25 Rarely, patients have been described as manifesting mastitis-like symptoms, skin ulceration, or chest wall and/or axillary pain. 10,18,26 Intervention in all cases has consisted of operative removal of the breast implant with either partial or complete capsulectomy; diagnosis is confirmed on the basis of pathologic assessment of the implant capsule.…”

Breast implant–associated anaplastic large cell lymphoma, a systematic review and in‐depth evaluation of the current understanding

“…The majority of cases presented with unilateral breast swelling (including enlargement and tenderness), lymphadenopathy, skin manifestations, and B symptoms (fever, chills, weight loss, night sweats, etc) . Imaging done showed a pericapsular fluid collection in the majority of patients, with masses and superficial lesions presenting much more rarely . One patient was clinically asymptomatic with the exception of relapsing pericapsular effusion, which was drained multiple times before being found on cytology to be BIA‐ALCL .…”

“…Breast implants and breast implant capsules have been associated with several types of non ALCL cancers, including squamous cell carcinoma, large B cell lymphoma, primary T‐cell lymphoma, Sezary syndrome, and hairy cell leukemia . To add to this heterogeneity, ALK+ cases of lymphoma around a breast implant have also been documented despite the fact that BIA‐ALCL is nearly always ALK−, a feature now required for its diagnosis.…”

Manejo del seroma crónico en pacientes con implantes de mama en relación con el diagnóstico de linfoma anaplásico de células gigantes

“…Trauma: un traumatismo puede evolucionar en un hematoma o bien sólo provocar un proceso inflamatorio que evolucionará a la formación de seroma. [26][27][28] Metaplasia sinovial: ocasionada por el cizallamiento mecánico entre el implante y la cápsula, lo cual ocasiona un estado inflamatorio crónico con el desarrollo resultante del seroma. 29,30 Se ha encontrado una mayor incidencia de seroma en pacientes con factores de riesgo como: obesidad, antecedente de radiación, diabetes mellitus y uso de matriz dérmica.…”