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Bone marrow involvement by breast implant‐associated anaplastic large cell lymphoma

A 56yearold otherwise healthy female presented in 2020 with right axillary lymphadenopathy. She had had bilateral breast augmentation in early 2000 with placement of bilateral textured implants. A positron emission tomography (18FFDG PET) scan showed a 2.4 cm hypermetabolic right axillary lymph node. Biopsy demonstrated anaplastic large cell lymphoma (ALCL), ALKnegative, T/null cell type (upper left, all microscopic images, objective × 40). Subsequent right breast biopsy demonstrated that these large neoplastic cells were positive for CD30 (upper right), granzyme B, TIA1 and p63. Clonal Tcell receptor gene rearrangement was detected, without TP63 or DUSP22 rearrangement. Bone marrow biopsy showed that lymphoma cells constituted approximately 1% of bone marrow cells (lower left). From May 2020 to September 2020, the patient underwent six 3weekly cycles of immunochemotherapy with cyclophosphamide, doxorubicin, prednisone and brentuximab vedotin. Posttreatment 18FFDG PET scan showed a complete response. Subsequently, the patient underwent bilateral capsulectomies. Intraoperatively, a “velvety” appearance of exudative, fibrinous tissue was noted on the surface of the right capsule, surrounded by brown, turbid fluid (lower right). The patient has been followed with serial PET scans and remains in remission. Breast implantassociated ALCL (BIAALCL) is a rare type of Tcell nonHodgkin lymphoma. The prognosis is favourable in the majority of patients, who have localised disease. Bone marrow involvement is uncommon. The addition of brentuximab vedotin, an antiCD30 antibody conjugate, to cyclophosphamide, doxorubicin and prednisone (ACHP) for treatment of CD30positive BIAALCL should be considered as a systemic regimen in combination with local therapy by capsulectomies.