title: Skin involvement as the first manifestation of breast implant-associated anaplastic large cell lymphoma.
abstract: Breast implant-associated anaplastic large cell lymphoma (ALCL) is a newly described clinical and pathologic entity that typically presents as seroma in the fibrous scar around the implant. Less frequently, it presents as a solid peri-implant mass, and there have been no reports to date of cutaneous lesions as the presenting manifestation. We report the case of a 56-year-old woman with a history of bilateral breast reconstruction following breast cancer of the right breast who consulted with several papules on the right breast suggestive of metastasis. Histopathology showed a proliferation of large epithelioid lymphocytes with highly pleomorphic cells and nuclei. The neoplastic cells were CD15 and CD30 positive and ALK-1 negative. The epithelial markers were all negative except for epithelial membrane antigen (EMA), which was weakly positive. Molecular analysis showed monoclonal T-cell receptor γ gene rearrangement, confirming a diagnosis of breast implant-associated ALCL. The non-specific morphology of the skin lesions, the epithelioid nature of the neoplastic cells and the expression of EMA can lead to an erroneous diagnosis of skin metastases from a poorly differentiated adenocarcinoma of the breast. We recommend immunohistochemical staining for CD30 and ALK-1 for patients with breast implants who develop anaplastic lesions.
authors.affiliation: Department of Dermatology, Instituto Valenciano de Oncología, Valencia, Spain.
authors.forename: Rebeca
authors.initials: R
authors.lastname: Alcalá
authors.affiliation: Department of Dermatology, Instituto Valenciano de Oncología, Valencia, Spain.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Llombart
authors.affiliation: Department of Oncology, Instituto Valenciano de Oncología, Valencia, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Lavernia
authors.affiliation: Department of Pathology, Instituto Valenciano de Oncología, Valencia, Spain.
authors.forename: Víctor
authors.initials: V
authors.lastname: Traves
authors.affiliation: Department of Dermatology, Instituto Valenciano de Oncología, Valencia, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Guillén
authors.affiliation: Department of Dermatology, Instituto Valenciano de Oncología, Valencia, Spain.|Department of Dermatology, Catholic University of Valencia 'San Vicente Mártir', Valencia, Spain.
authors.forename: Onofre
authors.initials: O
authors.lastname: Sanmartín
keywords: CD30; breast implant; implant-associated anaplastic large cell lymphoma; skin involvement