title: Cytological Diagnosis of Bilateral Breast Implant-Associated Lymphoma of the ALK-Negative Anaplastic Large-Cell Type. Clinical Implications of Peri-Implant Breast Seroma Cytological Reporting.
abstract: The cytological examination of peri-prosthetic breast effusions allowed the diagnosis of bilateral breast-implant ALK-negative anaplastic large cell lymphoma (BI-ALCL) in the case reported. Ten years after reconstructive surgery with bilateral breast implants, a large unilateral seroma developed and was cytologically analyzed. The presence of CD30 and CD4-positive large-sized atypical lymphoid cells exhibiting horseshoe-shaped nuclei and a brisk mitotic activity rendered the diagnosis of BI-ALCL. Similar cells were seen in the peri-prosthetic fluid intraoperatively collected from the contralateral breast. Although initial histological analysis of the capsulectomy specimens showed unilateral tumor, the cytological findings prompted a more thorough tissue sampling, resulting in the diagnosis of bilateral disease. BI-ALCL usually follows an indolent clinical course; however, there are reported cases with an aggressive behavior. While the presence of bilateral disease is a putative risk factor for a bad prognosis, the small number of cases reported precludes a definitive assessment of this risk. Since most BI-ALCL present with late seromas, cytologic analysis of these effusions in women with breast implants should be mandatory. Cytology is a safe tool for diagnosis and follow-up of patients with breast implant-related late seromas, sometimes proven more sensitive than histological analysis. Complete bilateral capsulectomy and a detailed histological analysis should follow a cytological diagnosis of BI-ALCL in a breast effusion in order to avoid false negative diagnoses. Our case constitutes the first published report of a bilateral BI-ALCL diagnosed by cytology. Diagn. Cytopathol. 2016;44:623-627. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Department of Pathology, Hospital Universitario de Getafe, Madrid, Spain.
authors.forename: Rosario
authors.initials: R
authors.lastname: Granados
authors.affiliation: Department of Plastic Surgery, Hospital Universitario de Getafe, Madrid, Spain.
authors.forename: Eva M
authors.initials: EM
authors.lastname: Lumbreras
authors.affiliation: Department of Radiology, Hospital Universitario de Getafe, Madrid, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Delgado
authors.affiliation: Department of Pathology, Hospital Universitario de Getafe, Madrid, Spain.
authors.forename: José A
authors.initials: JA
authors.lastname: Aramburu
authors.affiliation: Department of Pathology, Hospital Universitario de Fuenlabrada, Madrid, Spain.
authors.forename: Juan C
authors.initials: JC
authors.lastname: Tardío
mesh_terms: D000077548:Anaplastic Lymphoma Kinase; D014408:Biomarkers, Tumor / Q000378:metabolism; D018427:Breast Implants / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000150:complications / Q000378:metabolism / Q000473:pathology*; D005260:Female; D006801:Humans; D017728:Lymphoma, Large-Cell, Anaplastic / Q000150:complications / Q000378:metabolism / Q000473:pathology*; D008875:Middle Aged; D020794:Receptor Protein-Tyrosine Kinases / Q000378:metabolism; D049291:Seroma / Q000150:complications / Q000209:etiology / Q000473:pathology*
chemical_list: D014408:Biomarkers, Tumor; C000626173:ALK protein, human; D000077548:Anaplastic Lymphoma Kinase; D020794:Receptor Protein-Tyrosine Kinases
keywords: ALK-negative; bilateral; breast implant; cytological diagnosis; lymphoma