Anaplastic Large Cell Lymphoma (ALCL) of the breast is a rare malignancy, with roughly 60 cases reported associated with prosthetic breast implants. We present a case of ALK-1 negative ALCL in a woman with no prior history of breast implants.
A 36 year old woman with no prior history of breast implants presented with a complex left breast cyst which was aspirated, but recurred after four years, whereupon another blind fine need aspirate of the cyst obtained revealed an epitheliod population with marked cellular atypia. Within a month, the cyst recurred and the patient had the cystic lesion and its capsule excised.
Microscopic examination of the tissue capsule demonstrated fibrotic and inflamed breast capsule, the inner surface of which was lined by necrotic debris and fibrin, with clusters of highly atypical cells and focally degenerate cells with large pleomorphic nuclei with prominent nucleoli. Immunohistochemical stains were positive for CD30 and CD45 and TIA-1, and negative for CD3, CD5, CD20, ALK-1 and CD79b. Staging imaging revealed no distant disease, but evidence of inflammatory change around a post operative seroma. She was not offered adjuvant chemotherapy and remained disease free a year later.
Her investigations were consistent with ALK-1 negative ALCL of the breast, a condition not previously reported in association with a benign cyst. This may suggest that the development of ALCL does not rely on the presence of foreign material such as a prostheses and can occur de novo. The reported cases of prosthesis related ALCL could therefore be related to an inflammatory process related to the capsule or seroma rather than the implant. This has implications for surgeons to consider ALCL as a rare cause for new onset of pain or swelling in women with previous cysts which have been surgically excised or aspirated.