Anaplastic large cell lymphoma arising in a saline breast implant capsule after tissue expander breast reconstruction
Anaplastic large cell lymphoma arising in a saline breast implant capsule after tissue expander breast reconstruction
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DOI：
10.1097/sap.0b013e31804d442e
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发表时间：
2007-07-01
影响因子：
1.5
通讯作者：
Brooks, Glen S.
中科院分区：
文献类型：
--
作者：
Olack, Brian;Gupta, Raavi;Brooks, Glen S.
原发性乳腺淋巴瘤非常罕见，占所有乳腺肿瘤的不到0.5%。此外，大多数这些肿瘤是B细胞起源，虽然T细胞原发性淋巴瘤的乳房已报告。间变性大细胞淋巴瘤，T细胞表型先前已在硅胶和生理盐水乳房植入体附近报告。4-7然而，这只是第二个报告的病例，发生在乳房植入体的包膜中，用于既往乳房恶性肿瘤后的重建。之前的病例涉及一名87岁女性，在使用生理盐水植入体重建右乳房7年后出现右乳房肿块。4最初的活检显示强烈的细胞浸润，这被认为是对植入物的免疫反应。1年后，她的疼痛加剧，破裂植入物周围的组织显示T细胞表型的间变性大细胞淋巴瘤。其他病例涉及用于美容隆乳的植入物或既往有淋巴瘤病史的患者。一位33岁女性接受双侧硅胶隆乳，14年后出现左乳房肿胀和压痛，随后被诊断为淋巴瘤。5另一个病例涉及一名41岁的女性，她接受了双侧生理盐水植入，5年后出现了疼痛的右乳房肿块。肿块的切除活检显示淋巴瘤。6.一名46岁女性在双侧硅胶假体植入5年后出现右乳房肿胀。液体收集的抽吸显示存在淋巴瘤。7最后，一名50岁的女性，有霍奇金病病史，在左侧乳腺癌乳房切除术后20年植入了双侧硅胶植入体。9年后，对覆盖在她右乳房上的皮下结节进行活检，发现淋巴瘤。4虽然罕见，但这是一种容易漏诊的诊断，在评估之前植入植入体后的乳房疼痛或肿胀时应考虑到这一点。
DISCUSSIONPrimary breast lymphomas are extremely rare and represent less than 0.5% of all breast tumors. Furthermore, most of these tumors are of B-cell origin, although T-cell primary lymphoma of the breast has been reported. Anaplastic large cell lymphoma, T-cell phenotype has been previously reported in proximity to both silicone and saline breast implants. 4–7 However, this is only the second reported case arising in the capsule of a breast implant placed for reconstruction after a previous breast malignancy. The previous case involved an 87-year-old woman who presented with a right breast mass 7 years after reconstruction of the right breast with a saline implant. 4 An initial biopsy showed intense cellular infiltrate, which was thought to be an immune response to the implant. Her pain increased 1 year later, and tissue around the ruptured implant showed anaplastic large cell lymphoma of T-cell phenotype. The other cases involved implants placed for cosmetic augmentation or patients with a previous history of lymphoma. A 33-year-old woman underwent bilateral breast augmentation with silicone implants and developed swelling and tenderness of the left breast 14 years later, which was subsequently diagnosed as lymphoma. 5 Another case involves a 41-year-old woman who had a bilateral saline implant placed and developed a painful right breast mass 5 years later. Excisional biopsy of the mass revealed lymphoma. 6 A 46-year-old woman presented with right breast swelling 5 years after placement of bilateral silicone implants. Aspiration of the fluid collection revealed the presence of lymphoma. 7 Finally, a 50-year-old woman with a history of Hodgkin disease had bilateral silicone implants placed 20 years later after a mastectomy for left breast carcinoma. Nine years later, biopsy of subcutaneous nodules overlying her right breast revealed lymphoma. 4 Although rare, this is a diagnosis that is easily missed and should be considered in the evaluation of breast pain or swelling after previous implant placement.