Skin involvement as the first manifestation of breast implant-associated anaplastic large cell lymphoma
Skin involvement as the first manifestation of breast implant-associated anaplastic large cell lymphoma
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DOI：
10.1111/cup.12697
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发表时间：
2016-07-01
影响因子：
1.7
通讯作者：
Sanmartin, Onofre
中科院分区：
文献类型：
--
作者：
Alcala, Rebeca;Llombart, Beatriz;Sanmartin, Onofre
乳房植入体相关间变性大细胞淋巴瘤（ALCL）是一种新描述的临床和病理实体，通常表现为植入体周围纤维瘢痕中的血清肿。不太常见的是，它表现为种植体周围的实体肿块，迄今为止还没有皮肤病变作为表现的报道。我们报告的情况下，56岁的妇女与历史的双侧乳房再造后，乳腺癌的权利谁咨询与几个丘疹的权利乳房转移暗示。组织学检查显示大的上皮样淋巴细胞增殖，细胞和细胞核高度多形性。肿瘤细胞为CD 15和CD 30阳性，ALK-1阴性。上皮标志物除上皮膜抗原（EMA）呈弱阳性外，其余均为阴性。分子分析显示单克隆T细胞受体基因重排，证实了乳房植入体相关ALCL的诊断。皮肤病变的非特异性形态、肿瘤细胞的上皮样性质和EMA的表达可导致对乳腺低分化腺癌皮肤转移的误诊。我们建议对发生间变性病变的乳房植入体患者进行CD 30和ALK-1免疫组织化学染色。
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 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.