Case of the month March Dre Sonia Ziadi Dre Ana Barrigón Benítez Institut universitaire de pathologie, Lausanne

Transcription

1 Case of the month March 2018 Dre Sonia Ziadi Dre Ana Barrigón Benítez Institut universitaire de pathologie, Lausanne

2 Clinical history 78 years-old female, past medical history for right breast carcinoma in 2009 with breast implant and implant replacement in april 2017 (8 years post implantation) for capsulitis. Presenting november 2017 with swelling in right breast seroma fluid is sent for analysis.

3 Cytology Cytologic examination performed a markedly cellular sample with noncohesive medium-sized to large lymphocytes arranged in small groups or isolated.

4 Cytology Irregular nuclear contours with frequent indentations, granular chromatin irregularly distributed and sometimes showing nucleoli. Scant cytoplasm with a prominent pale perinuclear Golgi zone. Flow cytometry T lymphocytosis.

5 Cytology MGG 100x markedly cellular sample with noncohesive medium-sized to large cells.

6 Cytology MGG 200x. Many small mature lymphocytes accompany.

7 MGG 400x Cytology

8 Cytology MGG 600x. Prominent pale perinuclear Golgi zone.

9 PAP 600x. Cytology

10 PAP 600x. Cytology

11 Cytology PAP 400x. Mitotic figures are easily recognizable.

12 Cell-block HE 600x. Frequent nuclear indentations (arrows)

13 HE 400x Cell-block

14 Immunocytochemistry Cells are strongly positive for: CD30 (membranous and perinuclear) CD4 CD5. CD3 positivity is weak, but strong in small mature lymphocytes associated.

15 Immunocytochemistry Negative for: ALK, CD20 (positive in some associated B lymphocytes) CD2 CD8 EMA, GATA-3, TP63, CKAE1/AE3. MIB1: 2%.

16 Immunocytochemistry. CD30 (400x)

17 Immunocytochemistry. CD4 (400x)

18 Immunocytochemistry. CD5 (400x)

19 Immunocytochemistry. ALK- (40x and 400x)

20 Immunocytochemistry. CD20- (400x)

21 Cytologic Diagnostic Anaplastic Large Cell Lymphoma, ALKnegative, compatible with a Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL).

22 Possible association, without evidence of causation, between breast implants and ALCL. Very small but increased risk of developping ALCL in patients with breast implants <1 in one million per year (without implants: 3 in 100 million per year). To date, more than 300 reported cases of BIA- ALCL worldwide.

23 Median age of diagnosis: 50 years old (range years) Median time from implant placement to diagnosis: 9 years (range 1-31 years) Most common presenting symptom: unilateral swelling related to periprosthetic fluid collection, firmness, pain, capsular contracture, rarely periimplant mass (worse prognosis).

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25 Cyto/histologicaly, may present as epithelioid-like, mimicking poorly differentiated breast carcinoma IHC necessary! Uniform expression of CD30 and CK negative.

26 Cells are large and pleomorphic with dispersed chromatin and multiple or single prominent nucleoli and have eosinophilic to amphophilic cytoplasm. Hallmark cells can occasionally be observed with horseshoe- or kidney-shaped nuclei and a paranuclear eosinophilic region.

27 Two different subtypes of BIA-ALCL: In situ : indolent clinical course after breast implant removal and capsulectomy. 2-year overall survival > 95%. Infiltrative (rare) : agressive clinical course. Breast implant removal and capsulectomy + chemotherapy +/- radiation therapy. 2-year overall survival: 52,5%.

28 CONCLUSION Breast Implant-Associated Anaplastic Large T- Cell Lymphoma has recently been recognized as a new entity (different than peripheral Anaplastic Large T-Cell Lymphomas) less aggressive prognosis. IHC: CD30+ ALK- (>90% compared to 37% in peripheral Anaplastic Large T-Cell Lymphomas).

29 References Ezekwudo D.E., Ifabiyi T, Gbadamosi B., Haberichter K., Yu Z., Amin M., Shaheen K, Stender M. and Jaiyesimi I. Breast Implant Associated Anaplastic Large Cell Lymphoma: A Case Report and Review of the Literature. Hindawi, Case Reports in Oncological Medicine, Volume 2017, Article ID , 6 pages. W Peters. Update on anaplastic large cell lymphoma in women with breast implants. Plast Surg 2014;22 (4): J. Mychaluk, D. Perignon, Q. Qassemyar, M. Gianfermi, R. Sinna. Anaplastic large cell lymphoma and breast implants: What do we know? Annales de chirurgie plastique esthétique (2012) 57:1-8.