A 40-year-old patient was referred to the Breast Unit of our hospital for self-palpation of nodules in the left breast two weeks before.
Physical examination confirmed the presence of a tumor with a stony consistency attached to deep planes in the left infraclavicular region.
The patient reported no other associated symptoms.
Her personal history included a 17-year-old mammoplasty and subsequent rejuvenation mammoplasty with placement of implants at 33 years of age and unilateral breast reduction oophorectomy.
There were no other personal or family history of interest.
Mammography performed initially revealed no pathological findings in breasts with a dense fibroglandular pattern (composition D) and a potential masking effect that limited the detection of lesions.
Complementary ultrasound confirmed that the palpable lesion corresponded to a solid mass, aggressive behavior, associated with several periprocedural nodules.
The breast prostheses were in retropectoral position and showed an intact appearance, without periprocedural fluid or other signs of complications.
This examination also revealed the presence of lymphadenopathies in both internal mammary chain and axillary regions.
We catalyze the findings as BI-RADS 5 (Breast Imaging Reporting and Data System), i.e., highly axillary sentinel nodes of malignancy according to the current classification system of the ACR (American College of Radiology 2015).
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Magnetic resonance imaging (MRI) and computed tomography (CT) confirmed the involvement of the pectoral muscle and the extension of the tumor to the extrapulmonary space.
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Both this lesion and the other periprocedural nodules depicted on ultrasound showed morphological and dynamic behavior suggestive of malignancy, with signal intensity similar to parenchymal administration on T1-weighted images and kinetics
Likewise, both MRI and CT confirmed the presence of axillary lymph nodes and internal mammary chain.
We also tested the integrity of both prostheses and the absence of periprocedural fluid.
The CT extension study showed no distant lesions.
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The initial diagnosis was multicentric carcinoma with locoregional lymph node involvement T2 N2 M0 (American Joint Committee of Cancer 7th edition).
The pathological study confirmed the diagnosis of anaplastic T-cell lymphoma associated with breast implant.
Since this entity was diagnosed, we completed the extension study with bone marrow biopsy and positron emission tomography (PET-CT), which were negative.
The pathological study of the nodule demonstrated a polymorphous infiltrate with high proliferative index (90%) with cells expressing CD30 and CD15 and were negative for ALK (anaplastic lymphoma kinase).
Axillary lymph node biopsy revealed focal lymphoma.
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After evaluation in a multidisciplinary committee it was decided to remove the breast implants with complete capsulectomy in both breasts.
The implants removed were McGhan®, model MM, textured, 320 cc.
Given the nature of the primary lesion, neither mass nor periprocedural nodules were removed.
The pathological study of the surgical specimen confirmed the presence of a tumor in the left periprosthetic capsule, with no evidence of lesion in the contralateral breast.
One week after the intervention, we clinically evidenced a significant decrease in the infraclavicular mass, which is why we performed a reassessment CT that confirmed the practice of its resolution, as well as a marked reduction in the size of the adenopathy.
Histological confirmation of lymph node involvement completes the treatment with 6 cycles of chemotherapy following the CHOP formula (Ciclophamide, doxorubicin, Vincristine, Prednisolone).
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After 12 months of evolution, the patient underwent a periodical clinical and analytical follow-up, which we added the performance of several imaging tests: MRI at 6 months of diagnosis, periodic abdominal ultrasound and complete oncological CT evaluation.
