La Forgia Daniele, Catino Annamaria, Fausto Alfonso, Cutrignelli Daniela, Fanizzi Annarita, Gatta Gianluca, Losurdo Liliana, Maiorella Arianna, Moschetta Marco, Ressa Cosmo, Scattone Anna, Portincasa Aurelio
I.R.C.C.S. Istituto Tumori "Giovanni Paolo II", Bari.
Dip. di Diagnostica per Immagini, Azienda Ospedaliera Universitaria Senese, Siena.
Medicine (Baltimore). 2020 Jul 24;99(30):e21095. doi: 10.1097/MD.0000000000021095.
Anaplastic large T-cell lymphoma (BI-ALCL) is a rare primitive lymphoma described in women with breast implant prostheses, which has been arousing interest in recent years due to its potentially high social impact. The difficult diagnosis associated with the high and increasing number of prosthetic implants worldwide has led to hypothesize an underestimation of the real impact of the disease among prosthesis-bearing women. The aim of this work is to search for specific radiological signs of disease linked to the chronic inflammatory pathogenetic mechanism.
This work describes a case of BI-ALCL in an American woman with no personal or family history of cancer, who underwent breast augmentation for esthetic purposes at our Institute. After about 10 years of relative well-being, the patient returned to our Institute with clear evidence of breast asymmetry due to the increase in volume of the right breast which had progressively become larger over a period of 6 months. There was no evidence of palpable axillary lymph nodes or other noteworthy signs.
The ultrasound and magnetic resonance (MR) tests indicated the presence of seroma with amorphous material in the exudate which was confirmed by indirect signs, visible in right breast mammography. Due to suspected cold seroma, an ultrasound-guided needle aspiration was performed for the cytological analysis of the effusion which highlighted the presence of a number of large-sized atypical cells with an irregular nucleus with CD30 immunoreactivity, leucocyte common antigen (CD45) compatible with the BI-ALCL diagnosis.
In our case, a capsulectomy was performed because the disease was limited inside the capsule and periprosthetic seroma. The final histological examination confirmed the stage.
The patient is being monitored and shows no signs of recurrence of disease >24 months after surgery.
A diagnosis of BI-ALCL can be reached using new radiological indicators, such as fibrin, which is clearly visible by MR in the form of nonvascularized debris of amorphous material hypointense in all sequences, free flowing or adhered to the external surface of the prosthesis.
间变性大T细胞淋巴瘤（BI-ALCL）是一种在接受乳房植入假体的女性中发现的罕见原发性淋巴瘤，近年来因其潜在的巨大社会影响而备受关注。全球范围内假体植入数量众多且不断增加，与之相关的诊断困难使得人们推测该病在佩戴假体的女性中的实际影响可能被低估。这项研究的目的是寻找与慢性炎症发病机制相关的疾病特异性放射学征象。
本研究描述了一名美国女性患BI-ALCL的病例，该女性无个人或家族癌症病史，因美容目的在我院接受了隆胸手术。在经历了约10年的相对健康期后，患者因右乳房体积增大导致乳房不对称而再次回到我院，右乳房在6个月内逐渐变大。未发现可触及的腋窝淋巴结或其他值得注意的体征。
超声和磁共振（MR）检查显示存在血清肿，渗出液中有无定形物质，右乳房钼靶检查可见间接征象证实了这一点。由于怀疑是寒性血清肿，进行了超声引导下针吸，对积液进行细胞学分析，发现了一些大的非典型细胞，核不规则，CD30免疫反应阳性，白细胞共同抗原（CD45）与BI-ALCL诊断相符。
在我们的病例中，由于疾病局限于囊内和假体周围血清肿，因此进行了包膜切除术。最终的组织学检查证实了分期。
患者正在接受监测，术后24个月以上未出现疾病复发迹象。
使用新的放射学指标，如纤维蛋白，可诊断BI-ALCL，MR可清晰显示纤维蛋白，表现为在所有序列中均呈低信号的无定形物质的无血管化碎片，可自由流动或附着于假体外表面。
