Johnson Lisa, Lowry Kathryn, Scheel John, Mau Brian, Rockoff Steven J
University of Washington, Department of Radiology, 1959 N.E. Pacific St., Box 357115, Seattle, WA 98195-7115.
Breast Imaging Section, Department of Radiology, University of Washington, Seattle Cancer Care Alliance, Seattle, WA.
Radiol Case Rep. 2020 Oct 9;15(12):2572-2576. doi: 10.1016/j.radcr.2020.09.033. eCollection 2020 Dec.
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare type of T-cell lymphoma that arises in the setting of textured breast implants. In this case report, a 69-year-old woman with a remote history of right-sided invasive lobular carcinoma status post right mastectomy and bilateral breast reconstruction presents with spontaneous right breast swelling and pain, suspicious for implant rupture. Diagnostic MRI revealed a peri-implant fluid collection in the right breast and focal nonmass enhancement in the left breast. The patient was ultimately diagnosed with right-sided BIA-ALCL and left-sided invasive lobular carcinoma. Although intravenous gadolinium contrast is not needed to assess implant integrity, it can be used to evaluate for malignancy when the patient is at an increased risk for developing breast cancer. In this case, the use of contrast revealed the rare instance of a synchronous contralateral invasive lobular carcinoma. Despite the rarity of BIA-ALCL with an estimated incidence of 1:30,000 in women with textured implants, it is essential that radiologists include this entity in the differential in the appropriate clinical setting as surgical resection is curative if performed before the disease has spread.
乳房植入物相关间变性大细胞淋巴瘤（BIA-ALCL）是一种罕见的T细胞淋巴瘤，发生于有纹理的乳房植入物环境中。在本病例报告中，一名69岁女性，既往有右侧浸润性小叶癌病史，已行右侧乳房切除术及双侧乳房重建，现出现右侧乳房自发性肿胀和疼痛，怀疑植入物破裂。诊断性磁共振成像（MRI）显示右侧乳房植入物周围有液体积聚，左侧乳房有局灶性非肿块强化。该患者最终被诊断为右侧BIA-ALCL和左侧浸润性小叶癌。虽然评估植入物完整性不需要静脉注射钆造影剂，但当患者患乳腺癌风险增加时，可用于评估是否存在恶性肿瘤。在本病例中，使用造影剂发现了罕见的同步对侧浸润性小叶癌病例。尽管BIA-ALCL罕见，在有纹理植入物的女性中估计发病率为1:30000，但放射科医生在适当的临床情况下必须将该疾病纳入鉴别诊断，因为如果在疾病扩散前进行手术切除，是可以治愈的。
