Materazzo Marco, Vanni Gianluca, Rho Maurizio, Buonomo Chiara, Morra Emanuela, Mori Stefano
Oncoplastic Interdepartmental Unit, Istituto Nazionale Tumori IRCCS, Fondazione Pascale, Via Mariano Semmola, 52, 80131 Napoli, Italy; Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Viale Oxford, 81, 00133 Rome, Italy.
Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Viale Oxford, 81, 00133 Rome, Italy.
Int J Surg Case Rep. 2022 Sep;98:107520. doi: 10.1016/j.ijscr.2022.107520. Epub 2022 Aug 15.
Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) is a rare T-cell lymphoma occurring after breast implant procedures. As gender confirmation therapy (GCT) in male-to-female transgender (FT), up to 60-70 % of patients require breast augmentation and are at risk for BIA-ALCL. Hence, we report the youngest BIA-ALCL case in the Italian population and the first early-stage BIA-ALCL occurred in FT patients.
A 27-years-old FT was admitted to outpatients' clinics due to swollen left breast. The patient underwent GCT with a macrotextured implant four years before. Clinical examination revealed swollen left breast. Ultrasound and magnetic resonance imaging confirmed left breast periprosthetic effusion. Positron emission tomography-computed tomography scan did not reveal any focal pathological uptake. Fine needle aspiration cytology confirmed BIA-ALCL suspect. The patient underwent bilateral en bloc breast implant removal and periprosthetic capsulectomy. Due to the early stage, adjuvant chemotherapy was omitted. Postoperative follow-up was unremarkable.
BIA-ALCL is a rare, emergent clinical concern after breast implant surgery. GCT leads to improved body satisfaction and quality of life in FT individuals. As for non-trans patients undergoing breast reconstruction or breast augmentation, this clinical case once again demonstrates that FT patients undergoing breast implant surgery are at risk of BIA-ALCL.
Physicians should promote awareness among patients' GCT and tailored postoperative follow-up.
乳房植入物相关间变性大细胞淋巴瘤（BIA-ALCL）是一种在乳房植入手术后发生的罕见T细胞淋巴瘤。作为男变女跨性别者（FT）的性别确认疗法（GCT），高达60%-70%的患者需要隆乳，有患BIA-ALCL的风险。因此，我们报告了意大利人群中最年轻的BIA-ALCL病例以及首例发生在FT患者中的早期BIA-ALCL病例。
一名27岁的FT因左乳房肿胀入住门诊。该患者四年前接受了带有大纹理植入物的GCT。临床检查发现左乳房肿胀。超声和磁共振成像证实左乳房假体周围积液。正电子发射断层扫描-计算机断层扫描未发现任何局灶性病理摄取。细针穿刺细胞学检查证实怀疑为BIA-ALCL。患者接受了双侧整块乳房植入物取出术和假体周围囊切除术。由于处于早期阶段，未进行辅助化疗。术后随访无异常。
BIA-ALCL是乳房植入手术后一种罕见的、新出现的临床问题。GCT可提高FT个体的身体满意度和生活质量。对于接受乳房重建或隆乳的非跨性别患者，该临床病例再次表明接受乳房植入手术的FT患者有患BIA-ALCL的风险。
医生应提高患者对GCT的认识并进行有针对性的术后随访。
