Ali Syed H, Patel Akash P, Mohammad Khan O, Reddy Neha K
Department of Internal Medicine, University of Texas at Austin Dell Medical School, Austin, TX, USA.
J Cardiol Cases. 2024 Aug 29;30(6):193-195. doi: 10.1016/j.jccase.2024.08.004. eCollection 2024 Dec.
This case is a rare presentation of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), where malignant pericardial effusion (MPE) served as the primary manifestation. A 58-year-old woman, post-breast implant removal, presented with pleuritic chest pain, fever, and chills. Clinical evaluation revealed jugular venous distention, muffled heart sounds, and hemodynamic instability. Echocardiogram with Doppler confirmed large pericardial effusion with tamponade physiology. Following a multidisciplinary discussion, a diagnostic and therapeutic pericardiocentesis was performed, resulting in immediate symptomatic relief.Cytology studies of the pericardial fluid revealed CD30+, ALK-ALCL, confirming BIA-ALCL. Prompt initiation of brentuximab-cyclophosphamide, doxorubicin, and prednisolone therapy ensued. This case underscores the rarity of MPE as an initial presentation of BIA-ALCL and highlights the significance of early recognition and consideration of rare lymphomas in patients with breast implants.
Recognize the importance of considering breast implant-associated anaplastic large cell lymphoma in the differential diagnoses of malignant pericardial effusion.
该病例为乳房植入物相关间变性大细胞淋巴瘤（BIA-ALCL）的罕见表现，其中恶性心包积液（MPE）为主要表现。一名58岁女性，在乳房植入物取出后，出现胸痛、发热和寒战。临床评估发现颈静脉扩张、心音减弱和血流动力学不稳定。超声心动图及多普勒检查证实大量心包积液伴心脏压塞生理改变。经过多学科讨论后，进行了诊断性和治疗性心包穿刺术，症状立即缓解。心包积液的细胞学研究显示CD30+、ALK-间变性大细胞淋巴瘤，确诊为BIA-ALCL。随后迅速开始使用本妥昔单抗-环磷酰胺、多柔比星和泼尼松龙治疗。该病例强调了MPE作为BIA-ALCL初始表现的罕见性，并突出了早期识别以及考虑乳房植入物患者中罕见淋巴瘤的重要性。
认识到在恶性心包积液的鉴别诊断中考虑乳房植入物相关间变性大细胞淋巴瘤的重要性。
