Indolent B-cell lymphoma associated with breast implants: a case report

Background: Breast implant-associated lymphomas are rare neoplasms that have been increasingly recognized and reported, with T-cell lymphomas such as breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) being the most well-characterized. Breast implant-associated B-cell lymphomas are exceedingly rare, with only a handful of cases reported in the literature with high variability in patient demographics and lymphoma classification.

Case Description: We present a case of an 86-year-old female with a history of invasive ductal carcinoma and textured silicone-saline implants placed 37 years prior who presented with acute onset right breast pain, swelling, erythema, and constitutional symptoms overall concerning for BIA-ALCL. Initial core needle biopsy was unremarkable, but flow cytometry of periprosthetic fluid demonstrated low but significant levels of an abnormal monotypic B-cell population. Immunohistochemical staining of the biopsy revealed a mixed population of CD3/CD20-expressing lymphocytes. Explantation and capsulectomy were performed, and further pathological testing of the specimen was overall consistent with classic follicular lymphoma. Following extensive multi-disciplinary collaboration and shared decision making, close observation was pursued due to resolution of symptoms after surgery. The patient has remained symptom free in 3 years of follow-up postoperatively.

Conclusions: This case reports the unique presentation of a breast implant-associated indolent follicular lymphoma occurring decades after implantation. Clinicians should maintain an index of suspicion for B-cell lymphoma in patients who present with B-symptoms and peri-implant effusion. In this case, the patient was successfully managed with explantation and close observation alone, without the need for adjuvant systemic therapy. Given this condition’s rarity, multi-disciplinary collaboration is highly recommended in treatment planning. There remains a need to further characterize its epidemiology, pathogenesis, and behavior as the current literature on this process is sparse.