PMC5684586_01
Mammogram showing silicone implant in the (a) left and (b) right breasts.
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A 65-year-old Caucasian female had a past medical history significant for bilateral fibrocystic breast disease resulting in bilateral subcutaneous mastectomy, followed by bilateral cosmetic breast reconstruction with textured silicone gel implants at age 30 (Figure 1).
MRI showing fluid accumulation around the left breast subpectoral silicone implant.
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Two years later, edema was noted again in the left breast and confirmed by MRI (Figure 2)], resulting in a third replacement of the silicone gel implant.
Ultrasound of the left breast ((a) transverse view, (b) sagittal view at 12 : 00 position) and the right breast ((c) transverse view, (d) sagittal view at 10 : 00 position).
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A targeted ultrasound examination of the left breast at the approximate twelve o'clock position, left axilla, and of the right breast at the ten o'clock position over areas of concern demonstrated no discrete cystic or solid abnormalities (Figure 3).
Representative sections of the left breast capsule. Larger image: the capsule contains small lymphocytes, macrophages, plasma cells, and occasional eosinophils. In addition, there are clusters of large neoplastic cells throughout the capsule, adjacent to the luminal fibrinoid necrosis (hematoxylin and eosin, 100x). Inset image: the large neoplastic cells are pleomorphic with hyperchromatic nuclei and abundant clear to slightly eosinophilic cytoplasm. Occasional "hallmark" cells with eccentric horseshoe- and kidney-shaped nuclei (hematoxylin and eosin, 1000x).
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The atypical cells were large and pleomorphic, with hyperchromatic nuclei and occasional prominent nucleoli noted along with abundant clear to slightly eosinophilic cytoplasm (Figure 4).
Select immunostaining of the region of capsular tissue with atypical cells. (a) Large neoplastic cells stain positive with CD43, confirming T-cell lineage (200x). (b) In addition, the neoplastic cells have uniform membranous and Golgi staining with CD30 (200x). (c) There is weak staining with epithelial membrane antigen (EMA) (200x). (d) The cells lack expression of ALK (200x).
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Immunohistochemical analysis demonstrated strong CD30, CD43, and MUM1 expression, while EMA was weakly positive (Figure 5). The cells did not express ALK (Figure 5), CD20, CD79a, or estrogen receptor.
CT scan of chest: large fluid collection in the left chest wall measuring 12.9 x 2.8 x 10.1 cm.
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Computed tomography (CT) scans of the neck, chest, abdomen, and pelvis with IV and oral contrast were essentially negative for any malignancy or lymphadenopathy except for the noted fluid collection in the left breast measuring 12.9 x 2.8 x 10.1 cm (Figure 6).