PMC4331673_01
Firmness and marked increase in size of the right breast as seen on presenting physical examination.
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F1
She developed a recurrent fluid collection involving her right breast (Figure 1).
Effusion fluid (seroma). Anaplastic large cells present in the effusion surrounding the breast implant. Anaplastic large cells also involve the breast implant capsule (not shown). Immunohistochemical staining shows anaplastic large-cell lymphoma T-cell type.
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F2
On histopathologic analysis, anaplastic large-cell lymphoma (ALCL), anaplastic lymphoma kinase (ALK)-negative was demonstrated in the fibrous capsule, cystic fluid, and axillary lymph nodes (Figures 2 and 3).
Axillary lymph node. Axillary lymph node of the same patient shows large atypical cells involving the sinusoidal and lymphatic space, consistent with anaplastic large cells involving the lymph node.
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F3
On histopathologic analysis, anaplastic large-cell lymphoma (ALCL), anaplastic lymphoma kinase (ALK)-negative was demonstrated in the fibrous capsule, cystic fluid, and axillary lymph nodes (Figures 2 and 3).
Right axillary lymphadenopathy demonstrated on axial and coronal PET scan images with abnormal FDG avidity (A,B) and coronal CT images with contrast (C,D).
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F4
Imaging with CT and PET scans demonstrated residual right axillary lymphadenopathy with FDG avidity, as illustrated in Figure 4.
Coronal CT slice of treatment plan showing isodose lines and contoured axillary nodal volume.
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F5
The axilla levels 1-3 were contoured and a lightly weighted posterior axillary field was used to bring the volume up to the prescription dose (Figure 5).