PMC5828403_01
MRI at diagnosis showing fluid surrounding right breast implant, enlarged right axillary lymph node.
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Presence of a 2 cm mass in the lower inner quadrant of the right breast and an enlarged 3 cm right axillary lymph node was also confirmed on MRI (Figure 1). In addition, surgical pathology confirmed areas of disease found on the pretreatment imaging (Figures 1, 2, 2, and e2(e)), including the right breast capsule, right breast extracapsular tissue, right medial breast glandular tissue, and right breast chest wall.
Pretreatment PET/CT staging scan showing right medial breast involvement (a) and restaging PET/CT after surgery and chemotherapy showing complete resolution of disease in the breast (b), pretreatment PET/CT showing right lymph node involvement (c) and posttreatment decrease in size of the nodes (d), and pretreatment right chest wall involvement (e) and posttreatment resolution of disease in chest wall (f).
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Staging PET/CT showed multiple lesions in the right breast, the largest measuring up to 5 cm with SUV ranging from 10 to 52.4 (Figure 2) and two hypermetabolic lymph nodes in the right axilla measuring 1.7 and 3.7 cm with SUV of 6.0 and 15.8, respectively (Figure 2). There was also a hypermetabolic band posterior to the implant involving the pectoralis minor muscle measuring 5 x 1 cm with an SUV of 33.7 (Figure 2). In addition, surgical pathology confirmed areas of disease found on the pretreatment imaging (Figures 1, 2, 2, and e2(e)), including the right breast capsule, right breast extracapsular tissue, right medial breast glandular tissue, and right breast chest wall. PET/CT after 3 cycles of chemotherapy showed complete resolution of the previously noted hypermetabolic areas in the right breast (Figure 2) and chest wall (Figure 2), as well as a decrease in size of the right axillary lymph nodes to 0.5 cm (from 1.7 to 3.7 cm) (Figure 2).
High power (40x) of horseshoe cells (cells with eccentric nuclei) with a mixed infiltrate in between, which are the "hallmarks cells" in anaplastic lymphoma (a), lymphoma/large cells shown diffusely positive for CD30 (b), and ALK shown diffusely negative throughout (c).
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The biopsies of the breast, right axillary lymph nodes, and fluid cytology surrounding the breast capsule confirmed CD30+/ALK- anaplastic large cell lymphoma (Figure 3).