Anaplastic large cell lymphoma involving the breast: a clinicopathologic study of 6 cases and review of the literature

Arch Pathol Lab Med. 2009 Sep;133(9):1383-90. doi: 10.1043/1543-2165-133.9.1383.

Abstract

Context: Lymphomas involving the breast are rare, and most cases are of B-cell lineage; T-cell neoplasms represent less than 10% of all breast lymphomas.

Objective: To define the clinicopathologic spectrum of anaplastic large cell lymphomas (ALCLs) involving the breast.

Design: Six cases of ALCL involving the breast were identified at a single institution during 21 years. The clinicopathologic and immunophenotypic features are presented, and the literature is reviewed.

Results: All patients were women, with a median age of 52 years. There were 4 anaplastic lymphoma kinase- negative (ALK(-)) ALCL cases; 3 of these neoplasms developed around breast implants. Two patients with ALK(-) ALCL had a history of cutaneous ALCL. There were 2 ALK(+) ALCLs; both patients had stage IV disease. Histologically, all neoplasms were composed of large anaplastic cells that were uniformly CD30(+) and expressed markers of T-cell lineage. Four patients with adequate follow-up are alive, with a mean of 4.1 years (range, 1.5-9 years) after diagnosis of the breast tumor. Included in this group are 2 patients with ALK(-) ALCL associated with breast implants who were alive 4 years and 9 years after diagnosis.

Conclusions: Including the 6 cases we describe, a total of 21 cases of ALCL involving the breast are reported. Fifteen cases, all ALK(-), were associated with breast implants, suggesting a possible pathogenetic relationship, and associated with an excellent prognosis. Patients with cutaneous ALCL can subsequently develop ALK(-) ALCL involving the breast, and these tumors can be associated with breast implants.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Aged
  • Anaplastic Lymphoma Kinase
  • Biomarkers, Tumor / metabolism
  • Breast Implantation
  • Breast Neoplasms / genetics
  • Breast Neoplasms / metabolism
  • Breast Neoplasms / pathology*
  • Combined Modality Therapy
  • DNA, Neoplasm / analysis
  • Fatal Outcome
  • Female
  • Gene Rearrangement, gamma-Chain T-Cell Antigen Receptor / genetics
  • Humans
  • Ki-1 Antigen / metabolism
  • Lymphoma, Large-Cell, Anaplastic / genetics
  • Lymphoma, Large-Cell, Anaplastic / metabolism
  • Lymphoma, Large-Cell, Anaplastic / pathology*
  • Middle Aged
  • Protein-Tyrosine Kinases / metabolism
  • Receptor Protein-Tyrosine Kinases
  • Young Adult

Substances

  • Biomarkers, Tumor
  • DNA, Neoplasm
  • Ki-1 Antigen
  • ALK protein, human
  • Anaplastic Lymphoma Kinase
  • Protein-Tyrosine Kinases
  • Receptor Protein-Tyrosine Kinases