Breast implant associated EBV-positive Diffuse Large B-cell lymphoma: an underrecognized entity?

Area of Science:

• Hematology
• Oncology
• Pathology

Background:

• Breast implant-associated (BIA) lymphoma, specifically BIA-Anaplastic Large Cell Lymphoma (BIA-ALCL), is recognized as a CD30-positive T-cell lymphoma.
• B-cell lymphomas associated with breast implants are rare, with limited reporting in existing literature.

Purpose of the Study:

• To report two cases of Epstein-Barr virus-positive Diffuse Large B-cell Lymphomas (EBV+DLBCL) in patients with breast implants.
• To highlight the importance of accurate diagnosis to differentiate these B-cell lymphomas from BIA-ALCL and guide clinical management.

Main Methods:

• Histopathological examination of tumor samples from two patients with breast implants.
• Immunohistochemistry to assess CD30 expression and lineage-specific markers (B-cell and T-cell).
• EBER (Epstein-Barr virus-encoded RNA) in situ hybridization to detect EBV presence and latency type.

Main Results:

• Two cases of EBV+DLBCL were identified in relation to breast implants, both expressing CD30 and EBV latency type 3.
• One case presented as a solid mass (considered DLBCL associated with chronic inflammation), and the other as fibrin-associated DLBCL in an HIV patient.
• Both patients achieved complete remission after capsulectomy and graft removal without further chemotherapy.

Conclusions:

• EBV+DLBCL can occur in association with breast implants and may be misdiagnosed as BIA-ALCL due to CD30 expression.
• A comprehensive diagnostic panel including B-cell/T-cell markers and EBER in situ hybridization is crucial for accurate identification and management.
• Prompt surgical intervention (capsulectomy and graft removal) may be effective for these rare lymphomas.