Epstein Barr Virus (EBV) positive large B-cell lymphoma associated with breast implants: A case report

Breast lymphoma associated with implants is an uncommon condition, with B-cell lymphomas representing a small subset. Among these, diffuse large B-cell lymphoma (DLBCL), particularly Epstein-Barr Virus (EBV)-positive, is extremely rare and poorly characterized. This lymphoma subtype differs from the more prevalent implant-associated anaplastic large-cell lymphoma. Chronic inflammation caused by prolonged contact between the implant and surrounding tissues is believed to create a microenvironment favorable for lymphoid proliferation and malignancy, though the underlying mechanisms remain speculative and require further exploration. We report the case of a female patient with Poland syndrome, a congenital anomaly involving chest wall deformities, who underwent left-sided breast reconstruction with an implant. She presented with implant rupture and capsular contracture, necessitating surgical removal of the implant and surrounding capsule. A total capsulectomy was performed, and reconstruction utilized the "no-touch" technique to reduce contamination. Intraoperative abnormalities of the periprosthetic capsule led to its submission for pathological analysis. Histopathological and immunohistochemical studies confirmed EBV-positive DLBCL. A PET/CT scan showed no hypermetabolic activity or extramammary involvement. Multidisciplinary evaluation concluded that conservative management with regular follow-up was appropriate, given the favorable prognosis. The patient remains under observation with no signs of recurrence. This case highlights the importance of considering lymphoma in patients with implants presenting with capsular changes or unexplained symptoms. Early diagnosis, involving thorough histopathological analysis and advanced imaging, is critical to guide management. Although EBV-positive implant-associated B-cell lymphomas generally have a good prognosis and rarely require aggressive treatment, their rarity underscores the need for continued documentation and research. Expanding our understanding of their pathogenesis and clinical behavior will help refine diagnostic and therapeutic approaches, improving patient outcomes.

Reconstructive.