Breast Implant-Associated Epstein-Barr Virus-Positive Diffuse Large B-Cell Lymphoma

Breast implant-associated diffuse large B-cell lymphoma (BIA-DLBCL) is an extremely rare entity, often misdiagnosed as breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). Unlike BIA-ALCL, which is a T-cell neoplasm, BIA-DLBCL shows B-cell immunophenotype and is frequently associated with Epstein-Barr virus (EBV). Few cases have been reported and its optimal management remains unclear. We report the case of a 45-year-old woman with a history of breast augmentation surgery using textured silicone implants. She presented with left breast pain and deformity. Histopathological examination of the periprosthetic capsule revealed large atypical lymphoid cells, expressing CD20, CD19, PAX5, CD79a, and CD30, with EBV RNA positivity and absence of T-cell markers. There was no capsular rupture. PET-CT scanning showed hypermetabolic activity around the implant and ipsilateral axillary lymphadenopathy, without systemic involvement. A diagnosis of BIA-DLBCL was retained. The patient underwent total capsulectomy without adjuvant therapy. At 30-month follow-up, she remains in complete clinical and radiological remission. BIA-DLBCL is an increasingly reported entity which in most cases can be classified within the spectrum of fibrin-associated large B-cell lymphoma (FA-LBCL). While surgical excision alone may be sufficient for localized disease, the rarity of this lymphoma highlights the urgent need for more comprehensive data, particularly long-term survival outcomes, to refine classification and therapeutic recommendations.