Breast implant-associated diffuse large cell B-cell lymphoma (BIA-DLBCL) - a case report and a treatment algorithm

Implant-associated lymphomas of the breast are rare. Among breast-implant-associated lymphomas, anaplastic large cell lymphoma (BIA-ALCL) has gained significant attention in recent years and is recognized as a distinct entity. While ALCL is a well-known T-cell lymphoma, there are only a few reports concerning breast-implant-associated B-cell lymphomas. In our report, the lymphoma showed large blasts which were positive for CD20, highly proliferative and associated with Epstein-Barr-Virus. There was no tumor mass present, the cells were seroma associated. BIA-DLCBL has only been known for a few years. They are limited to lymphoma by definition and, unlike DLCBL, BIA-DLCBL is always EBV-positive. A comprehensive evaluation of immunohistochemical markers is crucial for establishing a differential diagnosis between BIA-ALCL and BIA-DLBCL, as overlapping features, particularly CD30 positivity, may lead to misdiagnosis. Other than ALCL, DLCBL typically do not show ALK, CD2, CD3, and other B-cell markers but are positive to CD20, CD5, BCL-2, CD21, CD23, IgD and IgM. This underscores the importance of referring patients to specialized centers to ensure accurate diagnosis and appropriate treatment. The subsequent therapy of BIA-DLCBL should include an en-bloc-resection of the capsule-implant-unit. There is currently no consensus on the optimal therapy for these cases, highlighting the need for further research and expert collaboration We report on a case of breast-implant-associated diffuse large cell B-cell lymphoma and a diagnostic algorithm based on the available data in the literature.