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

• Main Authors: Johanna Vets (Author), Lukas Marcelis (Author), Charlotte Schepers (Author), Yaliva Dorreman (Author), Sanne Verbeek (Author), Lieve Vanwalleghem (Author), Katrien Gieraerts (Author), Liesbeth Meylaerts (Author), Jan Lesaffer (Author), Helena Devos (Author), Natalie Put (Author), Sylvia Snauwaert (Author), Pascale De Paepe (Author), Thomas Tousseyn (Author)
• Format: Book
• Published: BMC, 2023-04-01T00:00:00Z.
• Subjects: article
• Online Access: Connect to this object online.
• Notes: 10.1186/s13000-023-01337-5; 1746-1596
• Keywords: EBV + DLBCL; Breast implant associated lymphoma; BIA-DLBCL; FA-DLBCL; CI-DLBCL; Pathology; RB1-214
• Source: Diagnostic Pathology, Vol 18, Iss 1, Pp 1-11 (2023)

Abstract Breast-implant associated (BIA) lymphoma is an infrequent type of cancer occurring in the fluid and fibrous capsule around a textured breast implant. Recently, both the 2022 WHO 5th edition classification of Haematological tumours (WHO HAEM5) and 2022 International Consensus Classification of Mature Lymphoid Neoplasms (22ICC), recognized breast implant-associated Anaplastic Large Cell Lymphoma (BIA-ALCL) as a definitive entity, defined as a mature CD30-positive T-cell lymphoma, confined by a fibrous capsule, in a breast implant setting. Only few B-cell lymphomas have been reported in the literature to be associated with breast implants. Here we report two EBV-positive Diffuse Large B-cell lymphomas (EBV + DLBCL) in relation to a breast implant, both expressing CD30 as well as EBV latency type 3. Both lesions were considered as DLBCL associated with chronic inflammation (CI-DLBCL), but one presented as a 7 cm solid mass, while the other presented as a fibrin-associated DLBCL (FA-DLBCL) in an HIV patient. Clinically, both are in complete remission 6 months or longer after capsulectomy and graft removal, without additional chemotherapy. Such cases, characterized by large CD30-positive cells, can easily be misdiagnosed as BIA-ALCL if the cell of origin is not further established. Therefore, a diagnostic panel including lineage-specific B-and T-cell markers and EBER in situ hybridization is essential to recognize this rare entity, to understand lymphomagenesis, to predict outcome and to define clinical approach.