We report the case of a 69-year-old woman who presented an aggressive breast implant-associated anaplastic large cell lymphoma with supra- and infradiaphragmatic disease. The diagnosis was made 17 years after her first prosthesis, following a right breast carcinoma, and three years after the replacement of this first prosthesis. Breast implant-associated anaplastic large cell lymphoma is a rare form of non-Hodgkin lymphoma caused by a breast implant. Unique features of this case include the fast clinical extension of a lymphoma that is indolent in the vast majority of the cases. Indeed, less than two months after the first symptoms on the breast, cutaneous metastasis appeared on the right arm. The key diagnosis exams are histology and immunohistochemistry including CD30 and cytotoxic markers and a PET-scan to evaluate the extension of the disease. The treatment should include removal of the prosthesis and any associated mass. Local residual or unresectable disease may benefit from radiation therapy to the chest wall. For regional lymph node involvement or confirmed extended disease, adjuvant chemotherapy more in line with systemic anaplastic large cell lymphoma anaplastic lymphoma kinase-negative treatments is recommended. Finally, brentuximab vedotin, an anti-CD30 monoclonal antibody, showed encouraging results in refractory disease but still needs more prospective trials.

(BELG J HEMATOL 2018;9(7):279–84)