Nodular sclerosing Hodgkin's lymphoma with breast involvement: Case report and review of the literature

Risk of Anaplastic Large-Cell Lymphoma (ALCL) in Cases of Late Seroma Formation After Breast Implant Insertion

Purpose: The aim of this study was to determine the odds ratio of anaplastic large-cell lymphoma in late seroma formation. Methods: In a PubMed search, 415 articles were found using the terms "breast implant AND seroma" (n = 232), "breast implant AND effusion" (n = 42), and "anaplastic large cell lymphoma AND breast (n = 141). Sixty-seven abstracts were read, and 27 full articles were reviewed. Results: Three articles reported the incidence of late seroma in breast implants, with a total of 75 seromas out of 48,211 implants (0.16%). One article reported 48 cases of non-Hodgkin lymphoma from 43,537 implants (0.11%). Another article reported that 11 patients had anaplastic large-cell lymphoma among 389 primary lymphoma of the breast (2.83%). Two articles reported 143 seromas out of 236 anaplastic large-cell lymphomas (60.59%). The risk of anaplastic large-cell lymphoma was significantly higher in the patients having late seroma than those without seroma (odds ratio = 998.93; 95% confidence interval, 768.90-1297.78; P < .001). The incidence of anaplastic large-cell lymphoma in seroma was calculated by dividing the number of anaplastic large cell lymphomas with seroma (n = 143) by total seroma (N = 11,843), which resulted in an incidence of 1.21%. The expected incidence of anaplastic large-cell lymphoma in seroma was 1.21%. Conclusion: If late seroma develops after breast implant insertion, ultrasonography-guided aspiration should be performed, with enzyme-linked-immunosorbent serologic assay for CD30.

Diagnostic challenge of soft tissue extranodal Hodgkin lymphoma in core-needle biopsy: case report

Hodgkin lymphoma (HL) is an uncommon malignancy usually limited to the lymph nodes and lymphatic system while extranodal involvement is much less common than in non-Hodgkin lymphoma. The current report presents an unusual case of primary classical HL (cHL), nodular sclerosis type with mixed cellularity in buttock soft tissue of 78-year old man. Primary lymphoma of the gluteal muscle is a rare disease and primary cHL is even rarer. In addition, to this unusual extranodal presentation, the present case highlight a diagnostic challenge in fine-needle biopsy masquerading a low grade sarcoma, primarily myxoinflammatory fibrosarcoma or an inflammatory lesion. However, surgical biopsy and immunohistochemistry guided correct diagnosis that was of major interest for further successful treatment.

Hodgkin Lymphoma Mimicking Inflammatory Breast Carcinoma: A Rare Case with Diagnostic Challenge and Novel Treatment

Extranodal Hodgkin lymphoma involving the breast is infrequent. Most cases reported in the literature were diagnosed by histology after lumpectomy. We present a Hodgkin lymphoma mimicking inflammatory breast carcinoma in a 57-year-old woman. The diagnosis was performed by fine-needle aspiration (FNA) of the breast lesion and the axillary lymph nodes with rapid on-site evaluation followed by immunocytochemistry, and it was confirmed by histology. The patient after first-line chemotherapy developed relapse/refractory disease. Salvage chemotherapy regimens were applied with poor results and severe toxicity. Total remission was achieved with monotherapy of brentuximab vedotin, a novel anti-CD30-targeted antibody drug conjugate. This is a unique case of breast HL with misleading clinical presentation initially diagnosed by cytology. FNA as a minimally invasive diagnostic tool was crucial in avoiding unnecessary breast surgery and further delay of chemotherapy. It is also the first report highlighting the importance of this novel immunotherapy in the management of refractory Hodgkin lymphoma with breast involvement.

Classical Hodgkin Lymphoma Arising Adjacent to a Breast Implant

Breast implant–associated lymphoma has recently gained wide recognition. Anaplastic large cell lymphoma (ALCL) is the most frequently diagnosed subtype in this setting but the spectrum is broadening. A 66-year-old woman developed swelling and itch around her saline implant 6 years after its insertion. Imaging revealed a fluid collection surrounding the implant with an adjacent mass. Microscopy showed sclerotic tissue punctuated by discrete cellular nodules comprising small lymphocytes, eosinophils and interspersed large atypical Hodgkin Reed-Sternberg (HRS)-like cells. The HRS-like cells stained positively for CD30 and CD15 by immunohistochemistry. Small T-lymphocytes formed rosettes around HRS-like cells. Appearances were consistent with classical Hodgkin lymphoma (HL). Multiplex polymerase chain reaction demonstrated no clonal rearrangements of immunoglobulin or T-cell receptor genes, however, a t(14;18)(q32;q21)BCL2-JH translocation involving the major breakpoint region of the bcl2 gene was present. Staging positron emission tomography–computed tomography scan revealed FDG-avid masses in the right axilla and pelvis. Subsequent pathological examination identified low-grade follicular lymphoma (FL) with a t(14;18) translocation at these sites. To our knowledge, this is the first case of HL arising adjacent to a breast implant. An awareness of this diagnosis is important as classical HL, with its prominent mixed inflammatory background, may be overlooked as a reactive process when histologically assessing capsulectomy specimens. It is also important in the differential diagnosis for implant-associated ALCL as both contain large atypical CD30-positive cells highlighting the need for full immunohistochemical and molecular workup in such cases. This case also adds to the large body of literature regarding the association between HL and FL.