• Daniele La Forgia, Annamaria Catino, Alfonso Fausto, Daniela Cutrignelli, Annarita Fanizzi, Gianluca Gatta, Liliana Losurdo, Arianna Maiorella, Marco Moschetta, Cosmo Ressa, Anna Scattone, and Aurelio Portincasa.
• aI.R.C.C.S. Istituto Tumori "Giovanni Paolo II", Bari bDip. di Diagnostica per Immagini, Azienda Ospedaliera Universitaria Senese, Siena cDip. di Medicina di Precisione, Università degli Studi della Campania Luigi Vanvitelli, Napoli dDip. di Scienze Fisiche, della Terra e dell'Ambiente, Università degli Studi di Siena, Siena eDip. di Emergenza e Trapianti d'organi, Università degli Studi di Bari "Aldo Moro," Bari fDip. di Chirurgia Plastica, Università di Foggia, Foggia, Italy.
• Medicine (Baltimore). 2020 Jul 24; 99 (30): e21095.

RationaleAnaplastic large T-cell lymphoma (BI-ALCL) is a rare primitive lymphoma described in women with breast implant prostheses, which has been arousing interest in recent years due to its potentially high social impact. The difficult diagnosis associated with the high and increasing number of prosthetic implants worldwide has led to hypothesize an underestimation of the real impact of the disease among prosthesis-bearing women. The aim of this work is to search for specific radiological signs of disease linked to the chronic inflammatory pathogenetic mechanism.Patient ConcernsThis work describes a case of BI-ALCL in an American woman with no personal or family history of cancer, who underwent breast augmentation for esthetic purposes at our Institute. After about 10 years of relative well-being, the patient returned to our Institute with clear evidence of breast asymmetry due to the increase in volume of the right breast which had progressively become larger over a period of 6 months. There was no evidence of palpable axillary lymph nodes or other noteworthy signs.DiagnosisThe ultrasound and magnetic resonance (MR) tests indicated the presence of seroma with amorphous material in the exudate which was confirmed by indirect signs, visible in right breast mammography. Due to suspected cold seroma, an ultrasound-guided needle aspiration was performed for the cytological analysis of the effusion which highlighted the presence of a number of large-sized atypical cells with an irregular nucleus with CD30 immunoreactivity, leucocyte common antigen (CD45) compatible with the BI-ALCL diagnosis.InterventionsIn our case, a capsulectomy was performed because the disease was limited inside the capsule and periprosthetic seroma. The final histological examination confirmed the stage.LessonsThe patient is being monitored and shows no signs of recurrence of disease >24 months after surgery.ConclusionA diagnosis of BI-ALCL can be reached using new radiological indicators, such as fibrin, which is clearly visible by MR in the form of nonvascularized debris of amorphous material hypointense in all sequences, free flowing or adhered to the external surface of the prosthesis.

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