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6 slides generated from the cancer page, with a quiz from the open benchmark and speaker notes that cite the sources. Arrow keys move between slides; Print gives one slide per page.
A rare lymphoma that grows in the scar capsule the body forms around a breast implant, usually many years after the operation, and usually shows itself as sudden swelling of the breast from fluid around the implant. It is linked to textured implants, and when it is confined to the capsule it is usually cured by removing the implant and the capsule whole.
What it is. A T-cell lymphoma that arises in the fibrous capsule the body builds around a breast implant. In most women it stays inside that capsule and in the fluid between the capsule and the implant, and does not invade. WHO-HAEM5 describes it as an entity distinct from other ALK-negative anaplastic large cell lymphomas, usually non-invasive, arising in association with textured-surface implants, and associated with an excellent outcome, and adds that invasion of adjacent structures worsens the outlook.
How it shows itself, and the one thing that must not be missed. The usual presentation is a late seroma: the reconstructed or augmented breast swells, often suddenly, more than a year after the operation and typically many years after it. The rule that follows is simple and is the single most useful sentence on this page. A late seroma around a breast implant is aspirated, and the fluid is sent for cytology and for CD30 immunohistochemistry, rather than simply drained. Less often the disease presents as a mass in the capsule or as contracture of the capsule, and those carry a worse outlook because the disease has left the fluid.
| Setting | Approach | Guideline |
|---|---|---|
| A late swelling around a breast implant | A seroma appearing around a breast implant more than a year after the operation is aspirated and the fluid sent for cytology and for CD30 immunohistochemistry, rather than simply drained. That single step is what makes the diagnosis, and draining without testing is how it is missed. The same applies to a new mass in the capsule or to capsular contracture appearing years after surgery. Imaging, usually ultrasound in the first instance, maps the fluid and any mass. | not mapped |
| Disease confined to the capsule | Complete removal of the implant together with the whole capsule, intact where it can be done, and removal of any associated mass. For disease that has not left the capsule this is usually the whole of the treatment, and WHO-HAEM5 describes the entity as usually non-invasive and associated with an excellent outcome. Removal of an implant on the other side is discussed case by case. Women with implants and no symptoms are not advised to have them removed. | not mapped |
| Disease that has formed a mass or spread | Staged and treated as a CD30-positive T-cell lymphoma, on the pathway used for systemic anaplastic large cell lymphoma, because WHO-HAEM5 records that invasion of adjacent structures worsens the outlook. Radiotherapy to the chest wall is used in some series for disease that cannot be removed completely. The evidence is case series; there are no trials and there will not be, because the great majority of patients are cured by surgery. | not mapped |