LY22 Folliculotropic mycosis fungoides in a patient with facial implants: a role for chronic antigenic stimulation?

Abstract

The aetiology of cutaneous T-cell lymphoma (CTCL) remains incompletely understood; however, evidence suggests an interaction between chronic antigenic stimulation and oncogenic mutations in disease pathogenesis. While breast-implant-associated anaplastic large cell lymphoma is a recognized entity, CTCL associated with silicone implants has been only rarely reported. We describe a case of folliculotropic mycosis fungoides (FMF) occurring in association with long-standing facial silicone implants. A 66-year-old woman presented with a 15-year history of a pruritic, polymorphic rash affecting the face, trunk and limbs. Examination revealed pronounced infiltrated plaques on the cheeks in close proximity to silicone prostheses inserted 25 years earlier. Histopathology demonstrated a dense perifollicular, CD4-dominant lymphoid infiltrate with identical monoclonal T-cell populations at multiple sites. Imaging excluded systemic disease and findings were consistent with stage IB disease. The patient achieved a partial response following 40 sessions of psoralen–ultraviolet A therapy and is currently being treated with pegylated interferon. A literature search identified four publications describing six cases of CTCL associated with silicone implants, including mycosis fungoides and Sézary syndrome. The median interval between implantation and disease onset was 3.4 years (range 3 months to 20 years), with longer latency associated with less aggressive disease. Most implants were intact at removal, suggesting that silicone alone may be sufficient to induce chronic inflammation. Most cases achieved remission following implant removal combined with local or systemic therapy. Although FMF has a recognized predilection for the head and neck, the marked localization and accentuation of disease adjacent to the implants raise the possibility that chronic antigen-driven immune activation may contribute to tumour evolution. While causality cannot be established, this case and literature review support a potential role for chronic antigenic stimulation in CTCL pathogenesis and highlight the need for increased clinical awareness and further research.