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Breast amyloidosis: a case report

Giulia Boscaini, Marco Pignatti, Giovanni Tazzioli, Giorgio De Santis
Department of Plastic, Reconstructive and Aesthetic Surgery, Azienda Ospedaliero Universitaria Policlinico di Modena, 41124
Modena, Italy.
Address for correspondence: Dr. Giulia Boscaini, Department of Plastic, Reconstructive and Aesthetic Surgery, Azienda Ospedaliero
Universitaria Policlinico di Modena, Via Del Pozzo 71, 41124 Modena, Italy. E-mail: boscaini.giulia@gmail.com

ABSTRACT
Amyloidosis is an uncommon disorder characterized by extracellular deposition of abnormal
proteins. Breast involvement has rarely been reported and can clinically be misdiagnosed as breast
cancer. A 60-year-old woman presented with a 3-mm diameter mass in the right breast close to
a silicon implant positioned 20 years before. A core biopsy, performed to rule out breast cancer,
showed amyloid deposit. Further exams confirmed a systemic amyloid light chain amyloidosis.
After few months the mass increased causing breast volume and shape distortion. Since breast
cancer may be the cause of amyloid deposits or be hidden by it, the patient underwent a bilateral
skin sparing mastectomy and expander and fat grafting breast reconstruction. The resection
specimens showed amyloid deposits only, no evidence of cancer. At 2 years follow-up, no breast
amyloidosis recurrence was shown. Breast amyloidosis is rare but can occur in a plastic surgeon’s
practice. It is mandatory to rule out a comitant breast cancer or systemic amyloidosis.

Key words:
Amyloidosis; breast amyloidosis; breast cancer; breast reconstruction

INTRODUCTION inflammatory disease (rheumatoid arthritis, Reiter
syndrome, etc.). The precise aetiology and pathogenesis
[1]
Amyloidosis is an uncommon disorder characterized by of amyloidosis are unknown.
extracellular deposition of amorphous and insoluble
proteins in an abnormal fibrillary configuration. Despite AL amyloidosis can be systemic, affect more than one
the various morphologic manifestations in tissue, organ or tissue (commonly involving heart, gastrointestinal
staining for amyloid protein with Congo red reveals a tract and tongue), or less commonly localized, affecting
characteristic apple-green birefringence under polarized individual organs.
light. The most common types of amyloidosis are amyloid
light chain (AL) and amyloid A (AA). AL, caused by Breast involvement by amyloidosis has rarely been
immunoglobulin light-chains [amyloid heavy chain (AH) is reported in the literature, first by Fernandez and
more rare and caused by heavy chains], is secondary to Hernandez in 1973. Breast amyloidosis can be part of a
[2]

plasma cell dyscrasia (clonal plasma cell disorder systemic amyloidosis disease or it may be limited to the
secreting fibril-forming monoclonal immunoglobulin), breast and therefore be cause of misdiagnosis.
while AA is reactive amyloidosis associated with chronic
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How to cite this article: Boscaini G, Pignatti M, Tazzioli G,
DOI: De Santis G. Breast amyloidosis: a case report. Plast Aesthet Res
2016;3:240-4.
10.20517/2347-9264.2015.96
Received: 01-09-2015; Accepted: 22-06-2016
240 © 2016 Plastic and Aesthetic Research | Published by OAE Publishing Inc.