case report Recurrent invasive lobular carcinoma presenting as a ruptured breast implant Maikel Botros1, Kenneth Chang2, Robert Miller3, Sunil Krishnan4, Matthew Iott3 1 East TN State University, Quillen College of Medicine, Johnson City, Tennessee, USA 2 Boston College, Chestnut Hill, Massachusetts, USA 3 Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA 4 Department of Radiation Oncology, the University of Texas MD Anderson Cancer Center, Houston, Texas, USA Radiol Oncol 2012; 46(1): 23-27. Received 31 July 2011 Accepted 1 September 2011 Correspondence to: Matthew Iott, MS, CNP, Department of Radiation Oncology, Mayo Clinic, 200 First St SW, Rochester, MN 55905. E-mail: iott.matthew@mayo.edu Disclosure: The authors have no conflicts of interest to disclose. Background. For years, the treatment for invasive lobular carcinoma (ILC) has been mastectomy secondary to the lack of studies investigating the efficacy of breast conservation therapy on patients afflicted with ILC and due to the lack of long-term follow up investigating locoregional recurrence in this patient population. In this article we report the clinical course of a patient diagnosed with ILC. Case report. We describe the case of a 50-year-old woman with stage IIB (T2N1M0) ER/PR positive right breast ILC who underwent a right modified radical mastectomy, postoperative chemotherapy, a prophylactic left simple mastectomy with bilateral breast reconstruction and tamoxifen. Approximately 12 years later, she presented with a deflated breast implant and recurrent breast cancer with metastatic spread. She received palliative radiotherapy then palliative chemotherapy. Unfortunately, she succumbed to the cancer less than a year after being diagnosed with metastatic disease. Conclusions. This may be the first case report of a ruptured breast implant presenting at the same time as the diag- nosis of recurrent breast cancer. Key words: breast cancer; invasive lobular carcinoma; breast implant; rupture Introduction There were an estimated 209,000 newly diagnosed cases of breast cancer in 2010. In the United States, breast cancer is the most common cancer among women and the second leading cause of cancer death for this cohort.1 Invasive ductal carcinoma (IDC) comprises 70-85% of diagnosed breast can- cers.2 The second most common histological type of breast cancer is invasive lobular carcinoma (ILC), which makes up 8-14% of invasive cancer cases.3 While it is thought that the prognosis of ILC is generally similar to that of IDC, given similar histological grades, differences between the two types do exist.3,4 These differences may include presenting as an indistinct thickening as opposed to a discrete nodule, having less microcalcifications and decreased density of the mass seen on mam- mography, as well as, the likelihood of having multicentric and/or bilateral disease. Metastatic dissemination of disease also varies.4 In addition, the management of IDC and ILC has differed. For years, the treatment for ILC has been mas- tectomy secondary to the lack of studies investigat- ing the efficacy of breast conservation therapy on patients afflicted with ILC and due to the lack of long-term follow up investigating locoregional re- currence in this patient population. In this article, we report the clinical course of a patient diagnosed with ILC. She underwent bilateral mastectomy fol- lowed by breast reconstruction. Almost 12 years lat- er, she suffered a breast implant rupture. Work up for the rupture resulted in her eventual diagnosis Radiol Oncol 2012; 46(1): 23-27. doi:10.2478/v10019-011-0032-5 23