201
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de Oliveira Sermoud LMC, Romano S, Chveid M, da Silva Amorim GL. Breast Implant-Associated Anaplastic Large-Cell Lymphoma: Why Must We Learn About It? J Glob Oncol 2019; 5:1-5. [PMID: 31454283 PMCID: PMC6733200 DOI: 10.1200/jgo.19.00224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2019] [Indexed: 12/04/2022] Open
Abstract
Breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) is a rare, breast implant-associated T-cell lymphoma in which CD30 is expressed and anaplastic lymphoma kinase (ALK) expression is absent. However, despite the low risk of developing the disease, more information on BIA-ALCL is necessary, because the number of women with breast implants has been increasing worldwide; Brazil is one of the main markets for this type of implant. The objectives of this review are to clarify the issue of BIA-ALCL occurrence after risk-reducing mastectomy, to show the importance of this disease, and to raise awareness among the medical community about this rare pathologic condition. In 2016, BIA-ALCL was included by WHO in the new classification of lymphomas, and this demonstrates the attention that medical entities should give to this disease. Thus, awareness about BIA-ALCL must be broadened among the medical societies and regulatory authorities, both to foster better approaches to this disease, which should be evaluated in a multidisciplinary manner, and to provide better knowledge among health care professionals and the target population about the use of implants.
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Affiliation(s)
| | - Sérgio Romano
- Brazilian National Cancer Institute and Microimagem Pathology Laboratory, Rio de Janeiro, Brazil
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202
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Ebner PJ, Liu A, Gould DJ, Patel KM. Breast implant-associated anaplastic large cell lymphoma, a systematic review and in-depth evaluation of the current understanding. J Surg Oncol 2019; 120:573-577. [PMID: 31373010 DOI: 10.1002/jso.25626] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 06/25/2019] [Indexed: 12/31/2022]
Abstract
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a T-cell neoplasm that arises in the capsule around breast implants. While an association with implants has been proposed, no causal link has been identified and the pathophysiology and natural history of BIA-ALCL remain unknown. A literature review of 391 articles was performed to assess the current understanding of BIA-ALCL and to provide a balanced and unbiased view of the current controversy surrounding the disease.
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Affiliation(s)
- Peggy J Ebner
- Keck School of Medicine of University of Southern California, Los Angeles, California
| | - Alice Liu
- Keck School of Medicine of University of Southern California, Los Angeles, California
| | - Daniel J Gould
- Department of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, California
| | - Ketan M Patel
- Department of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, California
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203
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Satou A, Bennani NN, Feldman AL. Update on the classification of T-cell lymphomas, Hodgkin lymphomas, and histiocytic/dendritic cell neoplasms. Expert Rev Hematol 2019; 12:833-843. [PMID: 31365276 DOI: 10.1080/17474086.2019.1647777] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Introduction: The classification of lymphomas is based on the postulated normal counterparts of lymphoid neoplasms and currently constitutes over 100 definite or provisional entities. As this number of entities implies, lymphomas show marked pathological, genetic, and clinical heterogeneity. Recent molecular findings have significantly advanced our understanding of lymphomas. Areas covered: The World Health Organization (WHO) classification of lymphoid neoplasms was updated in 2017. The present review summarizes the new findings that have been gained in the areas of mature T-cell neoplasms, Hodgkin lymphomas, and histiocytic/dendritic cell neoplasms since the publication of the 2017 WHO classification. Expert opinion: Although formal revisions to the WHO classification are published only periodically, our understanding of the pathologic, genetic, and clinical features of lymphoid neoplasms is constantly evolving, particularly in the age of -omics technologies and targeted therapeutics. Even in the relatively short time since the publication of the 2017 WHO classification, many significant findings have been identified in the entities covered in this review.
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Affiliation(s)
- Akira Satou
- Department of Laboratory Medicine and Pathology, Mayo Clinic , Rochester , MN , USA.,Department of Surgical Pathology, Aichi Medical University Hospital , Nagakute , Aichi , Japan
| | - N Nora Bennani
- Division of Hematology, Mayo Clinic , Rochester , MN , USA
| | - Andrew L Feldman
- Department of Laboratory Medicine and Pathology, Mayo Clinic , Rochester , MN , USA
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204
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D'Alessandris N, Lucatelli P, Tripodi D, Amabile MI, Ascoli V. Cytological features of breast implant-associated anaplastic large cell lymphoma in pleural effusion. Diagn Cytopathol 2019; 47:1213-1217. [PMID: 31348611 DOI: 10.1002/dc.24287] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 07/03/2019] [Accepted: 07/15/2019] [Indexed: 11/12/2022]
Abstract
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a very rare CD30-positive ALK-negative T-cell non-Hodgkin lymphoma included as a provisional entity in the 2017 WHO classification of lymphoid neoplasms. BIA-ALCL arises as proliferating cells over the surface of the implant. It is generally an indolent disease if confined within the fibrous capsule. In contrast, mass and/or infiltration beyond the capsule is much more aggressive. This report describes a case of infiltrative BIA-ALCL with massive pleural effusion containing hallmark BIA-ALCL cells showing the characteristic morphologic appearance of high-grade anaplastic lymphoma, CD30-positive but ALK-negative with variable staining for T-cell antigens. Detailed cytological features of BIA-ALCL in pleural fluid are described along with the results of a literature search performed for BIA-ALCL cases with pleural effusion. This report expands the spectrum of BIA-ALCL pathology to include chest wall involvement and pleural effusion.
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Affiliation(s)
- Nicoletta D'Alessandris
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Pierleone Lucatelli
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Domenico Tripodi
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Maria Ida Amabile
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Valeria Ascoli
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
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205
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Insights into the Microbiome of Breast Implants and Periprosthetic Tissue in Breast Implant-Associated Anaplastic Large Cell Lymphoma. Sci Rep 2019; 9:10393. [PMID: 31316085 PMCID: PMC6637124 DOI: 10.1038/s41598-019-46535-8] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 07/01/2019] [Indexed: 02/07/2023] Open
Abstract
Though rare, breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), a CD30+ T-cell lymphoma associated with textured breast implants, has adversely impacted our perception of the safety of breast implants. Its etiology unknown, one hypothesis suggests an initiating inflammatory stimulus, possibly infectious, triggers BIA-ALCL. We analyzed microbiota of breast, skin, implant and capsule in BIA-ALCL patients (n = 7), and controls via culturing methods, 16S rRNA microbiome sequencing, and immunohistochemistry. Alpha and beta diversity metrics and relative abundance of Gram-negative bacteria were calculated, and phylogenetic trees constructed. Staphylococcus spp., the most commonly cultured microbes, were identified in both the BIA-ALCL and contralateral control breast. The diversity of bacterial microbiota did not differ significantly between BIA-ALCL and controls for any material analyzed. Further, there were no significant differences in the relative abundance of Gram-negative bacteria between BIA-ALCL and control specimens. Heat maps suggested substantial diversity in the composition of the bacterial microbiota of the skin, breast, implant and capsule between patients with no clear trend to distinguish BIA-ALCL from controls. While we identified no consistent differences between patients with BIA-ALCL-affected and contralateral control breasts, this study provides insights into the composition of the breast microbiota in this population.
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206
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Gould DJ, Carey J, Shauly O, Patel KM, Siddiqi I. Response to "No Proven Association Between Anaplastic Large Cell Lymphoma (ALCL) and Textured Buttock Implants". Aesthet Surg J 2019; 39:368-369. [PMID: 31242278 DOI: 10.1093/asj/sjz168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Daniel J Gould
- Division of Plastic and Reconstructive Surgery and the Department of Pathology, Keck Hospital of University of Southern California, Los Angeles, CA
| | - Joseph Carey
- Division of Plastic and Reconstructive Surgery and the Department of Pathology, Keck Hospital of University of Southern California, Los Angeles, CA
| | - Orr Shauly
- Division of Plastic and Reconstructive Surgery and the Department of Pathology, Keck Hospital of University of Southern California, Los Angeles, CA
| | - Ketan M Patel
- Division of Plastic and Reconstructive Surgery and the Department of Pathology, Keck Hospital of University of Southern California, Los Angeles, CA
| | - Imran Siddiqi
- Division of Plastic and Reconstructive Surgery and the Department of Pathology, Keck Hospital of University of Southern California, Los Angeles, CA
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207
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Crèvecoeur J, Jossa V, Somja J, Parmentier JC, Nizet JL, Crèvecoeur A. Description of Two Cases of Anaplastic Large Cell Lymphoma Associated with a Breast Implant. Case Rep Radiol 2019; 2019:6137198. [PMID: 31346484 PMCID: PMC6620858 DOI: 10.1155/2019/6137198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 03/26/2019] [Accepted: 05/30/2019] [Indexed: 11/29/2022] Open
Abstract
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a recently recognized provisional entity in the 2017 revision of the World Health Organization classification of lymphoid neoplasms. Although the majority of the cases described in the literature demonstrate an effusion confined to the capsule of the breast implant, this rare pathology can also invade the capsule and adjacent tissues and/or involve lymph nodes. We hereby report two new cases of BIA-ALCL in a 58-year-old and a 47-year-old Caucasian female who received a silicone breast implant. The first patient showed a sudden and rapid right breast volume increase 6 years after the implantation surgery. As for the second patient, a left breast volume increase was observed also suddenly and quickly 11 years after surgery. In both cases, an uncompressed mammography was performed allowing a new approach to highlight periprosthetic fluid reaction. Pathologic examination of the fluid collection revealed atypical cells positive for CD30 and CD45 and negative for ALK and CK7. This allowed pathologists to diagnose a breast implant-associated anaplastic large cell lymphoma. Patients were treated with bilateral capsulectomy with no additional local or systemic therapy. The development of breast augmentation may come with an increase in the frequency of this pathology. Radiologists and senologists must therefore be careful when women with breast implants show an increase of breast volume and all cases of BIA-ALCL must be recorded and reported.
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Affiliation(s)
| | - Véronique Jossa
- Laboratory of Anatomy and Pathology, CHC St-joseph, Liège, Belgium
| | - Joan Somja
- Laboratory of Anatomy and Pathology, CHU, Liège, BelgiumBelgium
| | | | - Jean-Luc Nizet
- Department of Plastic and Maxillofacial Surgery, CHU, Liège, BelgiumBelgium
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208
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Beydoun AS, Ovalle F, Brannock K, Gobble RM. A Case Report of a Breast Implant-Associated Plasmacytoma and Literature Review of Non-ALCL Breast Implant-Associated Neoplasms. Aesthet Surg J 2019; 39:NP234-NP239. [PMID: 30475976 DOI: 10.1093/asj/sjy315] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 11/10/2018] [Accepted: 11/22/2018] [Indexed: 02/03/2023] Open
Abstract
Lymphomas associated with breast implants are rare, with the most common being anaplastic large cell lymphoma (ALCL). Non-ALCL breast implant-associated lymphomas are even more rare, with only a small handful of such neoplasms reported to date. Given the need to better understand these pathologies as well as the increasing clinical and media attention being paid to these diseases, we review the available literature of hematolymphoid neoplasms other than ALCL associated with breast implants and describe the first case of a patient diagnosed with a primary breast implant-associated plasmacytoma. LEVEL OF EVIDENCE: 5
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Affiliation(s)
| | | | | | - Ryan M Gobble
- University of Cincinnati Medical Center, Cincinnati, OH
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209
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Breast Implant-associated Plasmablastic Lymphoma: A Case Report and Discussion of the Literature. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2019; 19:e568-e572. [PMID: 31383476 DOI: 10.1016/j.clml.2019.05.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 04/27/2019] [Accepted: 05/20/2019] [Indexed: 12/29/2022]
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210
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Gunawardana RT, Dessauvagie BF, Taylor DB. Breast implant-associated anaplastic large cell lymphoma, an under-recognised entity. J Med Imaging Radiat Oncol 2019; 63:630-638. [PMID: 31173460 DOI: 10.1111/1754-9485.12905] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 04/19/2019] [Indexed: 11/30/2022]
Abstract
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare form of T-cell lymphoma, recently linked to the use of certain types of breast implants. Although rare, BIA-ALCL is being increasingly recognised and radiologists can play an important role in its early diagnosis. BIA-ALCL is thought to be related to chronic inflammation from indolent infection of the biofilm surrounding implants leading to malignant transformation of activated T cells in genetically susceptible individuals. Clinical features include breast enlargement or asymmetry, discomfort, heaviness and/or a palpable mass in the context of long-standing implant(s). Ultrasound is the primary imaging modality, and the presence of more than a trace of peri-implant fluid should prompt consideration of aspiration for cytology, flow cytometry and microbiological analysis. This article reviews the clinical, imaging and pathology features of BIA-ALCL. In addition, the current recommended management guidelines for suspected cases are discussed.
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Affiliation(s)
- Ruvini Thashila Gunawardana
- Department of Diagnostic and Interventional Radiology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Benjamin F Dessauvagie
- Anatomical Pathology, PathWest Laboratory Medicine W.A., Fiona Stanley Hospital, Murdoch, Western Australia, Australia.,Division of Pathology and Laboratory Medicine, Medical School University of Western Australia, Crawley, Western Australia, Australia
| | - Donna B Taylor
- Department of Diagnostic and Interventional Radiology, Royal Perth Hospital, Perth, Western Australia, Australia.,Division of Surgery, Medical School University of Western Australia, Crawley, Western Australia, Australia
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211
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Blombery P, Prince HM, Seymour JF. Primary Breast Lymphoma-Population-Level Insights into an Infrequent but Increasingly Recognized Subtype of Lymphoma. J Natl Cancer Inst 2019; 109:3067836. [PMID: 28376146 DOI: 10.1093/jnci/djx010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 01/11/2017] [Indexed: 01/12/2023] Open
Affiliation(s)
| | - Henry M Prince
- Peter MacCallum Cancer Centre, Melbourne, Australia.,Epworth Hospital, Melbourne, Australia.,Monash University, Melbourne, Australia
| | - John F Seymour
- Peter MacCallum Cancer Centre, Melbourne, Australia.,Epworth Hospital, Melbourne, Australia.,Royal Melbourne Hospital, Melbourne, Australia
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212
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The Dutch Breast Implant Registry: Registration of Breast Implant-Associated Anaplastic Large Cell Lymphoma-A Proof of Concept. Plast Reconstr Surg 2019; 143:1298-1306. [PMID: 31033810 DOI: 10.1097/prs.0000000000005501] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The Dutch Breast Implant Registry (DBIR) was established in April of 2015 and currently contains information on 38,000 implants in 18,000 women. As a clinical registry, it evaluates the quality of breast implant surgery, including adverse events such as breast implant-associated (BIA) anaplastic large cell lymphoma (ALCL). To examine the efficacy of the DBIR, the capture rate of BIA-ALCL was compared to the registration of BIA-ALCL in the Dutch Nationwide Network and Registry of Histo- and Cytopathology (PALGA) as a gold standard, in combination with matching these databases to obtain complementary information. METHODS All BIA-ALCL patients diagnosed and registered in The Netherlands in 2016 and 2017 were identified separately in the PALGA and DBIR databases. In addition, both databases were matched using indirect key identifiers. Pathologic information from the PALGA and clinical and device characteristics from the DBIR were obtained for all patients. RESULTS Matching of both databases gave a capture rate of BIA-ALCL in the DBIR of 100 percent (n = 6) in 2016 and 70 percent (n = 7) in 2017. In total, 17 patients were identified in the PALGA, of which 14 patients were also identified in the DBIR; three patients were not registered; and 10 patients were registered false-positive. Of all confirmed patients, symptoms, staging results, treatment, and implant information were registered. CONCLUSIONS Currently, the DBIR contains 2 full registration years and captures most of the BIA-ALCL patients despite overestimation. Therefore, pathology confirmation remains essential. By matching these databases, complementary clinical and implant information could be retrieved, establishing the DBIR as an essential postmarketing surveillance system for health risk assessments.
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213
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Raj SD, Shurafa M, Shah Z, Raj KM, Fishman MDC, Dialani VM. Primary and Secondary Breast Lymphoma: Clinical, Pathologic, and Multimodality Imaging Review. Radiographics 2019; 39:610-625. [DOI: 10.1148/rg.2019180097] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Sean D. Raj
- From the Department of Radiology, Baylor University Medical Center, American Radiology Associates, 712 N Washington Ave, Dallas, TX 75246 (S.D.R., M.S., Z.S.); Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (K.M.R.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (M.D.C.F., V.M.D.)
| | - Mahmud Shurafa
- From the Department of Radiology, Baylor University Medical Center, American Radiology Associates, 712 N Washington Ave, Dallas, TX 75246 (S.D.R., M.S., Z.S.); Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (K.M.R.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (M.D.C.F., V.M.D.)
| | - Zeeshan Shah
- From the Department of Radiology, Baylor University Medical Center, American Radiology Associates, 712 N Washington Ave, Dallas, TX 75246 (S.D.R., M.S., Z.S.); Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (K.M.R.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (M.D.C.F., V.M.D.)
| | - Karuna M. Raj
- From the Department of Radiology, Baylor University Medical Center, American Radiology Associates, 712 N Washington Ave, Dallas, TX 75246 (S.D.R., M.S., Z.S.); Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (K.M.R.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (M.D.C.F., V.M.D.)
| | - Michael D. C. Fishman
- From the Department of Radiology, Baylor University Medical Center, American Radiology Associates, 712 N Washington Ave, Dallas, TX 75246 (S.D.R., M.S., Z.S.); Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (K.M.R.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (M.D.C.F., V.M.D.)
| | - Vandana M. Dialani
- From the Department of Radiology, Baylor University Medical Center, American Radiology Associates, 712 N Washington Ave, Dallas, TX 75246 (S.D.R., M.S., Z.S.); Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (K.M.R.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (M.D.C.F., V.M.D.)
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214
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Collins K, DiGiuseppe JA. Breast implant-associated anaplastic large-cell lymphoma. Clin Case Rep 2019; 7:1106-1107. [PMID: 31110756 PMCID: PMC6509917 DOI: 10.1002/ccr3.2135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 03/14/2019] [Indexed: 01/31/2023] Open
Abstract
In patients with suspected breast implant-associated anaplastic large-cell lymphoma, cytologic evaluation of fine-needle aspirate specimens from the peri-implant seroma, together with flow cytometric immunophenotyping and immunohistochemistry, represents a suitable preoperative diagnostic approach when planning for surgical management.
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215
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Stack A, Levy I. Brentuximab vedotin as monotherapy for unresectable breast implant-associated anaplastic large cell lymphoma. Clin Case Rep 2019; 7:1003-1006. [PMID: 31110735 PMCID: PMC6510013 DOI: 10.1002/ccr3.2142] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 02/21/2019] [Accepted: 03/14/2019] [Indexed: 11/24/2022] Open
Abstract
BI-ALCL is a rare CD30+ T-cell malignancy, which is known to complicate textured breast implants. The CD30-targeting immunoconjugate, brentuximab vedotin, has been suggested for invasive BI-ALCL; however, its efficacy for unresectable BI-ALCL has not been demonstrated. We present a case of unresectable BI-ALCL, which was successfully treated with brentuximab vedotin.
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Affiliation(s)
- Anthony Stack
- Department of Internal MedicineTemple University HospitalPhiladelphiaPennsylvania
| | - Isaac Levy
- Millennium OncologyPembroke PinesFlorida
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216
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Abstract
PURPOSE OF REVIEW Breast implant-associated anaplastic large cell lymphoma (BI-ALCL) is a rare form of lymphoma arising adjacent to a breast implant. We aim to review the pathogenesis and clinico-biological features of BI-ALCL. RECENT FINDINGS BI-ALCL is a new provisional entity in the 2017 updated WHO classification. Among several hypotheses, BI-ALCL development seems to be determined by the interaction of immune response related to implant products and additional genetic events. SUMMARY BI-ALCL is an uncommon T-cell lymphoma which is increasingly diagnosed since its first description in 1997 with 500 estimated cases worldwide. Two BI-ALCL subtypes correlating with clinical presentation have been described. Although most BI-ALCL patients with tumor cell proliferation restricted to the periprosthetic effusion and capsule have excellent outcomes, other patients presenting with a tumor mass, may have a more aggressive disease. The pathogenesis of BI-ALCL remains elusive. It is postulated that local chronic inflammation elicitated by bacterial infection or implant products may promote the activation and proliferation of T cells. Additional genetic events resulting in the activation JAK/STAT pathway are also incriminated. Further investigations are needed to better characterize the pathogenesis of this disease in order to determine the potential risk to develop BI-ALCL after surgical implants.
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217
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Breast Reconstruction Following Breast Implant-Associated Anaplastic Large Cell Lymphoma. Plast Reconstr Surg 2019; 143:51S-58S. [PMID: 30817556 DOI: 10.1097/prs.0000000000005569] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Standard of care treatment of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) involves surgical resection with implant removal and complete capsulectomy. We report a case series of BIA-ALCL reconstruction with proposals for timing and technique selection. METHODS We retrospectively reviewed and prospectively enrolled all BIA-ALCL patients at 2 tertiary care centers and 1 private plastic surgery practice from 1998 to 2017. Demographics, treatment, reconstruction, pathology staging, patient satisfaction, and oncologic outcomes were reviewed. RESULTS We treated 66 consecutive BIA-ALCL patients and 18 (27%) received reconstruction. Seven patients (39%) received immediate reconstruction, and 11 (61%) received delayed reconstruction. Disease stage at presentation was IA (T1N0M0 disease confined to effusion or a layer on luminal side of capsule with no lymph node involvement and no distant spread) in 56%, IB in 17%, IC (T3N0M0 cell aggregates or sheets infiltrating the capsule, no lymph node involvement and no distant spread) in 6%, IIA (T4N0M0 lymphoma infiltrating beyond the capsule, no lymph node involvement and no distant spread) in 11%, and III in 11%. Types of reconstruction included smooth implants (72%), immediate mastopexy (11%), autologous flaps (11%), and fat grafting (6%). Outcomes included no surgical complications, but 1 patient progressed to widespread bone metastasis (6%); ultimately, all patients achieved complete remission. Ninety-four percent were satisfied/highly satisfied with reconstructions, whereas 6% were highly unsatisfied with immediate smooth implants. CONCLUSIONS Breast reconstruction following BIA-ALCL management can be performed with acceptable complications if complete surgical ablation is possible. Immediate reconstruction is reserved for disease confined to capsule on preoperative positive emission tomography/computed tomography scan. Genetic predisposition and bilateral cases suggest that BIA-ALCL patients should not receive textured implants. Autologous options are preferable for implant adverse BIA-ALCL patients. Patients with extensive disease at presentation should be considered for 6- to 12-month delayed reconstruction with interval positive emission tomography/computed tomography evaluation.
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218
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Achieving Reliable Diagnosis in Late Breast Implant Seromas: From Reactive to Anaplastic Large Cell Lymphoma. Plast Reconstr Surg 2019; 143:15S-22S. [PMID: 30817552 DOI: 10.1097/prs.0000000000005565] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Late onset of fluid collection surrounding breast implants may represent a serious issue when considering the possibility of breast implant-associated anaplastic large cell lymphoma, a newly recognized type of T-cell malignancy. However, many other factors, including trauma and infections, may be implicated in the formation of non-neoplastic periprosthetic delayed effusions. An appropriate management of late seromas, consisting of ultrasound-guided fluid drainage, cultures, cytology, and immunocytochemical and T-cell clonality studies, should be performed to achieve a correct and prompt diagnosis of breast implant-associated anaplastic large cell lymphoma. Criticisms in the diagnosis of late peri-implant effusions are here discussed in detail.
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219
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Current Risk Estimate of Breast Implant-Associated Anaplastic Large Cell Lymphoma in Textured Breast Implants. Plast Reconstr Surg 2019; 143:30S-40S. [PMID: 30817554 DOI: 10.1097/prs.0000000000005567] [Citation(s) in RCA: 128] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND With breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) now accepted as a unique (iatrogenic) subtype of ALCL directly associated with textured breast implants, we are now at a point where a sound epidemiologic profile and risk estimate are required. The aim of this article is to provide a comprehensive and up-to-date global review of the available epidemiologic data and literature relating to the incidence, risk, and prevalence of BIA-ALCL. METHODS All current literature relating to the epidemiology of BIA-ALCL was reviewed. Barriers relating to sound epidemiologic study were identified, and trends relating to geographical distribution, prevalence of breast implants, and implant characteristics were analyzed. RESULTS Significant barriers exist to the accurate estimate of both the number of women with implants (denominator) and the number of cases of BIA-ALCL (numerator), including poor registries, underreporting, lack of awareness, cosmetic tourism, and fear of litigation. The incidence and risk of BIA-ALCL have increased dramatically from initial reports of 1 per million to current estimates of 1/2,832, and is largely dependant on the "population" (implant type and characteristics) examined and increased awareness of the disease. CONCLUSIONS Although many barriers stand in the way of calculating accurate estimates of the incidence and risk of developing BIA-ALCL, steady progress, international registries, and collegiality between research teams are for the first time allowing early estimates. Most striking is the exponential rise in incidence over the last decade, which can largely be explained by the increasingly specific implant subtypes examined-driven by our understanding of the pathologic mechanism of the disease. High-textured high-surface area implants (grade 4 surface) carry the highest risk of BIA-ALCL (1/2,832).
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Mukhtar RA, Holland M, Sieber DA, Wen KW, Rugo HS, Kadin ME, Bean GR. Synchronous Breast Implant-associated Anaplastic Large Cell Lymphoma and Invasive Carcinoma: Genomic Profiling and Management Implications. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2188. [PMID: 31321184 PMCID: PMC6554181 DOI: 10.1097/gox.0000000000002188] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 01/25/2019] [Indexed: 01/17/2023]
Abstract
A 59-year-old woman with a history of cosmetic implants developed ipsilateral synchronous breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) and invasive ductal carcinoma in the left breast. Each tumor was subjected to next-generation sequencing, and separate analyses revealed mutually exclusive aberrations: an activating STAT3 mutation in the lymphoma and a PIK3CA in-frame deletion in the carcinoma. The patient was treated with removal of implants, capsulectomy, partial mastectomy, sentinel node biopsy, radiotherapy, and endocrine therapy with no evidence of recurrence for 1 year. This case illustrates the importance of obtaining thorough evaluation for concomitant malignancies in the breast at the time of diagnosis of BIA-ALCL. Herein, we review the current recommendations for evaluation and management of BIA-ALCL.
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Affiliation(s)
- Rita A Mukhtar
- Department of Surgery, University of California San Francisco, San Francisco, Calif
| | - Michael Holland
- Department of Surgery, University of California San Francisco, San Francisco, Calif
| | | | - Kwun Wah Wen
- Department of Pathology, University of California San Francisco, San Francisco, Calif
| | - Hope S Rugo
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco; San Francisco, Calif
| | - Marshall E Kadin
- Department of Dermatology and Skin Surgery, Boston University School of Medicine; Boston, Mass
- Department of Pathology and Laboratory Medicine, Rhode Island Hospital, Providence, R.I
| | - Gregory R Bean
- Department of Pathology, Stanford University School of Medicine, Stanford, Calif
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Standardized Practice Reduces Complications in Breast Augmentation: Results with the First 290 Consecutive Cases Versus Non-standardized Comparators. Aesthetic Plast Surg 2019; 43:336-347. [PMID: 30542977 DOI: 10.1007/s00266-018-1291-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 12/01/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Several systematic methods for breast augmentation have been published, providing key principles and technical steps for minimizing complications and optimizing patient satisfaction. The aim of this study was to compare complication rates in patients receiving a breast augmentation performed using a structured, standardized approach versus comparator patients operated on without a standardized approach. METHODS This was a single-center, retrospective review of 290 consecutive breast augmentations performed between October 2016 and September 2017 based on a standardized technique (Randquist's "five P's" combined with Adams' 14-point plan), and 235 comparators who underwent breast augmentations prior to standardization between April 2014 and September 2016. All study subjects were females aged ≥ 18 years, undergoing bilateral breast augmentation, either alone or in the context of augmentation mastopexy or implant replacement. Various implant ranges were used before standardization; most (94.8%) of the standardized procedures used Natrelle® devices. Follow-up lasted for ≥ 12 months. RESULTS Significantly fewer patients in the standardized surgery group experienced complications (14.5%, n = 42) compared with the non-standardized group [29.4%, n = 69; Chi square = 6.57; degrees of freedom (df) = 1; p = 0.01041]. Complication rates were also significantly lower in the standardized surgery group for each of the three types of breast augmentation surgery assessed separately. Reoperation rates with standardized and non-standardized surgery were 4.1% (n = 12) and 11.9% (n = 28), respectively (Chi square = 6.4; df = 1; p = 0.01145). Patient satisfaction was increased post-surgery in both groups. CONCLUSIONS The use of a structured, standardized approach to breast augmentation reduced the risk of postoperative complications. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Abstract
LEARNING OBJECTIVES After reading this article, the participant should be able to: 1. Develop a practical method for preoperative implant size selection. 2. List characteristics and examples of fourth- and fifth-generation silicone implants. 3. Recognize the differences in "profile" designations across implant manufacturers. 4. Recall updated statistics on breast implant-associated anaplastic large cell lymphoma and describe current guidelines on disease diagnosis and treatment. 5. Apply atraumatic and aseptic surgical techniques in primary breast augmentation. SUMMARY Modern primary breast augmentation requires an intimate knowledge of the expanding breast implant market, including characteristics of current generation silicone implants and "profile" types. Optimal implant size selection requires balancing patient desires with tissue qualities. Evidence and awareness of breast implant-associated anaplastic large cell lymphoma continue to grow, and patients and surgeons alike should be informed on the most updated facts of the disease entity. Atraumatic surgical technique and aseptic adjuncts are critical in reducing periprosthetic inflammation and contamination, both of which are known instigators of capsular contracture and potentially breast implant-associated anaplastic large cell lymphoma.
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Clinicopathologic Features and Prognostic Impact of Lymph Node Involvement in Patients With Breast Implant-associated Anaplastic Large Cell Lymphoma. Am J Surg Pathol 2019; 42:293-305. [PMID: 29194092 DOI: 10.1097/pas.0000000000000985] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Breast implant-associated anaplastic large cell lymphoma (BI-ALCL) is a rare T-cell lymphoma that arises around breast implants. Most patients manifest with periprosthetic effusion, whereas a subset of patients develops a tumor mass or lymph node involvement (LNI). The aim of this study is to describe the pathologic features of lymph nodes from patients with BI-ALCL and assess the prognostic impact of LNI. Clinical findings and histopathologic features of lymph nodes were assessed in 70 patients with BI-ALCL. LNI was defined by the histologic demonstration of ALCL in lymph nodes. Fourteen (20%) patients with BI-ALCL had LNI, all lymph nodes involved were regional, the most frequent were axillary (93%). The pattern of involvement was sinusoidal in 13 (92.9%) cases, often associated with perifollicular, interfollicular, and diffuse patterns. Two cases had Hodgkin-like patterns. The 5-year overall survival was 75% for patients with LNI and 97.9% for patients without LNI at presentation (P=0.003). Six of 49 (12.2%) of patients with tumor confined by the capsule had LNI, compared with LNI in 8/21 (38%) patients with tumor beyond the capsule. Most patients with LNI achieved complete remission after various therapeutic approaches. Two of 14 (14.3%) patients with LNI died of disease compared with 0/56 (0%) patients without LNI. Twenty percent of patients with BI-ALCL had LNI by lymphoma, most often in a sinusoidal pattern. We conclude that BI-ALCL beyond capsule is associated with a higher risk of LNI. Involvement of lymph nodes was associated with decreased overall survival. Misdiagnosis as Hodgkin lymphoma is a pitfall.
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Theories of Etiopathogenesis of Breast Implant–Associated Anaplastic Large Cell Lymphoma. Plast Reconstr Surg 2019; 143:23S-29S. [DOI: 10.1097/prs.0000000000005566] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Miranda RN, Medeiros LJ, Ferrufino-Schmidt MC, Keech JA, Brody GS, de Jong D, Dogan A, Clemens MW. Pioneers of Breast Implant-Associated Anaplastic Large Cell Lymphoma: History from Case Report to Global Recognition. Plast Reconstr Surg 2019; 143:7S-14S. [PMID: 30817551 DOI: 10.1097/prs.0000000000005564] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The first case of breast implant-associated anaplastic large cell lymphoma (breast implant ALCL) was described by John Keech and the late Brevator Creech in 1997. In the following 2 decades, much research has led to acceptance of breast implant ALCL as a specific clinicopathologic entity, a process that we bring up to life through the memories of 6 persons who were involved in this progress, although we acknowledge that many others also have contributed to the current state of the art of this disease. Dr. Keech recalls the events that led him and Creech to first report the disease. Ahmet Dogan and colleagues at the Mayo Clinic described a series of 4 patients with breast implant ALCL, and led to increased awareness of breast implant ALCL in the pathology community. Daphne de Jong and colleagues in the Netherlands were the first to provide epidemiologic evidence to support the association between breast implants and ALCL. Garry Brody was one of the first investigators to collect a large number of patients with the disease, present the spectrum of clinical findings, and alert the community of plastic surgeons. Roberto Miranda and L. Jeffrey Medeiros and colleagues studied the pathologic findings of a large number of cases of breast implant ALCL, and published the findings in 2 impactful studies in the medical oncology literature. The recognition and acceptance of this disease by surgeons, epidemiologists, and medical oncologists, working together, has led to subsequent studies on the pathogenesis and optimal therapy of this disease.
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Affiliation(s)
- Roberto N Miranda
- From the Department of Hematopathology, The University of Texas MD Anderson Cancer Center; Universidad Peruana de Ciencias Aplicadas; Department of Hematopathology, The University of Texas MD Anderson Cancer Center; MultiCare Regional Cancer Center, MultiCare Health Systems; Department of Plastic Surgery, Keck School of Medicine, University of Southern California; Department of Pathology, VU University Medical Center; Department of Pathology, Memorial Sloan Kettering Cancer Center; and Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center
| | - L Jeffrey Medeiros
- From the Department of Hematopathology, The University of Texas MD Anderson Cancer Center; Universidad Peruana de Ciencias Aplicadas; Department of Hematopathology, The University of Texas MD Anderson Cancer Center; MultiCare Regional Cancer Center, MultiCare Health Systems; Department of Plastic Surgery, Keck School of Medicine, University of Southern California; Department of Pathology, VU University Medical Center; Department of Pathology, Memorial Sloan Kettering Cancer Center; and Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center
| | - Maria C Ferrufino-Schmidt
- From the Department of Hematopathology, The University of Texas MD Anderson Cancer Center; Universidad Peruana de Ciencias Aplicadas; Department of Hematopathology, The University of Texas MD Anderson Cancer Center; MultiCare Regional Cancer Center, MultiCare Health Systems; Department of Plastic Surgery, Keck School of Medicine, University of Southern California; Department of Pathology, VU University Medical Center; Department of Pathology, Memorial Sloan Kettering Cancer Center; and Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center
| | - John A Keech
- From the Department of Hematopathology, The University of Texas MD Anderson Cancer Center; Universidad Peruana de Ciencias Aplicadas; Department of Hematopathology, The University of Texas MD Anderson Cancer Center; MultiCare Regional Cancer Center, MultiCare Health Systems; Department of Plastic Surgery, Keck School of Medicine, University of Southern California; Department of Pathology, VU University Medical Center; Department of Pathology, Memorial Sloan Kettering Cancer Center; and Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center
| | - Garry S Brody
- From the Department of Hematopathology, The University of Texas MD Anderson Cancer Center; Universidad Peruana de Ciencias Aplicadas; Department of Hematopathology, The University of Texas MD Anderson Cancer Center; MultiCare Regional Cancer Center, MultiCare Health Systems; Department of Plastic Surgery, Keck School of Medicine, University of Southern California; Department of Pathology, VU University Medical Center; Department of Pathology, Memorial Sloan Kettering Cancer Center; and Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center
| | - Daphne de Jong
- From the Department of Hematopathology, The University of Texas MD Anderson Cancer Center; Universidad Peruana de Ciencias Aplicadas; Department of Hematopathology, The University of Texas MD Anderson Cancer Center; MultiCare Regional Cancer Center, MultiCare Health Systems; Department of Plastic Surgery, Keck School of Medicine, University of Southern California; Department of Pathology, VU University Medical Center; Department of Pathology, Memorial Sloan Kettering Cancer Center; and Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center
| | - Ahmet Dogan
- From the Department of Hematopathology, The University of Texas MD Anderson Cancer Center; Universidad Peruana de Ciencias Aplicadas; Department of Hematopathology, The University of Texas MD Anderson Cancer Center; MultiCare Regional Cancer Center, MultiCare Health Systems; Department of Plastic Surgery, Keck School of Medicine, University of Southern California; Department of Pathology, VU University Medical Center; Department of Pathology, Memorial Sloan Kettering Cancer Center; and Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center
| | - Mark W Clemens
- From the Department of Hematopathology, The University of Texas MD Anderson Cancer Center; Universidad Peruana de Ciencias Aplicadas; Department of Hematopathology, The University of Texas MD Anderson Cancer Center; MultiCare Regional Cancer Center, MultiCare Health Systems; Department of Plastic Surgery, Keck School of Medicine, University of Southern California; Department of Pathology, VU University Medical Center; Department of Pathology, Memorial Sloan Kettering Cancer Center; and Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center
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Tevis SE, Hunt KK, Clemens MW. Stepwise En Bloc Resection of Breast Implant-Associated Anaplastic Large Cell Lymphoma with Oncologic Considerations. Aesthet Surg J Open Forum 2019; 1:ojz005. [PMID: 33791601 PMCID: PMC7984833 DOI: 10.1093/asjof/ojz005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Guidelines published by the National Comprehensive Cancer Network state that standard of care treatment for the majority of patients with breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) is surgical resection. This cancer is generally indolent, and if confined to the capsule, curative treatment is usually surgery alone. An en bloc resection involves a total capsulectomy, explantation, complete excision of associated masses, and excision of any involved lymph node(s). Patients with surgical control of disease have favorable long-term overall and event-free survival. Oncologic principles should be applied when resecting BIA-ALCL, and a complete oncologic resection is essential to cure patients of the disease. Incomplete resections, partial capsulectomies, and positive margins are all associated with high rates of disease recurrence and have potential for progression of the disease. Routine sentinel lymph node biopsy is unnecessary and full axillary lymph node dissection is rarely indicated except in cases of proven involvement of multiple nodes. Lymphoma oncology consultation and disease staging by imaging is performed prior to surgery. Importantly, en bloc resection is indicated only for an established diagnosis of BIA-ALCL, and is not recommended for merely suspicious or prophylactic surgeries. The purpose of this article was to demonstrate a stepwise approach to surgical ablation of BIA-ALCL with an emphasis on oncologic considerations critical to disease prognosis.
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Affiliation(s)
- Sarah E Tevis
- Assistant Professor of Surgery at Department of Surgery, University of Colorado, Aurora, CO
| | - Kelly K Hunt
- The Chair and a Professor at Department of Breast Surgery, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Mark W Clemens
- Associate Professor at Department of Plastic Surgery, University of Texas MD Anderson Cancer Center, Houston, TX.,The Breast Surgery Section Co-editor for Aesthetic Surgery Journal
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Transcriptional analysis distinguishes breast implant-associated anaplastic large cell lymphoma from other peripheral T-cell lymphomas. Mod Pathol 2019; 32:216-230. [PMID: 30206415 DOI: 10.1038/s41379-018-0130-7] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 08/06/2018] [Accepted: 08/07/2018] [Indexed: 11/08/2022]
Abstract
Breast implant-associated anaplastic large cell lymphoma is a new provisional entity in the revised World Health Organization classification of lymphoid malignancies, the pathogenesis and cell of origin of which are still unknown. We performed gene expression profiling of microdissected breast implant-associated anaplastic large cell lymphoma samples and compared their transcriptional profiles with those previously obtained from normal T-cells and other peripheral T-cell lymphomas and validated expression of selected markers by immunohistochemistry. Our results indicate that most breast implant-associated anaplastic large cell lymphomas exhibit an activated CD4+ memory T-cell phenotype, which is associated with CD25 and FoxP3 expression. Gene ontology analyses revealed upregulation of genes involved in cell motility programs (e.g., CCR6, MET, HGF, CXCL14) in breast implant-associated anaplastic large cell lymphomas compared to normal CD4+ T-cells and upregulation of genes involved in myeloid cell differentiation (e.g., PPARg, JAK2, SPI-1, GAB2) and viral gene transcription (e.g., RPS10, RPL17, RPS29, RPL18A) compared to other types of peripheral T-cell lymphomas. Gene set enrichment analyses also revealed shared features between the molecular profiles of breast implant-associated anaplastic large cell lymphomas and other types of anaplastic large cell lymphomas, including downregulation of T-cell receptor signaling and STAT3 activation. Our findings provide novel insights into the biology of this rare disease and further evidence that breast implant-associated anaplastic large cell lymphoma represents a distinct peripheral T-cell lymphoma entity.
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228
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Quesada AE, Medeiros LJ, Clemens MW, Ferrufino-Schmidt MC, Pina-Oviedo S, Miranda RN. Breast implant-associated anaplastic large cell lymphoma: a review. Mod Pathol 2019; 32:166-188. [PMID: 30206414 DOI: 10.1038/s41379-018-0134-3] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 05/31/2018] [Accepted: 06/02/2018] [Indexed: 12/23/2022]
Abstract
Breast implant-associated anaplastic large cell lymphoma is a newly recognized provisional entity in the 2017 revision of the World Health Organization Classification of Tumors of Hematopoietic and Lymphoid Tissues. It is an uncommon, slow growing T-cell lymphoma with morphology and immunophenotype similar to anaplastic lymphoma kinase-negative anaplastic large cell lymphoma. However, the presentation and treatment are unique. Breast implant-associated anaplastic large cell lymphoma often presents as a unilateral effusion confined to the capsule of a textured-surface breast implant, a median time of 9 years after the initial implants have been placed. Although it follows an indolent clinical course, breast implant-associated anaplastic large cell lymphoma has the potential to form a mass, to invade locally through the capsule into breast parenchyma or soft tissue and/or to spread to regional lymph nodes. In most cases, an explantation with a complete capsulectomy removing all disease, without chemotherapy is considered to be curative and confers an excellent event free and overall survival. Here we provide a comprehensive review of breast implant-associated anaplastic large cell lymphoma, including history, epidemiology, clinical features, imaging and pathology findings, pathologic handling, pathogenic mechanisms, model for progression, therapy and outcomes as well as an analysis of causality between breast implants and anaplastic large cell lymphoma.
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Affiliation(s)
- Andrés E Quesada
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - L Jeffrey Medeiros
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mark W Clemens
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Sergio Pina-Oviedo
- Department of Pathology and Laboratory Services, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Roberto N Miranda
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Clemens MW, Jacobsen ED, Horwitz SM. 2019 NCCN Consensus Guidelines on the Diagnosis and Treatment of Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL). Aesthet Surg J 2019; 39:S3-S13. [PMID: 30715173 DOI: 10.1093/asj/sjy331] [Citation(s) in RCA: 189] [Impact Index Per Article: 37.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
National Comprehensive Cancer Network (NCCN) guidelines represent the consensus standard of care for diagnosis and management of the majority of known cancers. NCCN guidelines on breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) have been recognized by the US Food and Drug Administration and widely advocated by national specialty societies. Consensus guidelines have helped create a treatment standardization for BIA-ALCL at all stages of disease. NCCN guidelines are evidence-based where possible and utilize expert consensus opinion to fill in gaps that may exist. NCCN undergoes annual panel review by multidisciplinary faculty members, and this article represents the most up-to-date 2019 guidelines. Recommendations focus on parameters for achieving reliable diagnosis and disease management and emphasize the critical role for complete surgical ablation. Suggestions for adjunct treatments and chemotherapy regimens are included for advanced BIA-ALCL with lymph node involvement. BIA-ALCL recurrence and management of unresectable disease, and organ metastasis are addressed. Adherence to recognized BIA-ALCL guidelines ensures patients receive the most current efficacious treatment available.
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Affiliation(s)
- Mark W Clemens
- Department of Plastic Surgery, MD Anderson Cancer Center, Houston, TX
| | - Eric D Jacobsen
- Hematologic Oncology, Dana Farber Cancer Center, Brigham & Women’s Hospital, Harvard Medical School, Boston, MA
| | - Steven M Horwitz
- Department of Hematology, Memorial Sloan Kettering Cancer Center, New York, NY
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Turner SD. The Cellular Origins of Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL): Implications for Immunogenesis. Aesthet Surg J 2019; 39:S21-S27. [PMID: 30715172 PMCID: PMC6355097 DOI: 10.1093/asj/sjy229] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The exact cellular origins of most malignancies are unknown, largely because of the complex nature of malignancies, and because the potential vast number of pathways towards transformation are difficult to discern from established growths. This is compounded by the fact that cancer cells have evolved rather than being the consequence of a design process, with most data collected from (sometimes epidemiological) studies of large numbers of related malignancies. In the case of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), the relative rarity of this disease, coupled with limited insight into its biological basis, have hampered progress. The known facts that are holding up as our knowledge increases with rising incidences are that most cases have been reported in the context of textured breast implants, although not all women with these implants develop BIA-ALCL, and cure for early-stage disease (accounting for the majority of patients) can be achieved via complete capsulectomy and implant removal. However, some theories can be gleaned from the limited biological studies conducted to date whereby a T-helper cell derivation is implicated, with its specific and apparent subset of origin dependent on, and shaped by, a number of factors, including the inflammatory microenvironment (the presence of other inflammatory cell types), the driving antigen (bacterial and/or synthetic), the acquisition of driving oncogenic events, and the inherent genetics/health status of the patient.
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Affiliation(s)
- Suzanne Dawn Turner
- Division of Cellular and Molecular Pathology, Department of Pathology, University of Cambridge, Cambridge, UK
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Primary extranodal lymphoma of the glands. Literature review and options for best practice in 2019. Crit Rev Oncol Hematol 2019; 135:8-19. [PMID: 30819450 DOI: 10.1016/j.critrevonc.2019.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 12/04/2018] [Accepted: 01/15/2019] [Indexed: 01/01/2023] Open
Abstract
Primary extranodal non-Hodgkin's lymphomas (EN-NHL) are a heterogeneous group of malignancies that involve numerous entities with significant difference in terms of tumor site locations, prognostic factors, biology expression, and therapeutic options. In the literature, many EN-NHL types were reported from limited series which only allowed narrow views for elucidating prognostic factors and defining the role of loco-regional therapies in the era of new systemic and biologically targeted therapies. The Rare Cancer Network (RCN), an international multidisciplinary consortium, has published a number of reports on several EN-NHL sites which included many gland locations. In this review, we will focus on the recent literature for a selected number of EN-NHL types in both exocrine and endocrine gland locations. We aim to provide renewed and clear messages for the best practice in 2019 for diagnosis, histopathology, treatments, and also their prognostic implications. We believe that better understanding of molecular and genetic characteristics of these particular diseases is crucial for an appropriate management in the era of personalized treatment developments.
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Abstract
Anaplastic Large Cell Lymphomas (ALCL) are clinically aggressive and pathologically distinct lymphoid neoplasms that originate from a mature post-thymic T-cell. The contemporary World Health Organization (WHO) Classification of Haematologic Malignancies recognizes two distinct subtypes of systemic ALCL: Anaplastic Lymphoma Kinase (ALK)-negative, and ALK-positive. An additional unique subtype of ALCL is known to arise after prolonged exposure to breast implants, known as Breast Implant Associated ALCL (BIALCL). While histologic features of ALCL subtypes have significant overlap, genomic studies suggest the unique pathophysiology and molecular events of tumorigenesis. As a group, ALCLs are rare among non-Hodgkin lymphomas comprising 1-3% overall. There seems to be age and geographic predilection with ALK-positive ALCL affecting younger individuals and being diagnosed more frequently in North America than Europe. Both subtypes are quite uncommon in Hispanic and Asian populations. ALK-positive ALCL patients have a better overall prognosis than those with ALK-negative ALCL, and clinical features at presentation (i.e., International Prognostic Index, IPI) define the outcome in both subtypes. Molecular events affecting DUSP22 and TP63 have been reported to predict survival outcomes as well, with former being favorable, and the latter an unfavorable prognostic marker. Multiagent CHOP-like chemotherapy remains a standard of care for newly diagnosed ALCL patients treated with curative intent and provide a chance of cure for the majority of ALK-positive ALCL patients, and at least half of the ALK-negative ALCL patients. The role of consolidative high-dose therapy and autologous hematopoietic stem cell transplantation remains unclear. Novel targeted agents are actively being investigated for their role in initial therapy. New immunoconjugates, targeted kinase inhibitors, and transgenic autologous T-cells are being studied in patients with relapsed and refractory disease. This review will discuss contemporary concepts in pathogenesis and management of systemic ALCL. The biology and management of primary cutaneous ALCL will be discussed elsewhere.
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Affiliation(s)
- Andrei Shustov
- Division of Hematology, Department of Medicine, University of Washington School of Medicine, 617 Eastlake Ave. East, P.O. Box CE3-300, Seattle, WA, 98109, USA.
| | - Lorinda Soma
- Department of Laboratory Medicine, University of Washington School of Medicine, 825 Eastlake Ave. East, P.O. Box G7-800, Seattle, WA, 98109, USA
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DePaola NEK, Coggins H. Breast Implant-Associated Anaplastic Large Cell Lymphoma: What We Know. J Adv Pract Oncol 2019; 10:54-61. [PMID: 31308988 PMCID: PMC6605706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare peripheral T-cell lymphoma, first reported in 1997. It is pathologically confirmed as a CD30-positive, anaplastic lymphoma kinase (ALK)-negative ALCL by immunohistochemistry. Unlike systemic ALK-negative ALCL, breast implant-associated disease has a much more favorable prognosis overall. In most cases, BIA-ALCL will present with delayed seroma more than 1 year after breast implantation indicated for either cosmetic or reconstructive purposes. The average onset of seroma presentation is 8 to 9 years after implantation. Breast implant-associated anaplastic large cell lymphoma may arise in one of two distinct forms: either in situ or infiltrative disease. In situ disease is confined within a seroma, while infiltrative disease may present with lymph node involvement either with or without palpable breast mass or tumor. Infiltrative disease has an overall worse prognosis in regards to disease-related mortality, up to 40% within 2 years. Appropriate pathological consultation with an experienced hematopathologist and oncologist is imperative when making a diagnosis of BIA-ALCL. There are several theorized risk factors associated with the disease; however, the exact pathophysiology is not yet known. Our objective in writing this review article is to provide an overview of what we know about the epidemiology, disease characteristics, and current management strategies. In doing so, we aim to bring awareness and familiarity to the advanced practitioner population in recognizing and treating BIA-ALCL.
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Shine JJ, Boghossian E, Beauchemin G, Papanastasiou VW, Borsuk DE. Breast Implant-Associated Anaplastic Large Cell Lymphoma: Immediate or Delayed Implant Replacement? Aesthetic Plast Surg 2018; 42:1492-1498. [PMID: 30094550 DOI: 10.1007/s00266-018-1204-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 07/21/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare and recently described type of peripheral T-cell lymphoma. Fewer than 550 cases have been reported worldwide. Although BIA-ALCL is usually indolent, early diagnosis and treatment have been shown to improve outcome. CASE DESCRIPTION This case report describes the management of a 50-year-old healthy Caucasian woman presenting with rapid painful enlargement of the left breast. Imaging revealed findings consistent with BIA-ALCL. This diagnosis was confirmed by fine needle aspiration cytology and subsequent pathological analysis. Bilateral removal of implants, complete left capsulectomy and immediate bilateral implant exchange were performed. CONCLUSION No consensus currently exists regarding optimal time of implant exchange and management of the contralateral capsule. The immediate replacement with smooth implants was thoroughly discussed with the patient and endorsed by expert opinion, given complete removal of the disease. There was no sign of recurrence at 6 months. Close clinical and radiological visits are planned for the next years. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Julien J Shine
- Department of Plastic and Reconstructive Surgery, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montreal, Canada
| | - Elie Boghossian
- Department of Plastic and Reconstructive Surgery, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montreal, Canada
| | - Gabriel Beauchemin
- Department of Plastic and Reconstructive Surgery, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montreal, Canada
| | - Vasilios W Papanastasiou
- Department of Plastic and Reconstructive Surgery, McGill University Health Center, Montreal, Canada
| | - Daniel E Borsuk
- Department of Plastic and Reconstructive Surgery, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montreal, Canada.
- Hôpital Sainte-Justine, 3175 Chemin de la Côte Sainte-Catherine, Montreal, QC, H3T 1C5, Canada.
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235
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Affiliation(s)
- J Michael Dixon
- Edinburgh Breast Unit, Western General Hospital, Edinburgh, UK
| | - Mark Clemens
- MD Anderson Cancer Center, University of Texas, Texas, USA
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236
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Blombery P, Thompson E, Ryland GL, Joyce R, Byrne DJ, Khoo C, Lade S, Hertzberg M, Hapgood G, Marlton P, Deva A, Lindeman G, Fox S, Westerman D, Prince M. Frequent activating STAT3 mutations and novel recurrent genomic abnormalities detected in breast implant-associated anaplastic large cell lymphoma. Oncotarget 2018; 9:36126-36136. [PMID: 30546832 PMCID: PMC6281423 DOI: 10.18632/oncotarget.26308] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Accepted: 10/25/2018] [Indexed: 11/25/2022] Open
Abstract
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare form of T-cell lymphoma that occurs after implantation of breast prostheses. We performed comprehensive next generation sequencing based genomic characterization of 11 cases of BIA-ALCL including sequence variant detection on 180 genes frequently mutated in haematological malignancy, genome-wide copy number assessment, structural variant detection involving the T-cell receptor loci and TRB deep-sequencing. We observed sequence variants leading to JAK/STAT activation in 10 out of 11 patients. We also observed germline TP53 mutations in two cases. In addition we detected a recurrent copy number loss involving RPL5 as well as copy number amplifications involving TNFRSF11A [RANK] (in 2 cases), MYC, P2RX7, TMEM119 and PDGFRA. In summary, our comprehensive genomic characterisation of 11 cases of BIA-ALCL has provided insight into potential pathobiological mechanisms (JAK/STAT, MYC and TP53) as well as identifying targets for future therapeutic intervention (TNFRSF11A, PDGFRA) in this rare entity.
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Affiliation(s)
- Piers Blombery
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia
| | - Ella Thompson
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia
| | - Georgina L Ryland
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Rachel Joyce
- Stem Cells and Cancer Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia.,Department of Medical Biology, The University of Melbourne, Parkville, VIC, Australia
| | - David J Byrne
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Christine Khoo
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Stephen Lade
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Mark Hertzberg
- Department of Haematology, Prince of Wales Hospital, University of New South Wales, Randwick, NSW, Australia
| | - Greg Hapgood
- Department of Haematology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Paula Marlton
- Department of Haematology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Anand Deva
- Surgical Infection Research Group, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Geoffrey Lindeman
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Stem Cells and Cancer Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia.,Department of Medicine, The University of Melbourne, Parkville, VIC, Australia
| | - Stephen Fox
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia
| | - David Westerman
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia
| | - Miles Prince
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia
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237
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Lowes S, MacNeill F, Martin L, O'Donoghue JM, Pennick MO, Redman A, Wilson R. Breast imaging for aesthetic surgery: British Society of Breast Radiology (BSBR), Association of Breast Surgery Great Britain & Ireland (ABS), British Association of Plastic Reconstructive and Aesthetic Surgeons (BAPRAS). J Plast Reconstr Aesthet Surg 2018; 71:1521-1531. [PMID: 30213745 DOI: 10.1016/j.bjps.2018.07.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 06/16/2018] [Accepted: 07/28/2018] [Indexed: 10/28/2022]
Abstract
This is an overview of the guidelines for breast imaging before and after aesthetic (cosmetic) breast surgery, which includes but is not limited to implants, lipomodelling and mammoplasty procedures. The guidelines are based on a review of the literature and consensus of breast imaging and aesthetic breast surgery specialists. 1. Pre-aesthetic surgery 2. Post-aesthetic surgery If breast imaging or breast assessment is required, it should be performed in a designated breast facility with access to specialist breast imaging and a complete breast multidisciplinary team in accordance with national guidelines and recommendations.
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Affiliation(s)
- Simon Lowes
- Breast Screening and Assessment Unit, Queen Elizabeth Hospital, Gateshead Health NHS Foundation Trust, Sheriff Hill, Gateshead, NE9 6SX, United Kingdom.
| | - Fiona MacNeill
- Breast Surgery Unit, The Royal Marsden Hospital, Fulham Road, London, SW3 6JJ, United Kingdom
| | - Lee Martin
- Breast Unit, Aintree University Hospital, Lower Lane, Liverpool, Merseyside, L9 7AL, United Kingdom
| | - Joe M O'Donoghue
- Department of Plastic Surgery, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, United Kingdom
| | - Mandana O Pennick
- Department of Breast Surgery, Glan Clwyd Hospital, Rhuddlan Road, Rhyl, Denbighshire, LL18 5UJ, North Wales, United Kingdom
| | - Alan Redman
- Breast Screening and Assessment Unit, Queen Elizabeth Hospital, Gateshead Health NHS Foundation Trust, Sheriff Hill, Gateshead, NE9 6SX, United Kingdom
| | - Robin Wilson
- Department of Clinical Radiology, The Royal Marsden Hospital NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, United Kingdom
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238
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Mehta-Shah N, Clemens MW, Horwitz SM. How I treat breast implant-associated anaplastic large cell lymphoma. Blood 2018; 132:1889-1898. [PMID: 30209119 PMCID: PMC6536699 DOI: 10.1182/blood-2018-03-785972] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 08/22/2018] [Indexed: 11/20/2022] Open
Abstract
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a recently described form of T-cell non-Hodgkin lymphoma now formally recognized by the World Health Organization classification of lymphoid neoplasms. The disease most often presents with a delayed seroma around the breast implant, almost exclusively with a textured surface, and manifests with breast pain, swelling or asymmetry, capsular contracture, but can also present with a breast mass, and lymph node involvement. The prognosis of BIA-ALCL is favorable compared with many other subtypes of systemic T-cell lymphoma; however, unlike other non-Hodgkin lymphomas, complete surgical excision for localized disease is an important part of the management of these patients. In this paper, we share our recommendations for a multidisciplinary team approach to the diagnosis, workup, and treatment of BIA-ALCL in line with consensus guidelines by the National Comprehensive Cancer Network.
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Affiliation(s)
- Neha Mehta-Shah
- Division of Oncology, Department of Medicine, Washington University in St. Louis, St. Louis, MO
| | - Mark W Clemens
- Department of Plastic Surgery, MD Anderson Cancer Center, Houston, TX; and
| | - Steven M Horwitz
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
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239
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Rastogi P, Deva AK, Prince HM. Breast Implant-Associated Anaplastic Large Cell Lymphoma. Curr Hematol Malig Rep 2018; 13:516-524. [DOI: 10.1007/s11899-018-0478-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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240
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Lynch RC, Gratzinger D, Advani RH. Clinical Impact of the 2016 Update to the WHO Lymphoma Classification. Curr Treat Options Oncol 2018; 18:45. [PMID: 28670664 DOI: 10.1007/s11864-017-0483-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OPINION STATEMENT The 2016 revision of the WHO classification of lymphoid neoplasms includes new entities along with a clearer definition of provisional and definitive subtypes based on better understanding of the molecular drivers of lymphomas. These changes impact current treatment paradigms and provide a framework for future clinical trials. Additionally, this update recognizes several premalignant or predominantly indolent entities and underscores the importance of avoiding unnecessarily aggressive treatment in the latter subsets.
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Affiliation(s)
- Ryan C Lynch
- Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Dita Gratzinger
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Ranjana H Advani
- Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
- Stanford University Medical Center, 875 Blake Wilbur Drive, Suite CC-2338, Stanford, CA, 94305-5821, USA.
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241
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How to Diagnose and Treat Breast Implant-Associated Anaplastic Large Cell Lymphoma. Plast Reconstr Surg 2018; 141:586e-599e. [PMID: 29595739 DOI: 10.1097/prs.0000000000004262] [Citation(s) in RCA: 112] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
LEARNING OBJECTIVES After reading this article, the participant should be able to: 1. Describe the diagnostic criteria for breast implant-associated (BIA) anaplastic large cell lymphoma (ALCL). 2. Appropriately evaluate a patient with suspected BIA-ALCL, including appropriate imaging, laboratory tests, and pathologic evaluation. 3. Understand the operative treatment of BIA-ALCL, and indications for systemic chemotherapy and/or radiation therapy in advanced disease. 4. Understand treatment outcomes and prognosis based on stage of disease. SUMMARY The goal of this continuing medical education module is to present the assessment of a patient with suspected breast implant-associated anaplastic large cell lymphoma, the evaluation and diagnosis, the preoperative oncologic workup, the formation and execution of a surgical treatment plan, and the inclusion of adjunct treatments when indicated. In addition, staging and disease progression for treatment of breast implant-associated anaplastic large cell lymphoma are discussed.
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242
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Miranda RN, Clemens MW. Letter to the Editor Regarding: Fleming D, Stone J, Tansley P. Spontaneous Regression and Resolution of Breast Implant-Associated Anaplastic Large Cell Lymphoma: Implications for Research, Diagnosis and Clinical Management. Aesth Plast Surg, 2018. Aesthetic Plast Surg 2018; 42:1170-1171. [PMID: 29626218 DOI: 10.1007/s00266-018-1125-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 03/20/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Roberto N Miranda
- Department of Hematopathology, M.D. Anderson Cancer Center, Houston, TX, USA
| | - Mark W Clemens
- Department of Plastic Surgery, M.D. Anderson Cancer Center, 1400 Pressler St., Unit 1488, Houston, TX, 77030, USA.
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243
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Kadin ME, Morgan J, Xu H, Epstein AL, Sieber D, Hubbard BA, Adams WP, Bacchi CE, Goes JCS, Clemens MW, Medeiros LJ, Miranda RN. IL-13 is produced by tumor cells in breast implant-associated anaplastic large cell lymphoma: implications for pathogenesis. Hum Pathol 2018; 78:54-62. [PMID: 29689246 DOI: 10.1016/j.humpath.2018.04.007] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 04/10/2018] [Accepted: 04/11/2018] [Indexed: 02/07/2023]
Abstract
More than 500 women worldwide have developed a CD30+ T-cell lymphoma around breast implants, strongly suggesting a cause-and-effect relationship, and designated as breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). The mechanism of lymphomagenesis is unknown. Recently, a bacterial biofilm containing gram-negative bacilli was discovered on the surface of breast implants associated with ALCL. We and others have described overexpression of the proto-oncogene JUNB and mutations of JAK1/2, TP53 and STAT3 in BIA-ALCL. Here we report that BIA-ALCL cell lines and anaplastic lymphoma cells in clinical specimens produce IL-13, the signature cytokine of allergic inflammation. Supporting the link of BIA-ALCL to allergic inflammation, lymphoma cells were often surrounded by eosinophils and mast cells, features typically absent in systemic ALCL. Because of the link of IL-13 to allergy, we looked for IgE and found it decorating the surface of mast cells and antigen-presenting follicular dendritic cells in capsules and lymph nodes infiltrated by anaplastic lymphoma cells, but not uninvolved capsules. Plasma cells within capsules and regional lymph nodes were identified as a possible source of IgE. Together, these findings suggest the hypothesis that an amplified immune response with features of a chronic allergic reaction in a susceptible patient underlies the pathogenesis of BIA-ALCL.
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Affiliation(s)
| | - John Morgan
- Roger Williams Medical Center, Providence, RI 02908
| | - Haiying Xu
- Roger Williams Medical Center, Providence, RI 02908
| | | | | | | | | | | | - Joao C S Goes
- Inst Bras Controle Câncer, San Paolo, Brazil 04536-010
| | - Mark W Clemens
- Plastic Surgery Division, MD Anderson Cancer Center, Houston, TX 77030
| | | | - Roberto N Miranda
- Hematopathology Division, MD Anderson Cancer Center, Houston, TX 77030
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244
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Reply to the Editor Regarding: Miranda RN, Clemens MW Letter to the Editor 2018 Apr 6 in Relation to: Fleming D, Stone J, Tansley P. Spontaneous Regression and Resolution of Breast Implant-Associated Anaplastic Large Cell Lymphoma: Implications for Research, Diagnosis and Clinical Management. Aesth Plast Surg, 2018. Aesthetic Plast Surg 2018; 42:1172-1175. [PMID: 29872907 DOI: 10.1007/s00266-018-1152-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 05/05/2018] [Indexed: 10/14/2022]
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245
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Molecular Insights Into Pathogenesis of Peripheral T Cell Lymphoma: a Review. Curr Hematol Malig Rep 2018; 13:318-328. [DOI: 10.1007/s11899-018-0460-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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246
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247
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Loghavi S, Medeiros LJ, Javadi S, Lin P, Khoury JD, Nastoupil L, Hunt KK, Clemens MW, Miranda RN. Breast Implant-Associated Anaplastic Large Cell Lymphoma With Bone Marrow Involvement. Aesthet Surg J 2018; 38:4964709. [PMID: 29635424 DOI: 10.1093/asj/sjy097] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
LEVEL OF EVIDENCE 5
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Affiliation(s)
- Sanam Loghavi
- Departments of Hematopathology, Diagnostic Radiology, Lymphoma/Myeloma, Breast Surgical Oncology, and Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - L Jeffrey Medeiros
- Departments of Hematopathology, Diagnostic Radiology, Lymphoma/Myeloma, Breast Surgical Oncology, and Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sanaz Javadi
- Departments of Hematopathology, Diagnostic Radiology, Lymphoma/Myeloma, Breast Surgical Oncology, and Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Pei Lin
- Departments of Hematopathology, Diagnostic Radiology, Lymphoma/Myeloma, Breast Surgical Oncology, and Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Joseph D Khoury
- Departments of Hematopathology, Diagnostic Radiology, Lymphoma/Myeloma, Breast Surgical Oncology, and Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Loretta Nastoupil
- Departments of Hematopathology, Diagnostic Radiology, Lymphoma/Myeloma, Breast Surgical Oncology, and Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kelly K Hunt
- Departments of Hematopathology, Diagnostic Radiology, Lymphoma/Myeloma, Breast Surgical Oncology, and Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Mark W Clemens
- Departments of Hematopathology, Diagnostic Radiology, Lymphoma/Myeloma, Breast Surgical Oncology, and Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Roberto N Miranda
- Departments of Hematopathology, Diagnostic Radiology, Lymphoma/Myeloma, Breast Surgical Oncology, and Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
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248
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Fleming D, Stone J, Tansley P. Spontaneous Regression and Resolution of Breast Implant-Associated Anaplastic Large Cell Lymphoma: Implications for Research, Diagnosis and Clinical Management. Aesthetic Plast Surg 2018; 42:672-678. [PMID: 29445921 PMCID: PMC5945759 DOI: 10.1007/s00266-017-1064-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 12/17/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND First described in 1997, breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) was recognised by the World Health Organisation in 2016 as a specific disease. It typically presents as a late seroma-containing atypical, monoclonal T cells which are CD30+ and anaplastic lymphoma kinase negative. Until recently, it was thought that the disease was very rare. However, it is being diagnosed increasingly frequently with 56 cases confirmed in Australia by September 2017 and the estimated incidence revised from 1 in 300,000 to between 1 in 1000 and 1 in 10,000 patients with bilateral implants. There is debate about the spectrum of BIA-ALCL. According to the current WHO classification, BIA-ALCL is a cancer in all cases. Treatment guidelines require that it is treated urgently with a minimum of bilateral removal of implants and capsulectomies. Whilst acknowledging the disease has been under diagnosed in the past, with some notable exceptions the BIA-ALCL literature has given scant attention to the epidemiological evidence. Now that it is known that the disease may occur in up to 1 in 1000 patients with a median of 7.5 years from implantation to diagnosis, understanding it in its epidemiological context is imperative. The epidemiology of cancer and lymphoma in women with breast implants strongly suggests that most patients do not have a cancer that will inevitably progress without treatment but instead a self-limiting lympho-proliferative disorder. Although the possibility of spontaneous regression has been raised and the observation made that treatment delay did not seem to increase the risk of spread, the main objection to the lympho-proliferative hypothesis has been the lack of documented cases of spontaneous regression or resolution. Because all cases currently are considered malignant and treated urgently, only case report evidence, interpreted in the proper epidemiological context, is likely to be available to challenge this thinking. METHODS AND RESULTS New observations and interpretation of the epidemiology of BIA-ALCL are made. These are supported by the presentation of two cases, which to the best of our knowledge comprise the first documented evidence of spontaneous regression and spontaneous resolution of confirmed BIA-ALCL. CONCLUSIONS The epidemiology of the disease strongly suggests that the vast majority of cases are not a cancer that will inevitably progress without treatment. The findings presented in the manuscript provide supportive clinical evidence. Consequently, an alternative view of BIA-ALCL with implications for research, diagnosis and clinical management needs to be considered. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Daniel Fleming
- Cosmetic Surgery Institute of Australia, PO Box 213, Fortitude Valley, Brisbane, QLD, 4006, Australia.
| | - Jason Stone
- QML Pathology, 1 Riverview Place, Metroplex on Gateway, Murarrie, QLD, 4172, Australia
| | - Patrick Tansley
- NorthEast Plastic Surgery, Wickham House, Level 1 155 Wickham Terrace, Spring Hill, Brisbane, QLD, 4000, Australia
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249
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Ronchi A, Montella M, Argenzio V, Lucia A, De Renzo A, Alfano R, Franco R, Cozzolino I. Diagnosis of anaplastic large cell lymphoma on late peri-implant breast seroma: Management of cytological sample by an integrated approach. Cytopathology 2018; 29:294-299. [PMID: 29633403 DOI: 10.1111/cyt.12541] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2018] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Peri-implant breast seroma is a late clinical presentation of reconstructive surgery or augmentation mammoplasty with breast implants. Pre-operative cytological evaluation of the peri-implant breast seroma is a common clinical approach, showing mainly an inflammatory reaction or more rarely a breast implant-associated anaplastic large cell lymphoma. Herein, we reported the role of cytology in the evaluation of peri-implant breast seroma and its critical pre-operative implications. METHODS Eight cases of peri-implant breast seroma from files at Luigi Vanvitelli University were identified between January and December 2017. In all cases, seroma was aspirated; cytospins were performed and stained by Papanicolaou stain; finally, in all cases, a cell block was obtained for immunocytochemical evaluation and, in one case, for FISH to detect ALK1-gene translocation. RESULTS The median age of patients was 48 years and the mean time between the implant placement and the occurrence of peri-implant breast seroma was 18 months. Microscopic examination showed breast implant-associated anaplastic large cell lymphoma in one case, aspecific inflammatory reaction in six cases and silicon-associated reaction in one case. CONCLUSIONS Peri-implant breast seroma may be caused by several pathological conditions with different clinical behaviour. A proper cytological approach to peri-implant breast seroma allows a correct differential diagnosis between inflammatory conditions and breast implant-associated anaplastic large cell lymphoma and an appropriate management of the patient.
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Affiliation(s)
- A Ronchi
- Division of Pathology, Department of Mental and Physical Health and Preventive Medicine, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - M Montella
- Division of Pathology, Department of Mental and Physical Health and Preventive Medicine, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - V Argenzio
- Division of General and GeriatricSurgery, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - A Lucia
- Division of General and GeriatricSurgery, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - A De Renzo
- Division of Haematology, Department of Clinical Medicine and Surgery, Università "Federico II", Naples, Italy
| | - R Alfano
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - R Franco
- Division of Pathology, Department of Mental and Physical Health and Preventive Medicine, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - I Cozzolino
- Division of Pathology, Department of Mental and Physical Health and Preventive Medicine, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
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250
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Patzelt M, Zarubova L, Klener P, Barta J, Benkova K, Brandejsova A, Trneny M, Gürlich R, Sukop A. Anaplastic Large-Cell Lymphoma Associated with Breast Implants: A Case Report of a Transgender Female. Aesthetic Plast Surg 2018; 42:451-455. [PMID: 29101436 DOI: 10.1007/s00266-017-1012-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Accepted: 10/18/2017] [Indexed: 11/28/2022]
Abstract
Breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) is a rare peripheral T cell lymphoma. BIA-ALCL is a disease of the fibrous capsule surrounding the implant and occurs in patients after both breast reconstruction and augmentation. More than 300 cases have been reported so far, including two in a transgender patient. Here we describe BIA-ALCL presented with a mass in a transgender patient and the first case of BIA-ALCL in the Czech Republic. In 2007, a 33-year-old transgender male to female underwent bilateral breast augmentation as a part of his transformation to female. In June 2014, the patient developed a 5-cm tumorous mass in her left breast. Magnetic resonance imaging of the chest revealed a ruptured implant and a tumorous mass penetrating into the capsule and infiltrating the pectoral muscle. An R0 surgery was indicated-the implant, silicone gel and capsule were removed, and the tumorous mass was resected together with a part of the pectoral muscle. Histology revealed anaplastic large-cell lymphoma. The patient underwent standard staging procedures for lymphoma including a bone marrow trephine biopsy, which confirmed stage IE. The patient was treated with the standard chemotherapy for systemic ALCL-6 cycles of CHOP-21. The patient was tumor-free at the 2-year follow-up. BIA-ALCL has been reported mostly in women who received implants for either reconstructive or aesthetic augmentation. This is the third report of BIA-ALCL in a transgender person, the first in the Czech Republic. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Matej Patzelt
- Department of Plastic Surgery, Royal Vinohrady Teaching Hospital, Srobarova 1150/50, 100 34, Prague, Czech Republic
- Third Faculty of Medicine, Charles University, Ruska 87, 100 00, Prague, Czech Republic
| | - Lucie Zarubova
- Department of Plastic Surgery, Royal Vinohrady Teaching Hospital, Srobarova 1150/50, 100 34, Prague, Czech Republic.
- Department of General Surgery, Royal Vinohrady Teaching Hospital, Srobarova 1150/50, 100 34, Prague, Czech Republic.
| | - Pavel Klener
- First Medical Department of Hematology, Charles University General, U Nemocnice 499/2, 128 08, Prague, Czech Republic
- Institute of Pathological Physiology, First Faculty of Medicine, Charles University, Katerinska 32, 121 08, Prague, Czech Republic
| | - Josef Barta
- Department of Radiology, Royal Vinohrady Teaching Hospital, Srobarova 1150/50, 100 34, Prague, Czech Republic
| | - Kamila Benkova
- Department of Pathology in Prague, AeskuLab Pathology, Evropska 2589/33b, 100 06, Prague, Czech Republic
| | - Adrianna Brandejsova
- Department of Plastic Surgery, Royal Vinohrady Teaching Hospital, Srobarova 1150/50, 100 34, Prague, Czech Republic
| | - Marek Trneny
- First Medical Department of Hematology, Charles University General, U Nemocnice 499/2, 128 08, Prague, Czech Republic
| | - Robert Gürlich
- Third Faculty of Medicine, Charles University, Ruska 87, 100 00, Prague, Czech Republic
- Department of General Surgery, Royal Vinohrady Teaching Hospital, Srobarova 1150/50, 100 34, Prague, Czech Republic
| | - Andrej Sukop
- Department of Plastic Surgery, Royal Vinohrady Teaching Hospital, Srobarova 1150/50, 100 34, Prague, Czech Republic
- Third Faculty of Medicine, Charles University, Ruska 87, 100 00, Prague, Czech Republic
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