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Joks MM, Czernikiewicz K, Mazurkiewicz Ł, Joks M, Balcerzak A, Kroll-Balcerzak R, Rupa-Matysek J. Breast Implant-Associated Anaplastic Large Cell Lymphoma: Where Hematology and Plastic Surgery Meet. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2024:S2152-2650(24)00179-4. [PMID: 38839449 DOI: 10.1016/j.clml.2024.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 05/05/2024] [Indexed: 06/07/2024]
Abstract
Breast implant insertion for breast reconstruction or breast augmentation is a developing procedure, with high demand worldwide-being the second most common plastic surgery in the US as of 2022. Breast-implant-associated anaplastic large cell lymphoma (BIA-ALCL) is T-cell, non-Hodgkin lymphoma, typically CD30+, ALK-, presenting with fluid collection in the inner aspect of the peri-implant capsule in most patients, with the onset exceeding 1-year after implantation. The mean time between breast implant insertion and BIA-ALCL development is 7-10 years. The main risk factor is the use of textured implants because of their susceptibility to triggering local inflammation and immune stimulation finally leading to lymphoproliferation. Genetic predispositions to hereditary breast cancer increase the risk of disease development as well. BIA-ALCL seems to be underestimated in many countries and the initial symptom-seroma might be overlooked and misdiagnosed. Despite its rarity, the awareness of the disease should be improved among patients and medical professionals. This paper summarizes epidemiology, etiopathogenesis, differential diagnosis, and treatment-both surgical and hematological approaches.
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Affiliation(s)
- Maria Magdalena Joks
- Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznan, Poland
| | - Krystian Czernikiewicz
- Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznan, Poland
| | - Łukasz Mazurkiewicz
- Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznan, Poland
| | - Monika Joks
- Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznan, Poland
| | - Andrzej Balcerzak
- Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznan, Poland
| | - Renata Kroll-Balcerzak
- Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznan, Poland
| | - Joanna Rupa-Matysek
- Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Poznan, Poland.
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Camicia A, Foppiani JA, Raska O, Hernandez Alvarez A, Lee D, Taritsa IC, Schuster KA, Wan R, Neradová S, Lin GJ, Lee TC, Molitor M, Zikan M, Lin SJ. From Case Reports to Molecular Insight: Examining the Outcomes and Underlying Mechanisms of Squamous Cell Carcinoma in Breast Implant Patients-A Systematic Review. Int J Mol Sci 2024; 25:2872. [PMID: 38474119 DOI: 10.3390/ijms25052872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 02/26/2024] [Accepted: 02/27/2024] [Indexed: 03/14/2024] Open
Abstract
There is extensive coverage in the existing literature on implant-associated lymphomas like anaplastic large-cell lymphoma, but breast implant-associated squamous cell carcinoma (BIA-SCC) has received limited scholarly attention since its first case in 1992. Thus, this study aims to conduct a qualitative synthesis focused on the underexplored association between breast implants and BIA-SCC. A systematic review was conducted utilizing the PubMed, Web of Science, and Cochrane databases to identify all currently reported cases of BIA-SCC. Additionally, a literature review was performed to identify potential biochemical mechanisms that could lead to BIA-SCC. Studies were vetted for quality using the NIH quality assessment tool. From an initial pool of 246 papers, 11 met the quality criteria for inclusion, examining a total of 14 patients aged between 40 and 81 years. BIA-SCC was found in a diverse range of implants, including those with smooth and textured surfaces, as well as those filled with saline and silicone. The condition notably manifested a proclivity for aggressive clinical progression, as evidenced by a mortality rate approximating 21.4% within a post-diagnostic interval of six months. Our literature review reveals that chronic inflammation, driven by various external factors such as pathogens and implants, can initiate carcinogenesis through epigenetic modifications and immune system alterations. This includes effects from exosomes and macrophage polarization, showcasing potential pathways for the pathogenesis of BIA-SCC. The study highlights the pressing need for further investigation into BIA-SCC, a subject hitherto inadequately addressed in the academic sphere. This necessitates the urgency for early screening and intervention to improve postoperative outcomes. While the review is confined by its reliance on case reports and series, it serves as a valuable reference for future research endeavors.
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Affiliation(s)
- Alexandra Camicia
- Faculty of Medicine and Surgery, Campus Bio-Medico University of Rome, 00128 Rome, Italy
| | - Jose A Foppiani
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
- Institute of Pathological Physiology, First Faculty of Medicine, Charles University, 12108 Praha, Czech Republic
| | - Otakar Raska
- Institute of Pathological Physiology, First Faculty of Medicine, Charles University, 12108 Praha, Czech Republic
| | - Angelica Hernandez Alvarez
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Daniela Lee
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Iulianna C Taritsa
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Kirsten A Schuster
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Rou Wan
- Mayo Clinic, Rochester, MN 55902, USA
| | - Sylva Neradová
- Institute of Pathological Physiology, First Faculty of Medicine, Charles University, 12108 Praha, Czech Republic
| | - Gavin J Lin
- Nobles and Greenough School, Dedham, MA 02026, USA
| | | | - Martin Molitor
- Institute of Pathological Physiology, First Faculty of Medicine, Charles University, 12108 Praha, Czech Republic
- Department of Plastic Surgery, Bulovka University Hospital, 46401 Praha, Czech Republic
| | - Michal Zikan
- Institute of Pathological Physiology, First Faculty of Medicine, Charles University, 12108 Praha, Czech Republic
- Department of Obstetrics and Gynecology, Bulovka University Hospital, 46401 Praha, Czech Republic
| | - Samuel J Lin
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
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O'Connell RL, Sharma B, El-Sharkawi D, Wotherspoon A, Attygalle AD, MacNeill F, Khan AA, Tasoulis MK. Oncological Outcomes After Multidisciplinary Management of Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL). Ann Surg Oncol 2023; 30:6170-6175. [PMID: 37454017 DOI: 10.1245/s10434-023-13889-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 06/19/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is an uncommon type of non-Hodgkin lymphoma, associated with breast implant capsules. Despite improvements in our understanding of BIA-ALCL, communicating the prognosis to patients remains challenging due to limited long-term follow-up data. This has important implications for decision-making, including recommendations for subsequent reconstructive procedures. The aim of this study was to assess the longer-term oncological outcomes of patients receiving multidisciplinary treatment for BIA-ALCL. METHODS This was a retrospective cohort study of BIA-ALCL patients treated at a tertiary referral unit. The data are presented using simple descriptive statistics. RESULTS Between 2015 and 2022, 18 BIA-ALCL patients were treated at our institution. The median age at diagnosis was 48.5 (IQR 41-55) years. Ten patients developed BIA-ALCL after cosmetic breast augmentation, and 8 after breast reconstruction following mastectomy for cancer. All patients had a history of textured implant insertion. The median time from first implant surgery to diagnosis was 8.5 (IQR 7-12) years. All patients underwent en-bloc total capsulectomy with implant removal, and 2 received systemic therapy. Fifteen patients had Stage I (IA-IC) disease, 2 had Stage IIA and 1 Stage III BIA-ALCL, based on the TNM classification system. At a median follow-up of 45 (IQR 15-71) months, there were no episodes of local or systemic relapse or death. CONCLUSIONS Surgical management for BIA-ALCL is sufficient in early-stage disease, and associated with excellent oncological outcomes. This information is reassuring for patients when discussing recurrence risk.
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Affiliation(s)
- Rachel L O'Connell
- Breast Surgery Unit, The Royal Marsden NHS Foundation Trust, London, UK
- The Institute of Cancer Research, London, UK
| | - Bhupinder Sharma
- The Institute of Cancer Research, London, UK
- Department of Radiology, The Royal Marsden NHS Foundation Trust, London, UK
| | - Dima El-Sharkawi
- Heamato-oncology Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - Andrew Wotherspoon
- Heamato-oncology Unit, The Royal Marsden NHS Foundation Trust, London, UK
- Hisopathology Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - Ayoma D Attygalle
- Heamato-oncology Unit, The Royal Marsden NHS Foundation Trust, London, UK
- Hisopathology Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - Fiona MacNeill
- Breast Surgery Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - Aadil A Khan
- The Institute of Cancer Research, London, UK
- Plastic Surgery Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - Marios-Konstantinos Tasoulis
- Breast Surgery Unit, The Royal Marsden NHS Foundation Trust, London, UK.
- The Institute of Cancer Research, London, UK.
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Galván JR, Cordera F, Arrangoiz R, Paredes L, Pierzo JE. Breast implant-associated anaplastic large cell lymphoma presenting as a breast mass: A case report and literature review. Int J Surg Case Rep 2023; 108:108482. [PMID: 37429209 PMCID: PMC10382832 DOI: 10.1016/j.ijscr.2023.108482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/16/2023] [Accepted: 06/27/2023] [Indexed: 07/12/2023] Open
Abstract
INTRODUCTION Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare neoplasm most frequently associated with textured implant placement. The classic presentation consists of a persistent periprosthetic seroma. Implant removal and individualized adjuvant treatment are potentially curative interventions. Most BIA-ALCL present with a seroma, not with a breast and/or axillary mass. Knowledge of this presentation and how to manage it allows an adequate diagnosis, and appropriate treatment with excellent results. PRESENTATION OF CASE A 44-year-old woman presented with a 3-month history of a right breast mass located in the lower medial quadrant, with associated right axillary lymphadenopathy. Medical history was significant for a mastoplasty with textured implants 15 years before the onset of her symptoms. Imaging studies and histological analysis helped to confirm the diagnosis of BIA-ALCL. A bilateral capsulectomy was performed and adjuvant chemotherapy and immunotherapy were administered. With these interventions, the patient had complete resolution of her symptoms, good cosmetic results, and absence of tumor activity detectable by positron emission tomography with fluorodeoxyglucose (PET-CT FDG) at a 2.5-year follow-up. DISCUSSION This case describes an atypical presentation of BIA-ALCL as a breast mass, as well as lymph node and bone marrow involvement. Knowledge of the different presentation modalities of this pathology is necessary for a correct diagnosis and treatment. Through a multidisciplinary approach, adequate treatment was given with excellent results. CONCLUSION Anaplastic large cell lymphoma associated with breast implants is a clinicopathological entity still little known in some medical fields. A variety of presentations must be considered, and high clinical suspicion must be maintained in patients with a history of textured breast implant placement to optimize diagnosis and avoid delays in treatment.
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Affiliation(s)
- Joab Rafael Galván
- American British Cowdray Medical Center, 154 Carlos Graef Fernandez Av, Central Tower, medical office 515, Mexico City 05300, Mexico
| | - Fernando Cordera
- American British Cowdray Medical Center, 154 Carlos Graef Fernandez Av, Central Tower, medical office 515, Mexico City 05300, Mexico.
| | - Rodrigo Arrangoiz
- Mount Sinai Medical Center, 4306 Alton Rd, 2nd Floor, Miami Beach, FL 33140, United States of America
| | - Luis Paredes
- American British Cowdray Medical Center, 154 Carlos Graef Fernandez Av, Central Tower, medical office 515, Mexico City 05300, Mexico
| | - Jean Enrique Pierzo
- American British Cowdray Medical Center, 154 Carlos Graef Fernandez Av, Central Tower, medical office 515, Mexico City 05300, Mexico
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De Lorenzi F, Alessandri Bonetti M, Borelli F. Reply to comment on 'postmastectomy breast reconstruction for women with hereditary gastric and breast cancer syndrome'. Eur J Cancer Prev 2023; 32:410-414. [PMID: 37302019 DOI: 10.1097/cej.0000000000000818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Francesca De Lorenzi
- Department of Plastic and Reconstructive Surgery, European Institute of Oncology, IRCCS
| | | | - Francesco Borelli
- Department of Plastic and Reconstructive Surgery, European Institute of Oncology, IRCCS
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Breast Reconstruction after Breast Implant-Associated Anaplastic Large Cell Lymphoma Treatment: A Case Report and Literature Review. J Clin Med 2023; 12:jcm12051885. [PMID: 36902672 PMCID: PMC10003959 DOI: 10.3390/jcm12051885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 02/24/2023] [Indexed: 03/08/2023] Open
Abstract
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a T-cell non-Hodgkin's lymphoma that occurs in patients with at least one prior textured breast implant. BIA-ALCL has a relatively good prognosis when treated promptly. However, data on the methods and timing of the reconstruction process are lacking. Herein, we report the first case of BIA-ALCL in Republic of Korea in a patient who underwent breast reconstruction using implants and an acellular dermal matrix (ADM). A 47-year-old female patient was diagnosed with BIA-ALCL stage IIA (T4N0M0) and underwent bilateral breast augmentation using textured breast implants. She then underwent removal of both breast implants, total bilateral capsulectomy, adjuvant chemotherapy, and radiotherapy. There was no evidence of recurrence at 28 months postoperatively; therefore, the patient wished to undergo breast reconstruction surgery. A smooth surface implant was used to consider the patient's desired breast volume and body mass index. The right breast was reconstructed with a smooth surface implant and an ADM in the prepectoral plane. Breast augmentation was performed on the left breast using a smooth surface implant. The patient was satisfied with the results and recovered fully with no complications.
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The Role of Microorganisms in the Development of Breast Implant-Associated Anaplastic Large Cell Lymphoma. Pathogens 2023; 12:pathogens12020313. [PMID: 36839585 PMCID: PMC9961223 DOI: 10.3390/pathogens12020313] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/06/2023] [Accepted: 02/13/2023] [Indexed: 02/16/2023] Open
Abstract
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a variant of anaplastic large cell lymphoma (ALCL) associated with textured-surface silicone breast implants. Since first being described in 1997, over 1100 cases have been currently reported worldwide. A causal relationship between BIA-ALCL and textured implants has been established in epidemiological studies, but a multifactorial process is likely to be involved in the pathogenesis of BIA-ALCL. However, pathophysiologic mechanisms remain unclear. One of the hypotheses that could explain the link between textured implants and BIA-ALCL consists in the greater tendency of bacterial biofilm in colonizing the surface of textured implants compared to smooth implants, and the resulting chronic inflammation which, in predisposed individuals, may lead to tumorigenesis. This review summarizes the existing evidence on the role of micro-organisms and rough surface implants in the development of BIA-ALCL. It also provides insights into the most updated clinical practice knowledge about BIA-ALCL, from clinical presentation and investigation to treatment and outcomes.
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