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Stack A, Ali N, Khan N. Breast Implant-associated Anaplastic Large Cell Lymphoma: A Review with Emphasis on the Role of Brentuximab Vedotin. JOURNAL OF CELLULAR IMMUNOLOGY 2020; 2:80-89. [PMID: 32914146 PMCID: PMC7480932 DOI: 10.33696/immunology.2.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Breast implant-associated anaplastic large cell lymphoma is a recently recognized complication of textured breast implants. It typically presents as unilateral peri-implant swelling approximately 7-10 years after implantation. While the course is usually indolent, breast implant-associated anaplastic large cell lymphoma may form a locally invasive mass and metastasize to regional lymph nodes or beyond to distant sites. Surgical excision has been well established as the standard of care for localized disease; however, guidelines directing management of advanced, recurrent or unresectable disease are based on limited and extrapolated evidence. The CD30-targeting immunoconjugate, brentuximab vedotin, has been utilized in this setting, typically in combination with chemotherapy. We recently reported a patient with unresectable breast implant-associated anaplastic large cell lymphoma who was treated with brentuximab vedotin monotherapy and has now sustained complete remission for 2.6 years. Herein, we provide an up-to-date review of the epidemiology, pathogenesis, clinical features, diagnosis and management of breast implant associated anaplastic large cell lymphoma with emphasis on the role of brentuximab vedotin.
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Affiliation(s)
- Anthony Stack
- Department of Internal Medicine, Temple University Hospital, Philadelphia, PA USA
| | - Nadia Ali
- Department of Medicine, section of Hematology, Temple University Hospital, Philadelphia, PA, USA
| | - Nadia Khan
- Department of Hematology and Oncology, Fox Chase Cancer Center, Philadelphia, PA USA
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Evans MG, Miranda RN, Young PA, Pai L, Wang HY, Konoplev SN, Medeiros LJ, Pinter-Brown LC. B-cell lymphomas associated with breast implants: Report of three cases and review of the literature. Ann Diagn Pathol 2020; 46:151512. [PMID: 32315816 DOI: 10.1016/j.anndiagpath.2020.151512] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 03/18/2020] [Indexed: 12/27/2022]
Abstract
Since the first reported case in 1997, over 600 women with breast implant-associated anaplastic large cell lymphoma (BI ALCL) have been reported. BI ALCL is a CD30-positive T-cell lymphoma that carries clonal T-cell receptor gene rearrangements, and a subset of cases harbors mutations in the JAK-STAT signaling pathway. Rarely, other histologic types of lymphoma have been reported in association with breast implants, including fewer than 10 cases of B-cell origin. Here, we describe three additional patients with B-cell lymphoma occurring around breast implants. Two of these patients developed extranodal marginal zone lymphoma in the peri-implant capsule, one of which had a concurrent ALCL within the superficial lining of the capsule. The third patient presented with diffuse large B-cell lymphoma inside the breast parenchyma surrounding her implant. Determining the etiology and risk factors for the development of B-cell lymphomas associated with breast implants remains challenging, given the wide spectrum of histologic features and the rarity of these neoplasms. Ultimately, we document three new cases of B-cell lymphoma arising around breast implants and highlight their clinical and pathologic features in order to expand our understanding of this rare disease presentation.
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Affiliation(s)
- Mark G Evans
- Department of Pathology and Laboratory Medicine, University of California Irvine (UCI) Medical Center, Orange, CA, United States of America.
| | - Roberto N Miranda
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America.
| | - Patricia A Young
- Department of Medicine, Hematology/Oncology Division, University of California Los Angeles (UCLA) Medical Center, Los Angeles, CA, United States of America.
| | - Linda Pai
- Franciscan Surgical Associates, St. Anthony Hospital, Gig Harbor, WA, United States of America.
| | - Huan-You Wang
- Department of Pathology, University of California San Diego (UCSD) Medical Center, San Diego, CA, United States of America.
| | - Sergej N Konoplev
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America.
| | - L Jeffrey Medeiros
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America.
| | - Lauren C Pinter-Brown
- Department of Medicine, Hematology/Oncology Division, University of California Irvine (UCI) Medical Center, Orange, CA, United States of America.
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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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Abstract
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is an uncommon neoplasia occurring in women with either cosmetic or reconstructive breast implants. The actual knowledge about BIA-ALCL deriving from the literature presents several limits, and it remains difficult to make inferences about BIA-ALCL epidemiology, cause, and pathogenesis. This is the reason why the authors decided to organize an evidence-based consensus conference during the Maurizio Bruno Nava (MBN 2016) Aesthetic Breast Meeting held in Milan in December of 2016. Twenty key opinion leaders in the field of plastic surgery from all over the world have been invited to express and discuss their opinion about some key questions on BIA-ALCL, trying to reach a consensus about BIA-ALCL cause, pathogenesis, diagnosis, and treatment in light of the actual best evidence.
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Clemens MW, Miranda RN. Commentary on: CD30+ T Cells in Late Seroma May Not Be Diagnostic of Breast Implant-Associated Anaplastic Large Cell Lymphoma. Aesthet Surg J 2017; 37:776-778. [PMID: 28402426 DOI: 10.1093/asj/sjx040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Mark W Clemens
- Dr Clemens is an Associate Professor, Department of Plastic Surgery, the University of Texas M.D. Anderson Cancer Center, Houston, TX; and is Breast Section Co-editor for Aesthetic Surgery Journal. Dr Miranda is a Professor, Department of Hematopathology, the University of Texas MD Anderson Cancer Center, Houston, TX
| | - Roberto N Miranda
- Dr Clemens is an Associate Professor, Department of Plastic Surgery, the University of Texas M.D. Anderson Cancer Center, Houston, TX; and is Breast Section Co-editor for Aesthetic Surgery Journal. Dr Miranda is a Professor, Department of Hematopathology, the University of Texas MD Anderson Cancer Center, Houston, TX
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Mosquera-Zamudio A, Parra-Medina R, Moreno L, Paez Lopez G, Montealegre Gomez G, Morales SD. Diffuse Large B-Cell Lymphoma in a Patient With Necrotizing Fasciitis Secondary to Silicone Biopolymer Implants in Buttock. Int J Surg Pathol 2017; 25:606-607. [PMID: 28420306 DOI: 10.1177/1066896917704900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Andres Mosquera-Zamudio
- 1 Department of Pathology, Fundación Universitaria de Ciencias de la Salud. Hospital San José, Bogotá, Colombia
| | - Rafael Parra-Medina
- 1 Department of Pathology, Fundación Universitaria de Ciencias de la Salud. Hospital San José, Bogotá, Colombia.,2 Doctoral Program in Biomedical Sciences, Universidad del Rosario, Bogotá, Colombia
| | - Liliana Moreno
- 1 Department of Pathology, Fundación Universitaria de Ciencias de la Salud. Hospital San José, Bogotá, Colombia
| | - German Paez Lopez
- 3 Department of Plastic surgery, Fundación Universitaria de Ciencias de la Salud, Hospital San José, Bogotá, Colombia
| | - Giovanni Montealegre Gomez
- 3 Department of Plastic surgery, Fundación Universitaria de Ciencias de la Salud, Hospital San José, Bogotá, Colombia
| | - Samuel D Morales
- 1 Department of Pathology, Fundación Universitaria de Ciencias de la Salud. Hospital San José, Bogotá, Colombia
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Clemens MW, Nava MB, Rocco N, Miranda RN. Understanding rare adverse sequelae of breast implants: anaplastic large-cell lymphoma, late seromas, and double capsules. Gland Surg 2017; 6:169-184. [PMID: 28497021 DOI: 10.21037/gs.2016.11.03] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Breast implant-associated anaplastic large cell lymphoma (BI-ALCL) is a distinct type of T-cell lymphoma arising around breast implants. The United States FDA recently updated the 2011 safety communication, warning that women with breast implants may have a very low risk of developing ALCL adjacent to a breast implant. According to the World Health Organization, BI-LCL is not a breast cancer or cancer of the breast tissue; it is a lymphoma, a cancer of immune cells. BI-ALCL is highly curable in the majority of patients. Informed consent should include the risk of BI-ALCL with breast implant patients. Women with breast implants are encouraged to contact their plastic surgeon if they notice swelling, fluid collections, or unexpected changes in breast shape. Physicians are encouraged to send suspicious peri-prosthetic fluid for CD30 immunohistochemistry, cell block cytology, and culture in symptomatic patients. An observation from reported cases indicates a predominance of textured device involvement. More information is needed to fully understand risk factors and etiology. The association of bacteria and biofilm with ALCL is currently being investigated and one theory is that biofilm may play a role in this disease process stressing the importance of best practice techniques intraoperatively. Recent studies have reported clinical presentation, prognosis, and treatment outcomes with long term followup demonstrating the critical role for surgical management.
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Affiliation(s)
- Mark W Clemens
- Department of Plastic Surgery, M.D. Anderson Cancer Center, Houston, TX, USA
| | | | - Nicola Rocco
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Roberto N Miranda
- Department of Hematopathology, the University of Texas M.D. Anderson Cancer, Center, Houston, TX, USA
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