1
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de Paule CFP, Pedroso RB, de Barros Carvalho MD, Pelloso FC, Roma AM, da Silva Freitas R, Cavalcante JM, Fiats Ribeiro H, Pelloso SM. Anaplastic lymphoma associated with breast implants-Early diagnosis and treatment. Clin Case Rep 2023; 11:e7727. [PMID: 37529127 PMCID: PMC10387511 DOI: 10.1002/ccr3.7727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/06/2023] [Accepted: 07/11/2023] [Indexed: 08/03/2023] Open
Abstract
Anaplastic large cell lymphoma associated with breast implants is a relatively new disease that deserves attention from the academic community. Brazil figures as one of the protagonists in plastic surgery, however publications are insufficient and very few cases are reported in comparison to other countries. It is a disease with excellent prognosis when diagnosed early and treated effectively, but for this to happen, it is essential that health care professionals and the patient understand its pathology. We reported two cases in a small town during a short period of time. In both cases reported by this study, the patients presented late seroma, associated with pain as a clinical presentation, at 13 and 9 years after the placement of silicone implants with textured polyurethane surfaces. After the procedure, the patients were screened for cancer. Further research with more robust samples is still needed to fully determine the risks and benefits of using textured versus smooth implants.
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2
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Keane GC, Keane AM, Diederich R, Kennard K, Duncavage EJ, Myckatyn TM. The evaluation of the delayed swollen breast in patients with a history of breast implants. Front Oncol 2023; 13:1174173. [PMID: 37476374 PMCID: PMC10354431 DOI: 10.3389/fonc.2023.1174173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 06/20/2023] [Indexed: 07/22/2023] Open
Abstract
Breast implants, whether placed for reconstructive or cosmetic purposes, are rarely lifetime devices. Rupture, resulting from compromised implant shell integrity, and capsular contracture caused by constriction of the specialized scar tissue that normally forms around breast implants, have long been recognized, and remain the leading causes of implant failure. It is apparent, however, that women with breast implants may also experience delayed breast swelling due to a range of etiologic factors. While a majority of delayed seromas associated with breast implants have a benign etiology, this presentation cannot be ignored without an adequate workup as malignancies such as breast implant associated anaplastic large cell lymphoma (BIA-ALCL), breast implant associated diffuse large B-cell lymphoma (BIA-DLBCL), and breast implant associated squamous cell carcinoma (BIA-SCC) can have a similar clinical presentation. Since these malignancies occur with sufficient frequency, and with sometimes lethal consequences, their existence must be recognized, and an appropriate diagnostic approach implemented. A multidisciplinary team that involves a plastic surgeon, radiologist, pathologist, and, as required, surgical and medical oncologists can expedite judicious care. Herein we review and further characterize conditions that can lead to delayed swelling around breast implants.
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Affiliation(s)
- Grace C. Keane
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Saint Louis, MO, United States
| | - Alexandra M. Keane
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Saint Louis, MO, United States
| | - Ryan Diederich
- MidAmerica Plastic Surgery, Glen Carbon, IL, United States
| | - Kaitlyn Kennard
- Division of Surgical Oncology, Washington University School of Medicine, Saint Louis, MO, United States
| | - Eric J. Duncavage
- Department of Pathology and Immunology, Washington University School of Medicine, Saint Louis, MO, United States
| | - Terence M. Myckatyn
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Saint Louis, MO, United States
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3
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Muacevic A, Adler JR. Current Understanding of Breast Implant-Associated Anaplastic Large Cell Lymphoma. Cureus 2022; 14:e30516. [PMID: 36420249 PMCID: PMC9678239 DOI: 10.7759/cureus.30516] [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: 08/17/2022] [Accepted: 10/20/2022] [Indexed: 01/25/2023] Open
Abstract
Every year, breast implants are inserted worldwide for reconstructive or aesthetic reasons. Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rather uncommon type of T cell lymphoma that is positive for the CD30 biomarker. Despite being far more common than other primary breast lymphomas, BIA-ALCL has a very low incidence. Textured types of implants have been linked to almost all cases. The majority of patients have a favorable prognosis after the removal of implants and capsules. Nevertheless, the chance of a fatal outcome is higher with capsular invasion and tumor bulk. Although the exact cause of BIA-ALCL is unknown, it has been suggested that persistent infections or toxins related to the implants may play a role. Therefore, physicians must be aware of breast implants' rare but potentially significant side effects. Before surgery, patients with verified instances should be directed to a breast medical oncologist or lymphoma specialist for oncologic assessment. Total en-bloc capsulectomy, a surgical procedure that removes the implant and the surrounding capsule, is usually adequate. In other cases, a late diagnosis necessitates more invasive surgery and systemic therapies, which, while typically effective, have been linked to poor outcomes and even fatalities. Since it is a recently described entity and the "denominator" (i.e., the total number of breast implant procedures) is unknown, it is challenging to determine the risk of development. In this review, we hope to emphasize the elements of etiology, demography, clinical features, and current treatment approaches for BIA-ALCL. In doing so, we hope to increase the medical professional's knowledge of the recognition and treatment of BIA-ALCL.
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4
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Santanelli di Pompeo F, Clemens MW, Atlan M, Botti G, Cordeiro PG, De Jong D, Di Napoli A, Hammond D, Haymaker CL, Horwitz SM, Hunt K, Lennox P, Mallucci P, Miranda RN, Munhoz AM, Swanson E, Turner SD, Firmani G, Sorotos M. 2022 Practice Recommendation Updates From the World Consensus Conference on BIA-ALCL. Aesthet Surg J 2022; 42:1262-1278. [PMID: 35639805 PMCID: PMC9924046 DOI: 10.1093/asj/sjac133] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Laboratory and clinical research on breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is rapidly evolving. Changes in standard of care and insights into best practice were recently presented at the 3rd World Consensus Conference on BIA-ALCL. OBJECTIVES The authors sought to provide practice recommendations from a consensus of experts, supplemented with a literature review regarding epidemiology, etiology, pathogenesis, diagnosis, treatment, socio-psychological aspects, and international authority guidance. METHODS A literature search of all manuscripts between 1997 and August 2021 for the above areas of BIA-ALCL was conducted with the PubMed database. Manuscripts in different languages, on non-human subjects, and/or discussing conditions separate from BIA-ALCL were excluded. The study was conducted employing the Delphi process, gathering 18 experts panelists and utilizing email-based questionnaires to record the level of agreement with each statement by applying a 5-point Likert Scale. Median response, interquartile range, and comments were employed to accept, reject, or revise each statement. RESULTS The literature search initially yielded 764 manuscripts, of which 405 were discarded. From the remaining 359, only 218 were included in the review and utilized to prepare 36 statements subdivided into 5 sections. After 1 round, panelists agreed on all criteria. CONCLUSIONS BIA-ALCL is uncommon and still largely underreported. Mandatory implant registries and actions by regulatory authorities are needed to better understand disease epidemiology and address initial lymphomagenesis and progression. Deviation from current diagnosis and treatment protocols can lead to disease recurrence, and research on breast implant risk factors provide insight to etiology. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Fabio Santanelli di Pompeo
- Corresponding Author: Prof Fabio Santanelli di Pompeo, Department of Neuroscience, Mental Health and Sense Organs (NESMOS), Sant’Andrea Hospital, Via di Grottarossa 1035-1039, 00189 Rome, Italy. E-mail: ; Instagram: @diepflap.it
| | - Mark W Clemens
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA and is a Breast Surgery section editor for Aesthetic Surgery Journal
| | - Michael Atlan
- Aesthetic Plastic Reconstructive Unit/CHU TENON PARIS—APHP, Université Pierre et Marie Curie, Paris, France
| | | | - Peter G Cordeiro
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Daphne De Jong
- Amsterdam UMC-Vrije Universiteit Amsterdam, Department of Pathology and Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Arianna Di Napoli
- Pathology Unit, Department of Clinical and Molecular Medicine, Sapienza University, Sant’Andrea Hospital, Rome, Italy
| | | | - Cara L Haymaker
- Department of Translational Molecular Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Steven M Horwitz
- Lymphoma Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Kelly Hunt
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Peter Lennox
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of British Columbia, Vancouver, BC, Canada and is a clinical editor for Aesthetic Surgery Journal
| | | | - Roberto N Miranda
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Alexandre M Munhoz
- Plastic Surgery Department, Hospital Moriah, Hospital Sírio-Libanês, Higienópolis, São Paulo, Brazil
| | | | - Suzanne D Turner
- Division of Cellular and Molecular Pathology, Department of Pathology, University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK
| | - Guido Firmani
- Faculty of Medicine and Psychology, Sapienza University of Rome, Department of Plastic Surgery, Sant’Andrea Hospital, Rome, Italy
| | - Michail Sorotos
- Faculty of Medicine and Psychology, Sapienza University of Rome, Department NESMOS, Sant’Andrea Hospital, Rome, Italy
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5
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Özer M, Toulabi SP, Fisher AD, T'Sjoen G, Buncamper ME, Monstrey S, Bizic MR, Djordjevic M, Falcone M, Christopher NA, Simon D, Capitán L, Motmans J. ESSM Position Statement "Sexual Wellbeing After Gender Affirming Surgery". Sex Med 2021; 10:100471. [PMID: 34971864 PMCID: PMC8847816 DOI: 10.1016/j.esxm.2021.100471] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 10/06/2021] [Accepted: 11/09/2021] [Indexed: 01/09/2023] Open
Abstract
Introduction Much has been published on the surgical and functional results following Gender Affirming Surgery (‘GAS’) in trans individuals. Comprehensive results regarding sexual wellbeing following GAS, however, are generally lacking. Aim To review the impact of various GAS on sexual wellbeing in treatment seeking trans individuals, and provide a comprehensive list of clinical recommendations regarding the various surgical options of GAS on behalf of the European Society for Sexual Medicine. Methods The Medline, Cochrane Library and Embase databases were reviewed on the results of sexual wellbeing after GAS. Main Outcomes Measure The task force established consensus statements regarding the somatic and general requirements before GAS and of GAS: orchiectomy-only, vaginoplasty, breast augmentation, vocal feminization surgery, facial feminization surgery, mastectomy, removal of the female sexual organs, metaidoioplasty, and phalloplasty. Outcomes pertaining to sexual wellbeing- sexual satisfaction, sexual relationship, sexual response, sexual activity, enacted sexual script, sexuality, sexual function, genital function, quality of sex life and sexual pleasure- are provided for each statement separately. Results The present position paper provides clinicians with statements and recommendations for clinical practice, regarding GAS and their effects on sexual wellbeing in trans individuals. These data, are limited and may not be sufficient to make evidence-based recommendations for every surgical option. Findings regarding sexual wellbeing following GAS were mainly positive. There was no data on sexual wellbeing following orchiectomy-only, vocal feminization surgery, facial feminization surgery or the removal of the female sexual organs. The choice for GAS is dependent on patient preference, anatomy and health status, and the surgeon's skills. Trans individuals may benefit from studies focusing exclusively on the effects of GAS on sexual wellbeing. Conclusion The available evidence suggests positive results regarding sexual wellbeing following GAS. We advise more studies that underline the evidence regarding sexual wellbeing following GAS. This position statement may aid both clinicians and patients in decision-making process regarding the choice for GAS. Özer M, Toulabi SP, Fisher AD, et al. ESSM Position Statement “Sexual Wellbeing After Gender Affirming Surgery”. Sex Med 2022;10:100471.
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Affiliation(s)
- Müjde Özer
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands.
| | - Sahaand Poor Toulabi
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Alessandra D Fisher
- Andrology, Women's Endocrinology, Gender Incongruence Unit, Department of Experimental Clinical and Biomedical Sciences, University of Florence, Florence, Italy
| | - Guy T'Sjoen
- Department of Endocrinology and Center for Sexology and Gender, Ghent University and Ghent University Hospital, Ghent, Belgium
| | - Marlon E Buncamper
- Department of Plastic, Reconstructive and Hand Surgery, Ghent University Hospital, Ghent, Belgium
| | - Stan Monstrey
- Department of Plastic, Reconstructive and Hand Surgery, Ghent University and Ghent University Hospital, Ghent, Belgium
| | - Marta R Bizic
- Department of Pediatric Urology, University of Belgrade, Belgrade, Serbia
| | | | - Marco Falcone
- Department of Urology, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Nim A Christopher
- Department of Urology, St Peter's Andrology Centre and The Institute of Urology, London, UK
| | - Daniel Simon
- Facialteam Surgical Group, HC Marbella International Hospital, Marbella, Málaga, Spain
| | - Luis Capitán
- Facialteam Surgical Group, HC Marbella International Hospital, Marbella, Málaga, Spain
| | - Joz Motmans
- Center for Sexology and Gender, Ghent University Hospital, Ghent, Belgium
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Santanelli di Pompeo F, Sorotos M, Clemens MW, Firmani G, Athanasopoulos E, Arctander K, Berenguer B, Bozikov K, Cardoso A, Nord ÅE, Filip C, Georgeskou Romania A, Heitman C, Kaarela O, Kolenda M, Hamdi M, Lantieri L, Lumenta D, Mercer N, Ruegg E, Santanelli di Pompeo F, Stanec Z, Van Der Hulst R, Vranckx JJ. Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL): Review of Epidemiology and Prevalence Assessment in Europe. Aesthet Surg J 2021; 41:1014-1025. [PMID: 33022037 DOI: 10.1093/asj/sjaa285] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) epidemiologic studies focus on incidence and risk estimates. OBJECTIVES The aim of this study was to perform a thorough literature review, and to provide an accurate estimate of BIA-ALCL prevalence in Europe. METHODS We searched PubMed, Web of Science, SCOPUS, and Google Scholar databases to identify publications reporting BIA-ALCL epidemiology. Research was conducted between November 2019 and August 2020. European prevalence was assessed as the ratio between pathology-confirmed cases and breast implant-bearing individuals. The Committee on Device Safety and Development (CDSD) collected data from national plastic surgery societies, health authorities, and disease-specific registries to calculate the numerator. The denominator was estimated by combining European demographic data with scientific reports. RESULTS Our research identified 507 articles: 106 were excluded for not being relevant to BIA-ALCL. From the remaining 401 articles, we selected 35 that discussed epidemiology and 12 reviews. The CDSD reported 420 cases in Europe, with an overall prevalence of 1:13,745 cases in the 28 member states of the European Union (EU-28). Countries where specific measures have been implemented to tackle BIA-ALCL account for 61% of the EU-28 population and actively reported 382 cases with an overall prevalence of 1:9121. CONCLUSION Countries where specific measures have been implemented show a higher prevalence of BIA-ALCL compared with the European mean, suggesting that these countries have improved the detection of the condition and reduced underreporting, which affects the numerator value. Other nations should adopt projections based on these measures to avoid underestimating how widespread BIA-ALCL is. LEVEL OF EVIDENCE: 4
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Affiliation(s)
| | - Michail Sorotos
- Department of Medicine, Surgery and Dentistry, PhD School of Translational Medicine of Development and Active Ageing, Università degli Studi di Salerno, Salerno, Italy
| | - Mark W Clemens
- Department of Plastic Surgery, M.D. Anderson Cancer Center, TX, USA
| | - Guido Firmani
- School of Medicine and Psychology, Sapienza University, Rome, Italy
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7
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Microbial community compositions in breast implant biofilms associated with contracted capsules. PLoS One 2021; 16:e0249261. [PMID: 33831065 PMCID: PMC8031459 DOI: 10.1371/journal.pone.0249261] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 03/15/2021] [Indexed: 12/12/2022] Open
Abstract
Subclinical bacterial infections (biofilms) are strongly implicated in breast augmentation failure due to capsular contracture, and while these infections are generally ascribed to common skin commensals, this remains largely unsubstantiated through robust cultivation independent analyses. To determine capsule biofilm microbial community compositions, we employed amplicon sequencing of the 16S rRNA gene using DNA extracted from breast implant capsule samples. These cultivation independent analyses revealed that capsule associated biofilms are more diverse than canonical single-species infections, but have relatively low diversity (~ <100 species) compared to many host-associated microbial communities. In addition to taxa commonly associated with capsular contracture, the biofilms analyzed comprised a number of taxa that escaped detection in cultivation-dependent work. We have also isolated several key taxa identified through the culture-independent analyses. Together our analyses reveal that capsule biofilms are more diverse than cultivation studies suggest and can be heterogeneous within an individual capsule, between breasts of the same patient, across similar implant types, and over a range in severity of contracture. The complex nature of these communities requires further study across a broader suite of patients in addition to higher resolution analyses including metagenomics to better assess the fundamental role of microorganisms in capsular contracture.
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8
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Mitry MA, Sogani J, Sutton EJ, Kumar P, Horwitz S, Elmi A, Patel SN, Gallagher K, Dashevsky BZ, Mango V. Rare Cancer on the Rise: An Educational Review of Breast Implant-associated Anaplastic Large Cell Lymphoma. JOURNAL OF BREAST IMAGING 2020; 2:398-407. [PMID: 38424964 DOI: 10.1093/jbi/wbaa041] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Indexed: 03/02/2024]
Abstract
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare but increasingly important diagnosis as the incidence of breast implant placement, both elective and reconstructive, continues to rise. When detected and treated early, this indolent disease carries an excellent prognosis. However, because the clinical presentation is often nonspecific, it is crucial for radiologists to accurately identify the imaging findings associated with BIA-ALCL to facilitate a timely diagnosis. This article will provide radiologists with an overview of the diagnosis, imaging findings, and management of BIA-ALCL.
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Affiliation(s)
- Maria A Mitry
- Memorial Sloan Kettering Cancer Center, Department of Radiology, New York, NY
| | - Julie Sogani
- Memorial Sloan Kettering Cancer Center, Department of Radiology, New York, NY
| | - Elizabeth J Sutton
- Memorial Sloan Kettering Cancer Center, Department of Radiology, New York, NY
| | - Priyadarshini Kumar
- Memorial Sloan Kettering Cancer Center, Department of Radiology, New York, NY
| | - Steven Horwitz
- Memorial Sloan Kettering Cancer Center, Department of Radiology, New York, NY
| | - Azadeh Elmi
- Memorial Sloan Kettering Cancer Center, Department of Radiology, New York, NY
| | - Sejal N Patel
- Memorial Sloan Kettering Cancer Center, Department of Radiology, New York, NY
| | - Katherine Gallagher
- Memorial Sloan Kettering Cancer Center, Department of Radiology, New York, NY
| | | | - Victoria Mango
- Memorial Sloan Kettering Cancer Center, Department of Radiology, New York, NY
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9
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Rahme J, Liu D, Chew G, Zinn R. Silicone nipple discharge: A case report of an unusual presentation of breast implant rupture. Int J Surg Case Rep 2020; 74:73-76. [PMID: 32823059 PMCID: PMC7452585 DOI: 10.1016/j.ijscr.2020.07.077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 07/16/2020] [Accepted: 07/27/2020] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Breast implant rupture is a well-documented complication of breast implant surgery. Diagnosis of ruptured silicone implants can be difficult due to the lack of overt symptoms. This is the first reported case of a patient with silicone breast implant rupture presenting with clear nipple discharge and is presented in line with SCARCE 2018 Guidelines [1]. PRESENTATION OF CASE A 45-year-old-female was referred to a breast surgeon with viscous clear nipple discharge, on a background of bilateral mastopexy-augmentation surgery 10 years prior. Imaging revealed extensive intraductal and free silicone causing significant stromal deformity secondary to breast implant rupture. Cytology of the nipple discharge was consistent with silicone gel. The patient was also found to have fibroadenoma without atypia in the right breast. She underwent an oncoplastic excision of free silicone and change of bilateral breast implants by a team of breast and plastic surgeons. DISCUSSION With breast implants being an increasingly common procedure worldwide, we can expect an increase in these unusual presentations. Clinicians and patients need to be aware of these in order to avoid an unnecessary delay in diagnosis. CONCLUSION Silicone implant rupture is a well-known complication and the rate of rupture increases over the life of the implant. Diagnosis of ruptured silicone implants is rare on clinical examination however remains an essential component of a doctor's examination of the patient and nipple discharge must be considered a symptom of rupture.
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Affiliation(s)
- Jessica Rahme
- General Surgery Unit, Austin Hospital, Melbourne, Victoria, Australia.
| | - David Liu
- Flinders Medical Centre, South Australia, Australia
| | - Grace Chew
- Breast Surgery Unit, Austin Hospital, Melbourne, Victoria, Australia
| | - Richard Zinn
- Plastic Surgery Unit, Northern Hospital, Melbourne, Victoria, Australia
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10
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Turner SD. Commentary on: Breast Implant-Associated Anaplastic Large Cell Lymphoma in Australia: A Longitudinal Study of Implant and Other Related Risk Factors. Aesthet Surg J 2020; 40:847-849. [PMID: 32011676 DOI: 10.1093/asj/sjz371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Suzanne D Turner
- Division of Cellular and Molecular Pathology, Department of Pathology, University of Cambridge, Cambridge, UK
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11
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Fiore D, Cappelli LV, Zumbo P, Phillips JM, Liu Z, Cheng S, Yoffe L, Ghione P, Di Maggio F, Dogan A, Khodos I, de Stanchina E, Casano J, Kayembe C, Tam W, Betel D, Foa’ R, Cerchietti L, Rabadan R, Horwitz S, Weinstock DM, Inghirami G. A Novel JAK1 Mutant Breast Implant-Associated Anaplastic Large Cell Lymphoma Patient-Derived Xenograft Fostering Pre-Clinical Discoveries. Cancers (Basel) 2020; 12:cancers12061603. [PMID: 32560455 PMCID: PMC7352499 DOI: 10.3390/cancers12061603] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/08/2020] [Accepted: 06/11/2020] [Indexed: 12/13/2022] Open
Abstract
Breast implant-associated lymphoma (BIA-ALCL) has recently been recognized as an independent peripheral T-cell lymphoma (PTCL) entity. In this study, we generated the first BIA-ALCL patient-derived tumor xenograft (PDTX) model (IL89) and a matching continuous cell line (IL89_CL#3488) to discover potential vulnerabilities and druggable targets. We characterized IL89 and IL89_CL#3488, both phenotypically and genotypically, and demonstrated that they closely resemble the matching human primary lymphoma. The tumor content underwent significant enrichment along passages, as confirmed by the increased variant allele frequency (VAF) of mutations. Known aberrations (JAK1 and KMT2C) were identified, together with novel hits, including PDGFB, PDGFRA, and SETBP1. A deep sequencing approach allowed the detection of mutations below the Whole Exome Sequencing (WES) sensitivity threshold, including JAK1G1097D, in the primary sample. RNA sequencing confirmed the expression of a signature of differentially expressed genes in BIA-ALCL. Next, we tested IL89’s sensitivity to the JAK inhibitor ruxolitinib and observed a potent anti-tumor effect, both in vitro and in vivo. We also implemented a high-throughput drug screening approach to identify compounds associated with increased responses in the presence of ruxolitinib. In conclusion, these new IL89 BIA-ALCL models closely recapitulate the primary correspondent lymphoma and represent an informative platform for dissecting the molecular features of BIA-ALCL and performing pre-clinical drug discovery studies, fostering the development of new precision medicine approaches.
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Affiliation(s)
- Danilo Fiore
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY 10065, USA; (D.F.); (L.V.C.); (S.C.); (L.Y.); (F.D.M.); (J.C.); (C.K.); (W.T.)
| | - Luca Vincenzo Cappelli
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY 10065, USA; (D.F.); (L.V.C.); (S.C.); (L.Y.); (F.D.M.); (J.C.); (C.K.); (W.T.)
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00161 Rome, Italy;
| | - Paul Zumbo
- Applied Bioinformatics Core, Weill Cornell Medicine, New York, NY 10065, USA;
| | - Jude M. Phillips
- Department of Medicine, Hematology-Oncology, Weill Cornell Medicine and the New York Presbyterian Hospital, New York, NY 10065, USA; (J.M.P.); (L.C.)
| | - Zhaoqi Liu
- Department of Systems Biology and Biomedical Informatics, Columbia University, New York, NY 10032, USA; (Z.L.); (R.R.)
| | - Shuhua Cheng
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY 10065, USA; (D.F.); (L.V.C.); (S.C.); (L.Y.); (F.D.M.); (J.C.); (C.K.); (W.T.)
| | - Liron Yoffe
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY 10065, USA; (D.F.); (L.V.C.); (S.C.); (L.Y.); (F.D.M.); (J.C.); (C.K.); (W.T.)
| | - Paola Ghione
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; (P.G.); (S.H.)
| | - Federica Di Maggio
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY 10065, USA; (D.F.); (L.V.C.); (S.C.); (L.Y.); (F.D.M.); (J.C.); (C.K.); (W.T.)
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, 80131 Naples, Italy
| | - Ahmet Dogan
- Departments of Pathology and Laboratory Medicine, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA;
| | - Inna Khodos
- Molecular Pharmacology Program, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (I.K.); (E.d.S.)
| | - Elisa de Stanchina
- Molecular Pharmacology Program, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (I.K.); (E.d.S.)
| | - Joseph Casano
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY 10065, USA; (D.F.); (L.V.C.); (S.C.); (L.Y.); (F.D.M.); (J.C.); (C.K.); (W.T.)
| | - Clarisse Kayembe
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY 10065, USA; (D.F.); (L.V.C.); (S.C.); (L.Y.); (F.D.M.); (J.C.); (C.K.); (W.T.)
| | - Wayne Tam
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY 10065, USA; (D.F.); (L.V.C.); (S.C.); (L.Y.); (F.D.M.); (J.C.); (C.K.); (W.T.)
| | - Doron Betel
- Department of Medicine and Institute for Computational Biomedicine, Weill Cornell Medicine, New York, NY 10065, USA;
| | - Robin Foa’
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00161 Rome, Italy;
| | - Leandro Cerchietti
- Department of Medicine, Hematology-Oncology, Weill Cornell Medicine and the New York Presbyterian Hospital, New York, NY 10065, USA; (J.M.P.); (L.C.)
| | - Raul Rabadan
- Department of Systems Biology and Biomedical Informatics, Columbia University, New York, NY 10032, USA; (Z.L.); (R.R.)
| | - Steven Horwitz
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; (P.G.); (S.H.)
| | - David M. Weinstock
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA 02215, USA;
| | - Giorgio Inghirami
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY 10065, USA; (D.F.); (L.V.C.); (S.C.); (L.Y.); (F.D.M.); (J.C.); (C.K.); (W.T.)
- Correspondence: ; Tel.: +1-212-746-5616; Fax: +1-212-746-8173
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Kim JH, Paik NS, Nam SY, Cho Y, Park HK. The Emerging Crisis of Stakeholders in Implant-based Augmentation Mammaplasty in Korea. J Korean Med Sci 2020; 35:e103. [PMID: 32301294 PMCID: PMC7167397 DOI: 10.3346/jkms.2020.35.e103] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 02/10/2020] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Korea is no longer safe from the risk of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL); the first reported case was a Korean woman in her 40s who had a 7-year-history of receiving an implant-based augmentation mammaplasty using a textured implant. We conducted this study to discuss the emerging crisis of stakeholders in implant-based augmentation mammaplasty and to propose a multi-disciplinary approach to early detection of its complications. METHODS We analyzed medical examination data that was collected from patients who visited us between August 12 and September 27, 2019. We evaluated a total of 114 women (n = 114) in the current study. They were evaluated for whether they were in healthy condition. Moreover, their baseline characteristics were also examined; these included age, gender, height (cm), weight (kg), duration since surgery (years), possession of a breast implant card, the site of surgical incision, side of symptoms and reasons for outpatient visit. Furthermore, the patients were also evaluated for their subjective awareness of the manufacturer, surface and shape of the breast implant. Potential complications include malrotation, folding, seroma, capsule thickening, upside-down rotation, rupture, capsule mass and breast mass. RESULTS A majority of the patients had a past history of receiving textured implants. The corresponding percentage was 78.95% (90/114) and 85.09% (97/114) based on their subjective awareness of a breast implant and sonographic findings, respectively. That is, it was slightly increased with the use of a breast ultrasound. CONCLUSION Here, we propose the following approaches. First, patient data should be prospectively collected. By tracking outcomes and complications of an implant-based augmentation mammaplasty, both high-quality care and patient safety can be ensured. Second, stakeholders in implant-based augmentation mammaplasty should collaborate with customers and regulatory authorities. Third, surgeons should consider applying imaging modalities for early detection of postoperative complications.
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Affiliation(s)
| | - Nam Sun Paik
- Department of Surgery, Breast and Thyroid Cancer Center, Ewha Womans University School of Medicine, Seoul, Korea
| | - Sang Yu Nam
- Department of Radiology, Gachon University Gil Medical Center, Incheon, Korea
| | - Younghye Cho
- Department of Pathology, Jangwon Medical Foundation, Seoul, Korea
| | - Heung Kyu Park
- Department of Surgery, Breast Cancer Center, Gachon University Gil Medical Center, Incheon, Korea.
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Turner SD. Commentary on: Deposition of Host Matrix Proteins on Breast Implant Surfaces Facilitates Staphylococcus Epidermidis Biofilm Formation: In Vitro Analysis. Aesthet Surg J 2020; 40:296-298. [PMID: 31165874 DOI: 10.1093/asj/sjz144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Suzanne D Turner
- University Reader in Cellular and Molecular Tumour Biology, Division of Cellular and Molecular Pathology, Department of Pathology, University of Cambridge, Cambridge, UK
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14
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Tchernev G, Patterson JW, Wollina U, Lotti T, Temelkova I. Granulomatous slack skin mycosis fungoides developing simultaneously with sarcoid-like lesions in a patient with repeated anabolic injections in the past? Dermatol Ther 2020; 33:e13200. [PMID: 31854482 DOI: 10.1111/dth.13200] [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: 11/11/2019] [Accepted: 12/16/2019] [Indexed: 12/01/2022]
Abstract
We present a 32-year-old man with successful treatment and remission of mycosis fungoides of both axillae in 2016 after PUVA therapy and systemic and local administration of corticosteroids. Subsequently, in 2017, the patient also achieved remission of a T-cell CD 30 positive, ALK-1 negative large-cell lymphoma of a retroperitoneal and inguinal lymph node after chemotherapy and radiotherapy. One year later, in 2018, the patient presented to our clinic with progression of skin lesions in both axillary areas and the appearance of а tumor in the right gluteal region.Dermatological examination showed livid-to-erythematous, partly sclerotic plaques in the right inguinal area, cutis laxa-like plaque formations in the right axillary region with similar but less-developed changes in the left axillary fold, a solitary subcutaneous tumor formation affecting the entire right gluteal region, and enlarged, palpable lymph nodes in the right para-axillary area. Biopsies were obtained from an axillary lesion and the surgically removed axillary lymph nodes, and histological examination revealed changes of granulomatous slack skin in the axilla and reactive inflammatory changes in the lymph nodes. Histology of gluteal tissue showed a "foreign body" type of reaction with sarcoid-like features, where the patient in the past have been injected with anabolic and steroidal drugs. Herein we describe a patient with simultaneous occurrence of granulomatous slack skin type mycosis fungoides and a sarcoid-like reaction. The question remains open whether this represents the so-called sarcoidosis-lymphoma syndrome or, more likely, granulomatous slack skin MF associated with a sarcoid-like reaction of "foreign body" type. The possibility that disturbance of tissue homeostasis by incorporation of certain adjuvants within injections (for example) in the past might have been an inducer of cutaneous T cell lymphoma and sarcoidosis/sarcoid like lesions seems reasonable but also speculative.
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Affiliation(s)
- Georgi Tchernev
- Onkoderma-Clinic for Dermatology, Venereology and Dermatologic Surgery, Sofia, Bulgaria
| | - James W Patterson
- Department of Pathology, University of Virginia Health System, Charlottesville, Virginia
| | - Uwe Wollina
- Department of Dermatology and Allergology, Teaching Hospital Dresden-Friedrichstadt, Dresden, Germany
| | - Torello Lotti
- Department of Dermatology and Venereology, University of Rome "G. Marconi", Rome, Italy
| | - Ivanka Temelkova
- Onkoderma-Clinic for Dermatology, Venereology and Dermatologic Surgery, Sofia, Bulgaria
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A Rare Case of Breast Implant-Associated Diffuse Large B-Cell Lymphoma. Case Rep Oncol Med 2019; 2019:1801942. [PMID: 31885969 PMCID: PMC6900937 DOI: 10.1155/2019/1801942] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 09/12/2019] [Indexed: 11/18/2022] Open
Abstract
This is a case of an elderly female who presented for follow-up ultrasound of the right breast after routine mammogram revealed a small benign mass. A subsequent ultrasound detected a small nodular mass that was described as benign in appearance. Although the patient was asymptomatic, a fine-needle biopsy was performed to rule out malignancy. Results from immunohistochemistry and FISH studies of the biopsy were positive for diffuse large B-cell lymphoma (DLBCL). The patient underwent surgery for lumpectomy and removal of breast implants. Intraoperative tissue samples were analyzed by pathology using both flow cytometry and microscopy, and results confirmed DLBCL. With total tumor resection and implant removal completed, the patient did not require additional treatments as the prognosis of DLBCL status post implant removal is excellent. She returned for follow-up six months later and has since had no signs of reoccurrence.
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Cell of Origin and Immunologic Events in the Pathogenesis of Breast Implant-Associated Anaplastic Large-Cell Lymphoma. THE AMERICAN JOURNAL OF PATHOLOGY 2019; 190:2-10. [PMID: 31610171 PMCID: PMC7298558 DOI: 10.1016/j.ajpath.2019.09.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 09/10/2019] [Accepted: 09/17/2019] [Indexed: 12/18/2022]
Abstract
Breast implant–associated anaplastic large-cell lymphoma (BIA-ALCL) is a CD30-positive, anaplastic lymphoma kinase–negative T-cell lymphoma. Nearly all cases have been associated with textured implants. Most cases are of effusion-limited, indolent disease, with an excellent prognosis after implant and capsule removal. However, capsular invasion and tumor mass have a more aggressive course and a fatal outcome risk. This review summarizes the current knowledge on BIA-ALCL cell of origin and immunologic factors underlying its pathogenesis. Cytokine expression profiling of BIA-ALCL cell lines and clinical specimens reveals a predominantly type 17 helper T-cell (Th17)/Th1 signature, implicating this as its cell of origin. However, a Th2 allergic inflammatory response is suggested by the presence of IL-13, with infiltration of eosinophils and IgE-coated mast cells in clinical specimens of BIA-ALCL. The microenvironment-induced T-cell plasticity, a factor increasingly appreciated, may partially explain these divergent results. Mutations resulting in constitutive Janus kinase (JAK)–STAT activation have been detected and associated with BIA-ALCL pathogenesis in a small number of cases. One possible scenario is that an inflammatory microenvironment stimulates an immune response, followed by polyclonal expansion of Th17/Th1 cell subsets with release of inflammatory cytokines and chemokines and accumulation of seroma. JAK-STAT3 gain-of-function mutations within this pathway and others may subsequently lead to monoclonal T-cell proliferation and clinical BIA-ALCL. Current research suggests that therapies targeting JAK proteins warrant investigation in BIA-ALCL.
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