1
|
Clemens MW, Myckatyn TM, Di Napoli A, Feldman AL, Jaffe ES, Haymaker CL, Horwitz SM, Hunt KK, Kadin ME, McCarthy CM, Miranda RN, Prince HM, Santanelli di Pompeo F, Holmes SD, Phillips LG. American Association of Plastic Surgeons Consensus on Breast Implant-Associated Anaplastic Large-Cell Lymphoma. Plast Reconstr Surg 2024; 154:473-483. [PMID: 38412359 PMCID: PMC11346714 DOI: 10.1097/prs.0000000000011370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 02/15/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND In the absence of high-quality evidence, there is a need for guidelines and multidisciplinary consensus recommendations on breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL). The purpose of this expert consensus conference was to evaluate the existing evidence regarding the diagnosis and management of BIA-ALCL caused by textured implants. This article aims to provide evidence-based recommendations regarding the management and prevention of BIA-ALCL. METHODS A comprehensive search was conducted in the MEDLINE, Cochrane Library, and Embase databases, and supplemented by manual searches of relevant English-language articles and "related articles" sections. Studies focusing on breast surgery and lymphoma associated with breast implants were included for analysis. Meta-analyses were performed and reviewed by experts selected by the American Association of Plastic Surgeons using a Delphi consensus method. RESULTS A total of 840 articles published between January of 2011 and January of 2023 were initially identified and screened. The full text of 188 articles was assessed. An additional 43 articles were excluded for focus, and 145 articles were included in the synthesis of results, with 105 of them being case reports or case series. The analysis encompassed a comprehensive examination of the selected articles to determine the incidence, risk factors, clinical presentation, diagnostic approaches, and treatment modalities related to BIA-ALCL. CONCLUSIONS Plastic surgeons should be aware of the elevated risks by implant surface type, implement appropriate patient surveillance, and follow the recommendations outlined in this statement to ensure patient safety and optimize outcomes. Ongoing research on the pathogenesis, genetic drivers, and preventative and prophylactic measures for BIA-ALCL is crucial for improving patient care. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, V.
Collapse
MESH Headings
- Humans
- Lymphoma, Large-Cell, Anaplastic/etiology
- Lymphoma, Large-Cell, Anaplastic/epidemiology
- Lymphoma, Large-Cell, Anaplastic/diagnosis
- Lymphoma, Large-Cell, Anaplastic/prevention & control
- Lymphoma, Large-Cell, Anaplastic/therapy
- Breast Implants/adverse effects
- Female
- Breast Neoplasms/etiology
- Breast Neoplasms/surgery
- Breast Neoplasms/diagnosis
- Breast Implantation/adverse effects
- Consensus
- United States/epidemiology
- Societies, Medical/standards
- Risk Factors
- Postoperative Complications/etiology
- Postoperative Complications/epidemiology
- Postoperative Complications/diagnosis
- Postoperative Complications/prevention & control
Collapse
Affiliation(s)
| | | | - Arianna Di Napoli
- Neurosciences, Mental Health, and Sense Organs Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant’Andrea Hospital
| | - Andrew L. Feldman
- Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Mayo Clinic
| | - Elaine S. Jaffe
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute
| | | | | | - Kelly K. Hunt
- From the MD Anderson Cancer Center, University of Texas
| | - Marshall E. Kadin
- Pathology and Laboratory Medicine, Brown University Alpert School of Medicine
| | | | | | - H. Miles Prince
- Epworth Healthcare, Peter MacCallum Cancer Center, University of Melbourne
| | - Fabio Santanelli di Pompeo
- Neurosciences, Mental Health, and Sense Organs Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant’Andrea Hospital
| | | | | |
Collapse
|
2
|
Nagura N, Kida K, Yumura C, Yamauchi H. A Case of Breast Cancer Recurrence Diagnosed from a Delayed Seroma after Breast Implant Reconstruction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e6113. [PMID: 39228418 PMCID: PMC11368213 DOI: 10.1097/gox.0000000000006113] [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: 06/13/2023] [Accepted: 07/02/2024] [Indexed: 09/05/2024]
Abstract
When a delayed seroma with a low volume is detected more than 1 year after silicone breast implant insertion, aspiration is necessary. However, if the seroma is small and difficult to collect, we may avoid puncturing it, considering the risk of damaging the implant, and the patient may be followed up intensively. Moreover, a delayed seroma is a major symptom of breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL). We encountered a case in which a delayed seroma around a breast implant was punctured to rule out BIA-ALCL after nipple-sparing mastectomy for breast cancer, which led to the diagnosis of locoregional recurrence in the nipple areola. Based on this experience, we suggest that puncture cytology for fluid around breast implants should be performed when a delayed seroma is observed, as it may indicate breast cancer recurrence as well as BIA-ALCL.
Collapse
Affiliation(s)
- Naomi Nagura
- From the Department of Breast Surgical Oncology, St. Luke’s International Hospital, Tokyo, Japan
| | - Kumiko Kida
- From the Department of Breast Surgical Oncology, St. Luke’s International Hospital, Tokyo, Japan
| | - Chika Yumura
- From the Department of Breast Surgical Oncology, St. Luke’s International Hospital, Tokyo, Japan
| | - Hideko Yamauchi
- From the Department of Breast Surgical Oncology, St. Luke’s International Hospital, Tokyo, Japan
| |
Collapse
|
3
|
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; 24:e293-e300. [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] [MESH Headings] [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.
Collapse
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.
| |
Collapse
|
4
|
Gunther JR, Iyer SP, Hunt KK, Fang H, Wang SA, Clemens MW, Pinnix CC. Beyond surgery: the proper role and delivery of radiation therapy in the local-regional management of BIA-ALCL. Case Reports Plast Surg Hand Surg 2024; 11:2389172. [PMID: 39119029 PMCID: PMC11308955 DOI: 10.1080/23320885.2024.2389172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 04/03/2024] [Indexed: 08/10/2024]
Abstract
For localized breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), surgical resection is crucial; however, radiation therapy (RT) can be utilized as local-regional therapy if surgery is incomplete or not recommended. We present the case of a woman with BIA-ALCL who received systemic therapy and consolidation RT.
Collapse
Affiliation(s)
- Jillian R. Gunther
- Department of Radiation Oncology, The University of TX MD Anderson Cancer Center, TX, USA
| | - Swaminathan P. Iyer
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, TX, USA
| | - Kelly K. Hunt
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, TX, USA
| | - Hong Fang
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, TX, USA
| | - Sa A. Wang
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, TX, USA
| | - Mark W. Clemens
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, TX, USA
| | - Chelsea C. Pinnix
- Department of Radiation Oncology, The University of TX MD Anderson Cancer Center, TX, USA
| |
Collapse
|
5
|
Miranda RN, Amador C, Chan JKC, Guitart J, Rech KL, Medeiros LJ, Naresh KN. Fifth Edition of the World Health Organization Classification of Tumors of the Hematopoietic and Lymphoid Tissues: Mature T-Cell, NK-Cell, and Stroma-Derived Neoplasms of Lymphoid Tissues. Mod Pathol 2024; 37:100512. [PMID: 38734236 DOI: 10.1016/j.modpat.2024.100512] [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: 12/31/2023] [Revised: 04/14/2024] [Accepted: 05/02/2024] [Indexed: 05/13/2024]
Abstract
This review focuses on mature T cells, natural killer (NK) cells, and stroma-derived neoplasms in the fifth edition of the World Health Organization classification of hematolymphoid tumors, including changes from the revised fourth edition. Overall, information has expanded, primarily due to advancements in genomic understanding. The updated classification adopts a hierarchical format. The updated classification relies on a multidisciplinary approach, incorporating insights from a diverse group of pathologists, clinicians, and geneticists. Indolent NK-cell lymphoproliferative disorder of the gastrointestinal tract, Epstein-Barr virus-positive nodal T- and NK-cell lymphoma, and several stroma-derived neoplasms of lymphoid tissues have been newly introduced or included. The review also provides guidance on how the fifth edition of the World Health Organization classification of hematolymphoid tumors can be applied in routine clinical practice.
Collapse
Affiliation(s)
- Roberto N Miranda
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Catalina Amador
- Department of Pathology, University of Miami, Miami, Florida
| | - John K C Chan
- Department of Pathology, Queen Elizabeth Hospital, Kowloon, Hong Kong
| | - Joan Guitart
- Department of Dermatology, Northwestern University Feinberg Medical School, Chicago, Illinois
| | - Karen L Rech
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - L Jeffrey Medeiros
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kikkeri N Naresh
- Section of Pathology, Translational Science and Therapeutics Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Laboratory Medicine & Pathology, University of Washington, Seattle, Washington.
| |
Collapse
|
6
|
Bak EEF, Larsen A, Weltz TK, Jørgensen MG, Ørholt M, Timmermann AM, Mathisen SB, Aydin D, Ulrik AF, Strålman KB, Hemmingsen MN, Vester-Glowinski PV, Herly M. The Prevalence and Histological Characteristics of the Double Capsule Phenomenon in Breast Augmentation With Implants. Aesthet Surg J 2024:sjae154. [PMID: 39012962 DOI: 10.1093/asj/sjae154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Revised: 07/01/2024] [Accepted: 07/08/2024] [Indexed: 07/18/2024] Open
Abstract
BACKGROUND Double capsule formation around breast implants is associated with implant rotation and seroma. However, the prevalence and histological characteristics remain unclear. OBJECTIVES To quantify the prevalence of double capsule formation between different implant surface textures and to explore the histological differences between the inner- and outer capsules from breast implant capsule biopsies. METHODS The study was performed on data from the Copenhagen Breast Implant (COBI) Biobank comparing the prevalence of double capsule formation around Allergan Biocell implants (Allergan, Dublin, Ireland), Eurosilicone Cristalline implants (GC Aesthetics, Dublin, Ireland), and Mentor Siltex implants (Mentor, Irvine, CA). The histological characteristics of the inner and outer capsules was analyzed using a validated assessment tool. RESULTS The study included data from 588 patients and 1128 implants. Double capsule formation was found around 25 implants resulting in an overall prevalence of 2.5% for textured implants. Mentor implants with a Siltex surface had a double capsule prevalence of 0.72%, which was significantly lower than the prevalence for Allergan implants with a Biocell surface (7.8%), (P<.001), and Eurosilicone implants with a Cristalline surface (3.4%), (P=.03). Histological analysis showed that inner capsules had lower cellular density (P=.04) and were more calcified (P=.03) compared with outer capsules. CONCLUSIONS The risk of double capsule formation was highly correlated with the roughness of the breast implant texture, with the risk of double capsule formation around Mentor Siltex implants being significantly lower than that of macrotextured implants. The histological analysis implies that loss of vascularization to the inner capsule results in a lower cellular density and more frequently calcification.
Collapse
Affiliation(s)
- Erik Eiler Frydshou Bak
- Copenhagen University Hospital, Department of Plastic Surgery and Burns Treatment, Rigshospitalet, Copenhagen, Denmark
| | - Andreas Larsen
- Copenhagen University Hospital, Department of Plastic Surgery and Burns Treatment, Rigshospitalet, Copenhagen, Denmark
| | - Tim Kongsmark Weltz
- Copenhagen University Hospital, Department of Plastic Surgery and Burns Treatment, Rigshospitalet, Copenhagen, Denmark
| | - Mads Gustaf Jørgensen
- Copenhagen University Hospital, Department of Plastic Surgery and Burns Treatment, Rigshospitalet, Copenhagen, Denmark
| | - Mathias Ørholt
- Copenhagen University Hospital, Department of Plastic Surgery and Burns Treatment, Rigshospitalet, Copenhagen, Denmark
| | - Adam Mandrup Timmermann
- Copenhagen University Hospital, Department of Plastic Surgery and Burns Treatment, Rigshospitalet, Copenhagen, Denmark
| | - Sif Birch Mathisen
- Copenhagen University Hospital, Department of Plastic Surgery and Burns Treatment, Rigshospitalet, Copenhagen, Denmark
| | - Dogu Aydin
- Copenhagen University Hospital, Department of Plastic Surgery and Burns Treatment, Rigshospitalet, Copenhagen, Denmark
| | | | | | - Mathilde Nejrup Hemmingsen
- Copenhagen University Hospital, Department of Plastic Surgery and Burns Treatment, Rigshospitalet, Copenhagen, Denmark
| | - Peter Viktor Vester-Glowinski
- Copenhagen University Hospital, Department of Plastic Surgery and Burns Treatment, Rigshospitalet, Copenhagen, Denmark
| | - Mikkel Herly
- Copenhagen University Hospital, Department of Plastic Surgery and Burns Treatment, Rigshospitalet, Copenhagen, Denmark
| |
Collapse
|
7
|
Keane Tahmaseb GC, Keane AM, Foppiani JA, Myckatyn TM. An Update on Implant-Associated Malignancies and Their Biocompatibility. Int J Mol Sci 2024; 25:4653. [PMID: 38731871 PMCID: PMC11083590 DOI: 10.3390/ijms25094653] [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: 03/12/2024] [Revised: 04/14/2024] [Accepted: 04/22/2024] [Indexed: 05/13/2024] Open
Abstract
Implanted medical devices are widely used across various medical specialties for numerous applications, ranging from cardiovascular supports to orthopedic prostheses and cosmetic enhancements. However, recent observations have raised concerns about the potential of these implants to induce malignancies in the tissues surrounding them. There have been several case reports documenting the occurrence of cancers adjacent to these devices, prompting a closer examination of their safety. This review delves into the epidemiology, clinical presentations, pathological findings, and hypothesized mechanisms of carcinogenesis related to implanted devices. It also explores how the surgical domain and the intrinsic properties and biocompatibility of the implants might influence the development of these rare but serious malignancies. Understanding these associations is crucial for assessing the risks associated with the use of medical implants, and for developing strategies to mitigate potential adverse outcomes.
Collapse
Affiliation(s)
- Grace C. Keane Tahmaseb
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, MO 63130, USA; (G.C.K.T.); (A.M.K.)
| | - Alexandra M. Keane
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, MO 63130, USA; (G.C.K.T.); (A.M.K.)
| | - Jose A. Foppiani
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA;
| | - Terence M. Myckatyn
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, MO 63130, USA; (G.C.K.T.); (A.M.K.)
| |
Collapse
|
8
|
Vorstenbosch J, Ghione P, Plitas G, Horwitz S, Kim M, Cordeiro P, Nelson J, McCarthy C. Surgical Management and Long-Term Outcomes of BIA-ALCL: A Multidisciplinary Approach. Ann Surg Oncol 2024; 31:2032-2040. [PMID: 38102324 DOI: 10.1245/s10434-023-14636-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 11/06/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a subtype of ALCL that arises as a seroma or a mass in the capsule surrounding textured breast implants. However, collections of cases usually come from large groups of institutions or countries, with different approaches regarding surgery and treatment. Here we describe a cohort of 18 cases undergoing implant removal and capsulectomy followed at Memorial Sloan Kettering Cancer Center (MSKCC). PATIENTS AND METHODS We retrospectively analyzed all the cases of women with breast implants undergoing implant removal and capsulectomy for BIA-ALCL at MSKCC from January 2011 to June 2020. RESULTS Median age at diagnosis was 57 (range 35-77) years following a median implant exposure of 11 (range 7-33) years. All known implants were macrotextured with the proprietary Biocell macrotexturing pattern from salt-loss technique. A total of 16 patients (89%) had implants placed for breast cancer reconstruction. Patients presented with clinically evident effusion in 78% of cases and a mass in 17% of cases, and 83% of patients presented with stage 1 BIA-ALCL. Patients were followed for a median of 43.4 months (SD 45 months) after diagnosis. There were no cases of recurrent ALCL. All patients remain disease free and no patients died of ALCL. CONCLUSIONS In this cohort of patients with BIA-ALCL surgically treated and followed at a single institution, we confirm the importance of adequate surgery (bilateral implant removal and complete capsulectomy) in patients presenting with seroma-confined disease. This dataset reinforces high rates of progression-free and overall survival when diagnosis is identified and treatment performed in those with limited-stage disease.
Collapse
Affiliation(s)
| | - Paola Ghione
- Lymphoma Section, Department of Medicine, Roswell Park Comprehensive Cancer Centre, Buffalo, NY, USA
| | - George Plitas
- Breast Surgical Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Steven Horwitz
- Hematology and Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Minji Kim
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Peter Cordeiro
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jonas Nelson
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Colleen McCarthy
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| |
Collapse
|
9
|
Ong SY, Zain JM. Aggressive T-cell lymphomas: 2024: Updates on diagnosis, risk stratification, and management. Am J Hematol 2024; 99:439-456. [PMID: 38304959 DOI: 10.1002/ajh.27165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/18/2023] [Accepted: 11/05/2023] [Indexed: 02/03/2024]
Abstract
INTRODUCTION Aggressive T-cell lymphomas continue to have a poor prognosis. There are over 30 different subtypes of peripheral T-cell lymphoma (PTCL), and we are now beginning to understand the differences between the various subtypes beyond histologic variations. MOLECULAR PATHOGENESIS OF VARIOUS SUBTYPES OF PTCL Gene expression profiling and other molecular techniques have enabled deeper understanding of differences in various subtypes as reflected in the latest 5th WHO classification of PTCL. It is becoming increasingly clear that therapeutic approaches that target specific cellular pathways are needed to improve the clinical outcomes of PTCL. TARGETED THERAPIES There are many targeted agents currently in various stages of clinical trials for PTCL that take advantage of the differential expression of specific proteins or receptors in PTCL tumors. This includes the CD30 directed antibody drug conjugate brentuximab vedotin. Other notable targets are phosphatidylinositol 3-kinase inhibitors, histone deacetylase inhibitors, CD25, and chemokine receptor 4. Anaplastic lymphoma kinase (ALK) inhibitors are promising for ALK expressing tumors. IMMUNOTHERAPIES Allogeneic stem cell transplant continues to be the curative therapy for most aggressive subtypes of PTCL. The use of checkpoint inhibitors in the treatment of PTCL is still controversial, with best results seen in cases of extranodal natural killer cell/T-cell lymphoma. Bispecific antibody-based treatments and chimeric antigen receptor cell-based therapies are in clinical trials.
Collapse
Affiliation(s)
- Shin Yeu Ong
- Department of Hematology/Hematopoietic Cell Transplantation, City of Hope Medical Center, Duarte, California, USA
- Department of Haematology, Singapore General Hospital, Singapore, Singapore
| | - Jasmine M Zain
- Department of Hematology/Hematopoietic Cell Transplantation, City of Hope Medical Center, Duarte, California, USA
| |
Collapse
|
10
|
Chan A, Auclair R, Gao Q, Ghione P, Horwitz S, Dogan A, Roshal M, Lin O. Role of flow cytometric immunophenotyping in the diagnosis of breast implant-associated anaplastic large cell lymphoma: A 6-year, single-institution experience. CYTOMETRY. PART B, CLINICAL CYTOMETRY 2024; 106:117-125. [PMID: 38297808 PMCID: PMC10978229 DOI: 10.1002/cyto.b.22162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 01/05/2024] [Accepted: 01/18/2024] [Indexed: 02/02/2024]
Abstract
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is an uncommon mature T-cell neoplasm occurring in patients with textured breast implants, typically after 7-10 years of exposure. Although cytopathologic or histopathologic assessment is considered the gold standard diagnostic method for BIA-ALCL, flow cytometry (FC)-based immunophenotyping is recommended as an adjunct test. However, the diagnostic efficacy of FC is not well reported. We reviewed 290 FC tests from breast implant pericapsular fluid and capsule tissue from 182 patients, including 16 patients with BIA-ALCL over a 6-year period, calculating diagnostic rates and test efficacy. FC showed an overall sensitivity of 75.9%, specificity of 100%, and negative and positive predictive values of 95.4% and 100%, respectively. Blinded expert review of false-negative cases identified diagnostic pitfalls, improving sensitivity to 96.6%. Fluid samples had better rates of adequate samples for FC testing compared with tissue samples. Paired with FC testing of operating room (OR)-acquired fluid samples, capsulectomy FC specimens added no diagnostic value in patients with concurrent fluid samples; no cases had positive capsule FC with negative fluid FC. Fluid samples are adequate for FC testing more often than tissue. Capsule tissue FC specimens do not improve FC efficacy when paired with OR-acquired fluid FC samples and are often inadequate samples. FC is 100% specific for BIA-ALCL and can serve as a confirmatory test but should not be the sole diagnostic method. Awareness of sample-specific diagnostic pitfalls greatly improves the sensitivity of BIA-ALCL testing by FC.
Collapse
Affiliation(s)
- Alexander Chan
- Department of Pathology, Hematopathology Service, Memorial Sloan Kettering Cancer Center
| | - Romany Auclair
- Department of Pathology, Hematopathology Service, Memorial Sloan Kettering Cancer Center
| | - Qi Gao
- Department of Pathology, Hematopathology Service, Memorial Sloan Kettering Cancer Center
| | - Paola Ghione
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center
| | - Steven Horwitz
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center
| | - Ahmet Dogan
- Department of Pathology, Hematopathology Service, Memorial Sloan Kettering Cancer Center
| | - Mikhail Roshal
- Department of Pathology, Hematopathology Service, Memorial Sloan Kettering Cancer Center
| | - Oscar Lin
- Department of Pathology, Hematopathology Service, Memorial Sloan Kettering Cancer Center
| |
Collapse
|
11
|
Riecke K, Steinhilper L, von Bülow C, Schwarz D, Burandt E, Striefler JK, Müller V, Schmalfeldt B, Witzel I. Breast Implant-Associated Anaplastic Large Cell Lymphoma: A Case Report about a Male Patient with Pectoral Implants. Breast Care (Basel) 2024; 19:73-76. [PMID: 38384492 PMCID: PMC10878702 DOI: 10.1159/000534367] [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: 08/24/2023] [Accepted: 09/24/2023] [Indexed: 02/23/2024] Open
Abstract
Introduction Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is still a rare extralymphatic lymphoma. As of March 1, 2023, approximately 1,355 cases of BIA-ALCL have been reported worldwide. However, no such case has yet been described with pectoral implants in male patients. Most patients with BIA-ALCL present with nonspecific implant-associated symptoms such as late-onset seroma, swollen breasts, and deformation of implants. Case Presentation Here, we describe BIA-ALCL in a 76-year-old male patient who presented with a late-onset seroma in order to raise awareness for BIA-ALCL also in men after esthetic chest surgery with silicone pectoral implants. The patient had undergone augmentation of the pectoralis muscle with implants for esthetic reasons 9 years before. First cytological specimens showed no malignancy. A repeated cytological assessment after 6 weeks from recurring seroma showed characteristic CD30+ T-cell clones. Surgery with complete bilateral capsulectomy and implant removal was performed. Due to the early-stage ALCL being limited only to the capsule and no evidence of systemic disease, adjuvant systemic treatment was not considered necessary. Conclusion Any persisting late-onset seroma also in male patients with pectoral implants should raise suspicion of ALCL as differential diagnosis and should be assessed with cytological examination.
Collapse
Affiliation(s)
- Kerstin Riecke
- Department of Gynaecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lisa Steinhilper
- Department of Gynaecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Charlotte von Bülow
- Department of Gynaecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Dorothee Schwarz
- Department of Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Eike Burandt
- Department of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jana Käthe Striefler
- Department of Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Volkmar Müller
- Department of Gynaecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Barbara Schmalfeldt
- Department of Gynaecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Isabell Witzel
- Department of Gynaecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Gynaecology, University Medical Center Zurich, University of Zurich, Zurich, Switzerland
| |
Collapse
|
12
|
Shoham G, Haran O, Singolda R, Madah E, Magen A, Golan O, Menes T, Arad E, Barnea Y. Our Experience in Diagnosing and Treating Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL). J Clin Med 2024; 13:366. [PMID: 38256500 PMCID: PMC10816524 DOI: 10.3390/jcm13020366] [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: 11/20/2023] [Revised: 12/22/2023] [Accepted: 01/03/2024] [Indexed: 01/24/2024] Open
Abstract
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is an uncommon T-cell lymphoma detected in association with textured implants. It presents as a fluid accumulation around the implant, usually years after the implantation. We present our experience in diagnosing and treating four patients with BIA-ALCL, each widely differing from the other. Data on patients' surgical history, relevant medical information, and findings on pathological slides were retrieved from their medical charts and retrospectively reviewed. Each of the four patients was diagnosed with BIA-ALCL, one after breast augmentation, one after breast reconstruction with an implant, one after breast reconstruction with a latissimus dorsi flap and implant, and the fourth after the removal of breast implants. The cases were presented to a multidisciplinary team and subsequently underwent surgery. All four are currently free of tumors, as established by a negative follow-up via positron emission tomography-computed tomography. Although the incidence of BIA-ALCL is rare, these cases emphasize the need to rule out the diagnosis of BIA-ALCL in patients with textured implants or a history of implanted textured devices who present with symptoms such as late seroma or peri-implant mass. This pathology is typically indolent and slow-growing and heightened awareness for an early diagnosis could lead to quicker intervention and enhanced patient management.
Collapse
Affiliation(s)
- Gon Shoham
- Department of Plastic and Reconstructive Surgery, Tel Aviv Sourasky Medical Center, Affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Oriana Haran
- Department of Plastic and Reconstructive Surgery, Tel Aviv Sourasky Medical Center, Affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Roei Singolda
- Department of Plastic and Reconstructive Surgery, Tel Aviv Sourasky Medical Center, Affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Ehab Madah
- Department of Plastic and Reconstructive Surgery, Tel Aviv Sourasky Medical Center, Affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Ada Magen
- Breast Health Center, Tel Aviv Sourasky Medical Center, Affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Orit Golan
- Breast Imaging Center, Tel Aviv Sourasky Medical Center, Affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Tehillah Menes
- Meirav Breast Center, Sheba Medical Center, Affiliated with the Faculty of Medicine, Tel Aviv University, Tel Hashomer 5262000, Israel
| | - Ehud Arad
- Department of Plastic and Reconstructive Surgery, Tel Aviv Sourasky Medical Center, Affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Yoav Barnea
- Department of Plastic and Reconstructive Surgery, Tel Aviv Sourasky Medical Center, Affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| |
Collapse
|
13
|
Ziegler-Rodriguez G, Garces-Ruiz M, De La Cruz-Ku G, Ziegler-Rodriguez O, Ziegler-Gutierrez O, Garces-Castre M, Montes-Gil J, Neira J, Taxa-Rojas L, Cebrian R, Chatterjee A. Prepectoral and Retropectoral Breast-implant-Associated Anaplastic Large-cell Lymphoma. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5520. [PMID: 38204871 PMCID: PMC10781137 DOI: 10.1097/gox.0000000000005520] [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: 08/27/2023] [Accepted: 11/08/2023] [Indexed: 01/12/2024]
Abstract
Breast-implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a non-Hodgkin lymphoma that arises in the space between the surface of a breast implant and the fibrous capsule that grows around the implant. Since its first description 20 years ago, almost 1000 cases of BIA-ALCL have been diagnosed worldwide. Nowadays, guidelines describe the diagnosis, staging, and treatment of this disease. We present the first two cases diagnosed and treated in Peru, demonstrating a wide range of aggressiveness of BIA-ALCL.
Collapse
Affiliation(s)
- Gonzalo Ziegler-Rodriguez
- From the Instituto Nacional de Enfermedades Neoplasicas (INEN), Lima, Peru
- Clinica Ziegler, Lima, Peru
- Universidad Peruana de Ciencias Aplicas (UPC), Lima, Peru
| | - Milko Garces-Ruiz
- From the Instituto Nacional de Enfermedades Neoplasicas (INEN), Lima, Peru
- Universidad Peruana de Ciencias Aplicas (UPC), Lima, Peru
| | - Gabriel De La Cruz-Ku
- University of Massachusetts Medical School, Worcester, Mass
- Universidad Cientifica del Sur, Lima, Peru
| | | | | | | | - Jaime Montes-Gil
- From the Instituto Nacional de Enfermedades Neoplasicas (INEN), Lima, Peru
| | - Jimena Neira
- From the Instituto Nacional de Enfermedades Neoplasicas (INEN), Lima, Peru
| | - Luis Taxa-Rojas
- From the Instituto Nacional de Enfermedades Neoplasicas (INEN), Lima, Peru
| | - Rosa Cebrian
- Department of Radiology, Clinical Ricardo Palma, Lima, Peru
| | - Abhishek Chatterjee
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tufts Medical Center, Boston, Mass
| |
Collapse
|
14
|
Tesfaye EA, O'Neill RC, McGregor T, Clemens MW. Financial Toxicity in Breast Implant-Associated Anaplastic Large Cell Lymphoma. Ann Plast Surg 2024; 92:34-40. [PMID: 37994417 DOI: 10.1097/sap.0000000000003720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
BACKGROUND Financial toxicity is a growing concern due to its considerable effects on medical adherence, quality of life, and mortality. The cost associated with breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is substantial from diagnosis to treatment, including adjuvant therapy and surgery. This study aims to assess the prevalence of financial toxicity in BIA-ALCL patients. METHODS We performed a cross-sectional, survey-based study on women with confirmed cases of BIA-ALCL from December 2019 to March 2023. The primary study outcomes were financial toxicity measured by Comprehensive Score for Financial Toxicity (COST) score and patient-reported financial burden measured by the responses to the Evaluation of the Financial Impact of BIA-ALCL survey. Lower COST scores signify higher financial toxicity. Responses were linked to patient data extracted from the medical records. RESULTS Thirty-two women treated for confirmed BIA-ALCL were included. Patients were all White and were diagnosed at a median age of 51 years (range, 41-65 years). The mean COST score was 27.9 ± 2.23. Lower COST scores were associated with receipt of radiotherapy ( P = 0.033), exceeding credit card limits ( P = 0.036), living paycheck to paycheck ( P = 0.00027), requiring financial support from friends and family ( P = 0.00044), and instability in household finances ( P = 0.034). CONCLUSIONS Financial toxicity is prevalent in BIA-ALCL patients and has a substantial impact on patient reported burden. Insurance denial is frequent for patients with a prior history of cosmetic augmentation. Risk assessments and cost discussions should occur throughout the care continuum to minimize financial burden.
Collapse
Affiliation(s)
- Eliora A Tesfaye
- From the Department of Plastic Surgery, Virginia Commonwealth University, Richmond, VA
| | - Rebecca C O'Neill
- Division of Plastic Surgery, Baylor College of Medicine, Houston, TX
| | - Terri McGregor
- Breast Implant Safety Alliance (BISA), North Bay, Ontario, Canada
| | - Mark W Clemens
- Department of Plastic Surgery, MD Anderson Cancer Center, University of Texas, Houston, TX
| |
Collapse
|
15
|
Foppiani JA, Raska O, Taritsa I, Hernandez Alvarez A, Lee D, Escobar-Domingo MJ, Berger J, Klener P, Schuster KA, Abdo D, Clemens MW, Lin SJ. Incidental Bystander or Essential Culprit: A Systematic Review of Bacterial Significance in the Pathogenesis of Breast Implant-Associated Anaplastic Large Cell Lymphoma. Int J Mol Sci 2023; 25:355. [PMID: 38203524 PMCID: PMC10778958 DOI: 10.3390/ijms25010355] [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: 12/05/2023] [Revised: 12/18/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024] Open
Abstract
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a distinct subtype of T-cell non-Hodgkin lymphoma that arises in the context of prolonged exposure to textured breast implants. The intent of this manuscript is to explore whether the bacterial presence in biofilms on these implants is a mere incidental finding or plays a pivotal role in the pathogenesis of BIA-ALCL. Our goal is to delineate the extent of bacterial involvement, offering insights into potential underlying mechanisms, and establishing future research priorities aimed at resolving the remaining uncertainties surrounding this complex association. A comprehensive systematic review of several databases was performed. The search strategy was designed and conducted by an experienced librarian using controlled vocabulary with keywords. The electronic search identified 442 publications. After evaluation, six studies from 2015 to 2021 were included, encompassing 201 female patients aged 23 to 75. The diagnosis span post-implantation ranged from 53 to 135.6 months. Studies consistently found bacteria near breast implants in both BIA-ALCL cases and controls, with varied microbial findings. Both BIA-ALCL cases and controls exhibited the presence of specific bacteria, including Pseudomonas aeruginosa, Klebsiella oxytoca, Staphylococcus aureus, and Ralstonia spp., without any statistically significant differences between groups. The use of antiseptic and antimicrobial agents during implant insertion did not demonstrate any impact on reducing or altering the risk of developing BIA-ALCL. Our systematic review reveals that the current evidence is inadequate to link bacterial etiology as a central factor in the development of BIA-ALCL. The limitations in the existing data prevent a complete dismissal of the role of biofilms in its pathogenesis. The observed gap in knowledge underscores the need for more focused and comprehensive research, which should be structured in a multi-faceted approach. Initially, this involves the utilization of sophisticated genomic and proteomic methods. Following this, it is crucial to delve into the study of immunological reactions specifically induced by biofilms. Finally, this research should incorporate extended observational studies, meticulously tracking the evolution of biofilm development and its correlation with the emergence of BIA-ALCL. In light of the inconclusive nature of current findings, further investigation is not only justified but urgently needed to clarify these unresolved issues.
Collapse
Affiliation(s)
- Jose A. Foppiani
- Division of Plastic Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA; (J.A.F.); (I.T.); (A.H.A.); (D.L.); (M.J.E.-D.); (K.A.S.); (S.J.L.)
- Institute of Pathological Physiology, First Faculty of Medicine, Charles University, 12108 Prague, Czech Republic
| | - Otakar Raska
- Institute of Pathological Physiology, First Faculty of Medicine, Charles University, 12108 Prague, Czech Republic
| | - Iulianna Taritsa
- Division of Plastic Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA; (J.A.F.); (I.T.); (A.H.A.); (D.L.); (M.J.E.-D.); (K.A.S.); (S.J.L.)
| | - Angelica Hernandez Alvarez
- Division of Plastic Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA; (J.A.F.); (I.T.); (A.H.A.); (D.L.); (M.J.E.-D.); (K.A.S.); (S.J.L.)
| | - Daniela Lee
- Division of Plastic Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA; (J.A.F.); (I.T.); (A.H.A.); (D.L.); (M.J.E.-D.); (K.A.S.); (S.J.L.)
| | - Maria J. Escobar-Domingo
- Division of Plastic Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA; (J.A.F.); (I.T.); (A.H.A.); (D.L.); (M.J.E.-D.); (K.A.S.); (S.J.L.)
| | | | - Pavel Klener
- Institute of Pathological Physiology, First Faculty of Medicine, Charles University, 12108 Prague, Czech Republic
- First Department of Internal Medicine, Department of Hematology, First Faculty of Medicine Charles University, General University Hospital, 12808 Prague, Czech Republic
| | - Kirsten A. Schuster
- Division of Plastic Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA; (J.A.F.); (I.T.); (A.H.A.); (D.L.); (M.J.E.-D.); (K.A.S.); (S.J.L.)
| | - Daoud Abdo
- Institute of Pathological Physiology, First Faculty of Medicine, Charles University, 12108 Prague, Czech Republic
| | - Mark W. Clemens
- MD Anderson Cancer Center, The University of Texas, Houston, TX 77030, USA;
| | - Samuel J. Lin
- Division of Plastic Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA; (J.A.F.); (I.T.); (A.H.A.); (D.L.); (M.J.E.-D.); (K.A.S.); (S.J.L.)
| |
Collapse
|
16
|
Meshkin DH, Firriolo JM, Karp NS, Salibian AA. Management of complications following implant-based breast reconstruction: a narrative review. ANNALS OF TRANSLATIONAL MEDICINE 2023; 11:416. [PMID: 38213810 PMCID: PMC10777227 DOI: 10.21037/atm-23-1384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 06/15/2023] [Indexed: 01/13/2024]
Abstract
Background and Objective Complications associated with implant-based reconstruction have a spectrum of severity with sequelae ranging from mild aesthetic deformities to additional surgery, reconstructive failure and systemic illness. The purpose of this narrative review of the literature is to provide updated evidence-based information on the management of complications in implant-based reconstruction. Methods A systematic search of PubMed, OVID MEDLINE and the Cochrane Library databases was performed to identify common complications associated with implant-based breast reconstruction, incidences of occurrence as well as preventative and management strategies. Key Content and Findings Pertinent short and long-term complications of implant-based breast reconstruction include hematoma, implant infection, seroma, skin envelope necrosis, capsular contracture, rupture, malposition, animation and contour deformities, implant-associated anaplastic large cell lymphoma, and breast implant illness. Important preventative measures for short term complications include meticulous sterile technique and antibiotic irrigation, adequate drainage and critical evaluation of mastectomy flaps. Management of short-term complications requires early recognition and aggressive treatment to prevent reconstructive failure as well as long-term complications such as capsular contracture. Important technological advances include dual-port expanders for seroma drainage, indocyanine green angiography for mastectomy flap perfusion evaluation, cohesive form-stable implants for treatment of rippling, and various biologic and synthetic mesh products for pocket control and correction. Conclusions Important principles in management of short-term complications in implant-based reconstruction include aggressive and early intervention to maximize the chance of reconstructive salvage. Contemporary technological advances have played an important role in both prevention and treatment of complications. Over-arching principles in management of implant-based reconstruction complications focus on preventative techniques and preoperative patient counseling on potential risks, their likelihood, and necessary treatments to allow for informed and shared decision-making.
Collapse
Affiliation(s)
- Dean H. Meshkin
- Division of Plastic and Reconstructive Surgery, University of California, Davis School of Medicine, Sacramento, CA, USA
| | - Joseph M. Firriolo
- Division of Plastic and Reconstructive Surgery, University of California, Davis School of Medicine, Sacramento, CA, USA
| | - Nolan S. Karp
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY, USA
| | - Ara A. Salibian
- Division of Plastic and Reconstructive Surgery, University of California, Davis School of Medicine, Sacramento, CA, USA
| |
Collapse
|
17
|
Yeow M, Ching AH, Guillon C, Alperovich M. Breast implant capsule-associated squamous cell carcinoma: A systematic review and individual patient data meta-analysis. J Plast Reconstr Aesthet Surg 2023; 86:24-32. [PMID: 37666057 DOI: 10.1016/j.bjps.2023.08.002] [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: 04/05/2023] [Revised: 07/31/2023] [Accepted: 08/13/2023] [Indexed: 09/06/2023]
Abstract
INTRODUCTION New concerns have been raised by the US Food and Drug Administration regarding breast implant capsule-associated squamous cell carcinoma (BICA-SCC) but very little is known about this emerging topic. To gain a better understanding of the disease, a systematic review and individual patient data meta-analysis of patients with BICA-SCC were performed. METHODS PubMed, Embase, and Cochrane were searched from inception to 26th February 2023 for studies including patients with BICA-SCC. Individual patient data were extracted and pooled. Risk of bias was assessed using the Joanna Briggs Institute critical appraisal tool. RESULTS A total of 16 studies reported 19 patients with BICA-SCC, commonly presented with swelling (84.2%), pain (73.7%), and erythema (21.1%). The median age at SCC diagnosis was 52.0 (interquartile range [IQR] 46.0-60.0) years. The median time from breast augmentation to SCC diagnosis was 20.0 (IQR 15.0-35.0) years. The majority of patients (68.4%) were found to have extracapsular spread at SCC diagnosis. All patients with breast implants in situ underwent implant removal with at least 60.0% of patients undergoing capsulectomy. The mean follow-up period was 17.6 months with 1-year overall survival of 80.8% and 1-year disease-free survival of 53.0%. CONCLUSION While rare, surgeons should counsel patients on the risks of malignancy including BICA-SCC before breast implantation and consider the possibility of BICA-SCC when treating patients with late-onset peri-implant changes. A centralized registry is needed to better understand and improve outcomes in patients with BICA-SCC.
Collapse
Affiliation(s)
- Marcus Yeow
- Department of Plastic, Reconstructive and Aesthetics Surgery, Singapore General Hospital, Singapore
| | | | - Christelle Guillon
- Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, National University Hospital, Singapore
| | - Michael Alperovich
- Division of Plastic Surgery, Yale School of Medicine, New Haven, CT, USA.
| |
Collapse
|
18
|
Bonev V. A Case Report of Breast Implant-Associated Anaplastic Large-Cell Lymphoma in a PALB2 Mutation-Positive Woman. Am Surg 2023; 89:4874-4877. [PMID: 33856922 DOI: 10.1177/00031348211011056] [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] [Indexed: 11/16/2022]
Abstract
Breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) is a rare peripheral T-cell lymphoma composed of anaplastic pleomorphic T cells. The first case was reported in 1997 but was not recognized until 2016 by the World Health Organization. The exact incidence is unknown but is estimated to be 0.1 to 0.3 per 100,000 women with implants. Almost every case has been found in women with textured breast implants. The median time of onset after implantation is 10.7 years. Patients presenting with localized disease, most commonly manifesting as breast enlargement, can be managed solely with surgical resection and have a 100% survival rate. This report describes a PALB2 mutation-positive woman with a strong family history of breast cancer who underwent prophylactic bilateral nipple-sparing mastectomy with textured silicone implant placement. She was diagnosed with BIA-ALCL less than 4 years later after seroma aspiration. She was treated with implant removal and capsulectomy; but, surprisingly, final surgical pathology did not show any malignancy.
Collapse
Affiliation(s)
- Valentina Bonev
- Breast Surgical Oncology, Breastlink Medical Group, Orange, CA, USA
| |
Collapse
|
19
|
Chetlen A, Niell BL, Brown A, Baskies AM, Battaglia T, Chen A, Jochelson MS, Klein KA, Malak SF, Mehta TS, Sinha I, Tuscano DS, Ulaner GA, Slanetz PJ. ACR Appropriateness Criteria® Breast Implant Evaluation: 2023 Update. J Am Coll Radiol 2023; 20:S329-S350. [PMID: 38040459 DOI: 10.1016/j.jacr.2023.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 08/22/2023] [Indexed: 12/03/2023]
Abstract
This document discusses the appropriate initial imaging in both asymptomatic and symptomatic patients with breast implants. For asymptomatic patients with saline implants, no imaging is recommended. If concern for rupture exists, ultrasound is usually appropriate though saline rupture is often clinically evident. The FDA recently recommended patients have an initial ultrasound or MRI examination 5 to 6 years after initial silicone implant surgery and then every 2 to 3 years thereafter. In a patient with unexplained axillary adenopathy with current or prior silicone breast implants, ultrasound and/or mammography are usually appropriate, depending on age. In a patient with concern for silicone implant rupture, ultrasound or MRI without contrast is usually appropriate. In the setting of a patient with breast implants and possible implant-associated anaplastic large cell lymphoma, ultrasound is usually appropriate as the initial imaging. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
Collapse
Affiliation(s)
- Alison Chetlen
- Penn State Health Hershey Medical Center, Hershey, Pennsylvania.
| | - Bethany L Niell
- Panel Chair, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Ann Brown
- Panel Vice-Chair, University of Cincinnati, Cincinnati, Ohio
| | - Arnold M Baskies
- Virtua Willingboro Hospital, Willingboro, New Jersey; American College of Surgeons
| | - Tracy Battaglia
- Boston University Schools of Medicine and Public Health, Boston, Massachusetts, Primary care physician
| | - Andrew Chen
- University of Connecticut School of Medicine, Farmington, Connecticut; American Society of Plastic Surgeons
| | | | | | | | - Tejas S Mehta
- UMass Memorial Medical Center/UMass Chan Medical School, Worcester, Massachusetts
| | - Indranil Sinha
- Harvard Medical School, Boston, Massachusetts; American Geriatrics Society
| | | | - Gary A Ulaner
- Hoag Family Cancer Institute, Newport Beach, California, and University of Southern California, Los Angeles, California; Commission on Nuclear Medicine and Molecular Imaging
| | - Priscilla J Slanetz
- Specialty Chair, Boston University School of Medicine, Boston, Massachusetts
| |
Collapse
|
20
|
Falini B, Lazzi S, Pileri S. A comparison of the International Consensus and 5th WHO classifications of T-cell lymphomas and histiocytic/dendritic cell tumours. Br J Haematol 2023; 203:369-383. [PMID: 37387351 DOI: 10.1111/bjh.18940] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/17/2023] [Accepted: 06/05/2023] [Indexed: 07/01/2023]
Abstract
Since the publication in 2017 of the revised 4th Edition of the World Health Organization (WHO) classification of haematolymphoid tumours, here referred to as WHO-HAEM4, significant clinicopathological, immunophenotypic and molecular advances have been made in the field of lymphomas, contributing to refining the diagnostic criteria of several diseases, upgrading entities previously defined as provisional and identifying new entities. This process has resulted in two recent classification proposals of lymphoid neoplasms: the International Consensus Classification (ICC) and the 5th edition of the WHO classification (WHO-HAEM5). In this paper, we review and compare the two classifications in terms of diagnostic criteria and entity definition, focusing on T-cell lymphomas and histiocytic/dendritic cell tumours. Moreover, we update the genetic data of the various pathological entities. The main goal is to provide a tool to facilitate the work of the pathologists, haematologists and researchers involved in the diagnosis and treatment of these haematological malignancies.
Collapse
Affiliation(s)
- Brunangelo Falini
- Institute of Haematology and CREO, University and Santa Maria della Misericordia Hospital of Perugia, Perugia, Italy
| | - Stefano Lazzi
- Department of Medical Biotechnology, Institute of Pathology, University of Siena, Siena, Italy
| | - Stefano Pileri
- European Institute of Oncology IRCCS, Milan, Italy
- Diatech Pharmacogenetics, Jesi, Italy
| |
Collapse
|
21
|
Vittorietti M, Mazzola S, Costantino C, De Bella DD, Fruscione S, Bonaccorso N, Sciortino M, Costanza D, Belluzzo M, Savatteri A, Tramuto F, Contiero P, Tagliabue G, Immordino P, Vitale F, Di Napoli A, Mazzucco W. Implant replacement and anaplastic large cell lymphoma associated with breast implants: a quantitative analysis. Front Oncol 2023; 13:1202733. [PMID: 37927474 PMCID: PMC10622658 DOI: 10.3389/fonc.2023.1202733] [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: 04/21/2023] [Accepted: 09/28/2023] [Indexed: 11/07/2023] Open
Abstract
Introduction Breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) is a rare form of non-Hodgkin T-cell lymphoma associated with breast reconstruction post-mastectomy or cosmetic-additive mammoplasty. The increasing use of implants for cosmetic purposes is expected to lead to an increase in BIA-ALCL cases. This study investigated the main characteristics of the disease and the factors predicting BIA-ALCL onset in patients with and without an implant replacement. Methods A quantitative analysis was performed by two independent researchers on cases extracted from 52 primary studies (case report, case series, and systematic review) published until April 2022 and searched in PubMed, Scopus, and Google-Scholar databases using "Breast-Implant" AND/OR "Associated" AND/OR "Anaplastic-Large-Cell-Lymphoma". The statistical significance was verified by Student's t-test for continuous variables, while Fisher's exact test was applied for qualitative variables. Cox model with time-dependent covariates was used to estimate BIA-ALCL's onset time. The Kaplan-Meier model allowed the estimation of the probability of survival after therapy according to breast implant exposure time. Results Overall, 232 patients with BIA-ALCL were extracted. The mean age at diagnosis was 55 years old, with a mean time to disease onset from the first implant of 10.3 years. The hazard of developing BIA-ALCL in a shorter time resulted significantly higher for patients not having an implant replacement (hazard ratio = 0.03; 95%CI: 0.005-0.19; p-value < 0.01). Patients with implant replacement were significantly older than patients without previous replacement at diagnosis, having a median time to diagnosis since the first implant of 13 years (7 years in patients without replacement); anyway, the median time to BIA-ALCL occurrence since the last implantation was equal to 5 years. Discussion Our findings suggest that, in BIA-ALCL patients, the implant substitution and/or capsulectomy may delay the disease's onset. However, the risk of reoccurrence in an earlier time should be considered in these patients. Moreover, the time to BIA-ALCL onset slightly increased with age. Selection bias, lack of awareness, misdiagnosis, and limited data availability could be identified as limits of our study. An implant replacement should be considered according to a risk stratification approach to delay the BIA-ALCL occurrence in asymptomatic patients, although a stricter follow-up after the implant substitution should be recommended. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO, identifier: CRD42023446726.
Collapse
Affiliation(s)
| | - Sergio Mazzola
- U.O.C. of Clinical Epidemiology with Cancer Registry, Azienda Ospedaliera Universitaria Policlinico di Palermo, Palermo, Italy
| | - Claudio Costantino
- U.O.C. of Clinical Epidemiology with Cancer Registry, Azienda Ospedaliera Universitaria Policlinico di Palermo, Palermo, Italy
- PROMISE Department, University of Palermo, Palermo, Italy
| | | | | | | | | | | | | | | | - Fabio Tramuto
- U.O.C. of Clinical Epidemiology with Cancer Registry, Azienda Ospedaliera Universitaria Policlinico di Palermo, Palermo, Italy
- PROMISE Department, University of Palermo, Palermo, Italy
| | - Paolo Contiero
- Environmental Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovanna Tagliabue
- Cancer Registry Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Francesco Vitale
- U.O.C. of Clinical Epidemiology with Cancer Registry, Azienda Ospedaliera Universitaria Policlinico di Palermo, Palermo, Italy
- PROMISE Department, University of Palermo, Palermo, Italy
| | - Arianna Di Napoli
- Department of Clinical and Molecular Medicine, University of Rome “Sapienza”, Rome, Italy
| | - Walter Mazzucco
- U.O.C. of Clinical Epidemiology with Cancer Registry, Azienda Ospedaliera Universitaria Policlinico di Palermo, Palermo, Italy
- PROMISE Department, University of Palermo, Palermo, Italy
- College of Medicine, University of Cincinnati, Cincinnati, OH, United States
| |
Collapse
|
22
|
Kolasiński J, Sorotos M, Firmani G, Panagiotakos D, Płonka J, Kolenda M, Santanelli di Pompeo F. BIA-ALCL Epidemiology in an Aesthetic Breast Surgery Cohort of 1501 Patients. Aesthet Surg J 2023; 43:1258-1268. [PMID: 37289985 DOI: 10.1093/asj/sjad181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 06/02/2023] [Accepted: 06/02/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Epidemiologic studies on breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) currently estimate the risk between 1:300 and 1:30,000, assessed mainly in large breast reconstruction populations. OBJECTIVES The aim of the study was to assess BIA-ALCL epidemiology in a cohort of patients who have received textured implants for cosmetic indications. METHODS In a prospective cohort observational study, 1501 patients who received a cosmetic breast augmentation between 2006 and 2016 were monitored, recording any implant-related complications, including BIA-ALCL. Cross-checking of clinical, pathology, and external records data identified cases. Prevalence, implant-specific prevalence (I-SP), incidence rate (IR), event-free time (EFT), and the Kaplan-Meier survival estimate were calculated. RESULTS All but 2 patients received macrotextured or microtextured devices bilaterally. Mean follow-up was 3.2 years (1 months to 16.4 years). Five BIA-ALCL cases were investigated. Prevalence was 1:300 patients; I-SP was 6.9 cases/1000 individuals/Allergan BIOCELL devices and 1.3 cases/1000 individuals/Mentor Siltex devices; and IR was 1.07 cases/1000 females/year. Mean (SD) EFT was 9.2 years. CONCLUSIONS When using a denominator based on a cohort of cosmetic patients, BIA-ALCL occurrence is higher than previously reported, particularly with macrotextured devices. Given the similar IRs in reconstructive and cosmetic cohorts, their even distribution could be consequent to underreporting due to poorer follow-up and lower awareness in the latter group. The genetic predisposition in the oncologic cohort reasonably affects the early onset more than the IR. The importance of accurate follow-up is confirmed. Stratification risks analysis can guide surgeons during patient counseling regarding the decision for prophylactic explantation. LEVEL OF EVIDENCE: 4
Collapse
|
23
|
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: 1] [Impact Index Per Article: 1.0] [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.
Collapse
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.
| |
Collapse
|
24
|
Di Napoli A, Soma L, Quintanilla-Martinez L, de Leval L, Leoncini L, Zamò A, Ng SB, Ondrejka SL, Climent F, Wotherspoon A, Dirnhofer S. Cavity-based lymphomas: challenges and novel concepts. A report of the 2022 EA4HP/SH lymphoma workshop. Virchows Arch 2023; 483:299-316. [PMID: 37555981 PMCID: PMC10542738 DOI: 10.1007/s00428-023-03599-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/16/2023] [Accepted: 07/07/2023] [Indexed: 08/10/2023]
Abstract
The 2022 European Association for Haematopathology/Society for Hematopathology lymphoma workshop session on cavity-based lymphomas included sixty-eight cases in seven sections. The disease entities discussed include primary effusion lymphomas (PEL), extracavitary primary effusion lymphomas and confounding entities (ECPEL), HHV8-negative B-lineage lymphomas-effusion based (EBV-negative, EBV-positive, and plasmablastic types), diffuse large B-cell lymphoma associated with chronic inflammation, fibrin-associated diffuse large B-cell lymphoma (FA-DLBCL), breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), and other lymphomas presenting as an effusion. All entities above are discussed; however, three are delved into greater detail given the challenges with classification: ECPEL, HHV8-negative effusion-based lymphomas, and FA-DLBCL. Cases exemplifying the diagnostic difficulty in differentiating ECPEL from HHV8-positive diffuse large B-cell lymphoma and germinotropic lymphoproliferative disorder were discussed. The more recently recognized effusion-based HHV8-negative large B-cell lymphoma is explored, with several cases submitted raising the question if this subset should be carved out as a specific entity, and if so, what should be the refining diagnostic criteria. Case submissions to the FA-DLBCL section yielded one of the largest case series to date, including classic cases, cases furthering the discussion on disease sites and prognosis, as well as novel concepts to be considered in this entity. The 2022 EA4HP/SH workshop cases allowed for further confirmation of the characteristics of some of the more historically accepted cavity-based lymphomas, as well as further inquiry and debate on relatively new or evolving entities.
Collapse
Affiliation(s)
- Arianna Di Napoli
- Department of Clinical and Molecular Medicine, Sant'Andrea University Hospital, Sapienza University of Rome, Rome, Italy.
| | - Lori Soma
- Department of Pathology, City of Hope National Medical Center, Duarte, CA, USA
| | - Leticia Quintanilla-Martinez
- Institute of Pathology and Neuropathology, Eberhard Karls University of Tübingen and Comprehensive Cancer Center, University Hospital Tübingen, Tübingen, Germany
| | - Laurence de Leval
- Institute of Pathology, Department of Laboratory Medicine and Pathology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Lorenzo Leoncini
- Department of Medical Biotechnology, University of Siena, Siena, Italy
| | - Alberto Zamò
- Institute of Pathology, University of Würzburg, Würzburg, Germany
| | - Siok-Bian Ng
- Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Sarah L Ondrejka
- Pathology, and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Fina Climent
- Pathology Department, Hospital Universitari de Bellvitge, IDIBELL, L'Hospitalet De Llobregat, Barcelona, Spain
| | | | - Stefan Dirnhofer
- Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Basel, Switzerland
| |
Collapse
|
25
|
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.
Collapse
|
26
|
Al-Shaikhli SA, Mautner S, Nasseri-Nik N, Lampen-Sachar K. Breast Implant-Associated Anaplastic Large Cell Lymphoma Presenting in a Postpartum Patient: A Case Report. Cureus 2023; 15:e43334. [PMID: 37700989 PMCID: PMC10493074 DOI: 10.7759/cureus.43334] [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: 03/15/2023] [Accepted: 08/10/2023] [Indexed: 09/14/2023] Open
Abstract
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare cancer found in women with breast implants, occurring approximately eight years after their placement. Since the initial case report of BIA-ALCL in 1997, over 700 cases have been described worldwide and there is now a registry of cases diagnosed in the United States to help learn more about this disease process and prognosis. The majority of cases have been associated with Allergan's textured implants which have been recalled. As this disease is relatively rare with only 1,130 cases described worldwide, it is important to keep BIA-ALCL in mind in the differential diagnosis of a woman presenting with breast swelling and peri-implant fluid collection in the setting of having a textured implant. Outcomes for women with BIA-ALCL are favorable, as most disease is contained within the peri-implant capsule. Thus, complete surgical resection is often curative. Here, we report the case of a 40-year-old woman with BIA-ALCL who presented with unilateral breast swelling in the peripartum period.
Collapse
Affiliation(s)
- Seema A Al-Shaikhli
- Radiology, Herbert Wertheim College of Medicine at Florida International University, Miami, USA
| | | | | | | |
Collapse
|
27
|
Brennan C, Moorhouse A, Vermeland R, Kneeshaw P. Anaplastic large cell lymphoma in people with breast implants. BMJ 2023; 382:e073834. [PMID: 37433618 DOI: 10.1136/bmj-2022-073834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/13/2023]
|
28
|
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.
Collapse
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
| |
Collapse
|
29
|
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.
Collapse
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
| |
Collapse
|
30
|
Xagoraris I, Stathopoulou K, Aulerio RD, He M, Ketscher A, Jatta K, de Flon FH, Barbany G, Rosenquist R, Westerberg LS, Rassidakis GZ. Establishment and characterization of a novel breast implant-associated anaplastic large cell lymphoma cell line and PDX model (BIA-XR1) with a unique KRAS mutation. Curr Res Transl Med 2023; 71:103401. [PMID: 37364351 DOI: 10.1016/j.retram.2023.103401] [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: 01/14/2023] [Revised: 04/25/2023] [Accepted: 06/19/2023] [Indexed: 06/28/2023]
Abstract
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is an uncommon T-cell lymphoma type with distinct clinical, molecular and genetic features. Establishment of BIA-ALCL cell lines and patient-derived xenograft (PDX) models are essential experimental tools to investigate the molecular pathogenesis of the disease. We characterized a novel BIA-ALCL cell line and PDX model, named BIA-XR1, derived from a patient with textured breast implant who developed lymphoma. Next-generation sequencing revealed a STAT3 mutation, commonly detected in BIA-ALCL, and a unique KRAS mutation reported for the first time in this lymphoma type. Both JAK/STAT3 and RAS/MEK/ERK oncogenic pathways were activated in BIA-XR1, which are targetable with clinically available agents.
Collapse
Affiliation(s)
- Ioanna Xagoraris
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden; Department of Pathology and Cancer Diagnostics, Karolinska University Hospital, Stockholm, Sweden
| | | | - Roberta D' Aulerio
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Minghui He
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Anett Ketscher
- Department of Pathology and Cancer Diagnostics, Karolinska University Hospital, Stockholm, Sweden
| | - Kenbugul Jatta
- Department of Pathology and Cancer Diagnostics, Karolinska University Hospital, Stockholm, Sweden
| | - Felix Haglund de Flon
- Department of Pathology and Cancer Diagnostics, Karolinska University Hospital, Stockholm, Sweden
| | - Gisela Barbany
- Department of Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
| | - Richard Rosenquist
- Department of Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Lisa S Westerberg
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - George Z Rassidakis
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden; Department of Pathology and Cancer Diagnostics, Karolinska University Hospital, Stockholm, Sweden.
| |
Collapse
|
31
|
Broccoli A, Zinzani PL. Peripheral T-cell lymphomas. Hematol Oncol 2023; 41 Suppl 1:82-87. [PMID: 37294962 DOI: 10.1002/hon.3142] [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: 03/28/2023] [Accepted: 03/28/2023] [Indexed: 06/11/2023]
Abstract
The treatment of peripheral T-cell lymphomas is challenging, as they often display a severe prognosis and lack effective treatment strategies. We will try to answer three burning questions: can we differentiate the initial treatment based on the histotype and the clinical presentation of peripheral T-cell lymphoma patients? Do we require an autologous stem cell transplantation in all patients? Is there room for improvement in the setting of relapsed and refractory disease?
Collapse
Affiliation(s)
- Alessandro Broccoli
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy
- Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy
| | - Pier Luigi Zinzani
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy
- Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy
| |
Collapse
|
32
|
Azis KA, Al-Chalabi MMM, Mat Johar SFN, Wan Sulaiman WA. Atypical Chest Pain in a Patient With Breast Implant. Cureus 2023; 15:e37751. [PMID: 37214021 PMCID: PMC10193515 DOI: 10.7759/cureus.37751] [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] [Accepted: 04/18/2023] [Indexed: 05/23/2023] Open
Abstract
Breast implant surgery typically improves patient breast satisfaction and health-related quality of life. However, breast implants are also linked to long-term local problems like capsular contracture and breast discomfort. Chest pain is one of the reasons that patients with breast implants seek consultations, which is not typically attributable to cardiovascular reasons. The potential reasons for atypical chest pain are diverse. The absence of a precise diagnosis may also result in incorrect examinations and management, leading to further worry and wasted work time. A 55-year-old woman with a breast implant 10 years prior to the incident, presented with atypical chest pain on and off for a year and was treated as a case of unstable angina, costochondritis, and vasospastic spasm. Despite multiple visits, her symptoms did not resolve. Later, the patient presented with a lump over the left breast, associated with constitutional symptoms. Examination revealed a left breast implant with capsular contracture grade III, and ultrasonography showed signs of a ruptured implant. Symptoms eventually resolved after the removal of the breast implant.
Collapse
Affiliation(s)
- Khairul Anuar Azis
- Reconstructive Sciences Unit, Universiti Sains Malaysia (USM), Kota Bharu, MYS
| | | | | | | |
Collapse
|
33
|
A Spectrum of Disease: Breast Implant-Associated Anaplastic Large Cell Lymphoma, Atypicals, and Other Implant Associations. Clin Plast Surg 2023; 50:249-257. [PMID: 36813403 DOI: 10.1016/j.cps.2022.12.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Breast implant associated anaplastic large cell lymphoma (BIA-ALCL) is an uncommon and emerging malignancy caused by textured breast implants. The most common patient presentation is delayed seromas, other presentations include breast asymmetry, overlying skin rashes, palpable masses, lymphadenopathy, and capsular contracture. Confirmed diagnoses should receive lymphoma oncology consultation, multidisciplinary evaluation, and PET-CT or CT scan evaluation prior to surgical treatment. Disease confined to the capsule is curable in the majority of patients with complete surgical resection. BIA-ALCL is now recognized as one disease among a spectrum of inflammatory mediated malignancies which include implant-associated squamous cell carcinoma and B cell lymphoma.
Collapse
|
34
|
Marques-Piubelli ML, Medeiros LJ, Stewart J, Miranda RN. Breast Implant-Associated Anaplastic Large Cell Lymphoma. Surg Pathol Clin 2023; 16:347-360. [PMID: 37149362 DOI: 10.1016/j.path.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
Abstract
Pathologic staging including assessment of margins is essential for the proper management of patients with breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL). As most patients present with effusion, cytologic examination with immunohistochemistry and/or flow cytometry immunophenotyping are essential for diagnosis. Upon a diagnosis of BIA-ALCL, en bloc resection is recommended. When a tumor mass is not identified, a systematic approach to fixation and sampling of the capsule, followed by pathologic staging and assessment of margins, is essential. Cure is likely when lymphoma is contained within the en bloc resection and margins are negative. Incomplete resection or positive margins require a multidisciplinary team assessment for adjuvant therapy.
Collapse
|
35
|
Simultaneous Salvage Auto-augmentation: Contemporary Strategy for Management of the Breast Explantation Patient. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e4860. [PMID: 36891568 PMCID: PMC9988272 DOI: 10.1097/gox.0000000000004860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 01/18/2023] [Indexed: 03/08/2023]
Abstract
The treatment of patients requiring explantation of breast prostheses is a complicated clinical issue, for which a consensus regarding the best way forward is still evolving. We believe that simultaneous salvage auto-augmentation (SSAA) is a viable option for the treatment of patients with explantation. Methods Sixteen cases (32 breasts) were reviewed over a 19-year period. The management of the capsule is based on intraoperative findings and not on preoperative evaluation because of the poor interobserver correlation of Baker grades. Results The mean age and clinical follow-up duration were 48 years (range: 41-65) and 9 months, respectively. We observed no complications, and only one patient underwent unilateral surgical revision of the periareolar scar, under local anaesthesia. Conclusions This study suggests that SSAA with or without autologous fat injection is a safe option for women undergoing explantation, with potential aesthetic and cost-saving benefits. In the current climate of public anxiety regarding breast implant illness, breast implant-associated atypical large cell lymphoma, and asymptomatic textured implants, it is anticipated that the number of patients desiring explantation and SSAA will continue to increase.
Collapse
|
36
|
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.
Collapse
|
37
|
Akkad N, Kodgule R, Duncavage EJ, Mehta-Shah N, Spencer DH, Watkins M, Shirai C, Myckatyn TM. Evaluation of Breast Implant-Associated Anaplastic Large Cell Lymphoma With Whole Exome and Genome Sequencing. Aesthet Surg J 2023; 43:318-328. [PMID: 36351182 DOI: 10.1093/asj/sjac282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/18/2022] [Accepted: 10/19/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare malignancy originating from the periprosthetic capsule of a textured, most often macrotextured, breast implant. Identified in women whose indications for breast implants can be either aesthetic or reconstructive, the genomic underpinnings of this disease are only beginning to be elucidated. OBJECTIVES The aim of this study was to evaluate the exomes, and in some cases the entire genome, of patients with BIA-ALCL. Specific attention was paid to copy number alterations, chromosomal translocations, and other genomic abnormalities overrepresented in patients with BIA-ALCL. METHODS Whole-exome sequencing was performed on 6 patients, and whole-genome sequencing on 3 patients, with the Illumina NovaSeq 6000 sequencer. Data were analyzed with the Illumina DRAGEN Bio-IT Platform and the ChromoSeq pipeline. The Pathseq Genome Analysis Toolkit pipeline was used to detect the presence of microbial genomes in the sequenced samples. RESULTS Two cases with STAT3 mutations and 2 cases with NRAS mutations were noted. A critically deleted 7-Mb region was identified at the 11q22.3 region of chromosome 11, and multiple nonrecurrent chromosomal rearrangements were identified by whole-genome sequencing. Recurrent gene-level rearrangements, however, were not identified. None of the samples showed evidence of potential microbial pathogens. CONCLUSIONS Although no recurrent mutations were identified, this study identified mutations in genes not previously reported with BIA-ALCL or other forms of ALCL. Furthermore, not previously reported with BIA-ALCL, 11q22.3 deletions were consistent across whole-genome sequencing cases and present in some exomes. LEVEL OF EVIDENCE: 5
Collapse
Affiliation(s)
- Neha Akkad
- Resident of internal medicine, Department of Medicine, Washington University School of Medicine, Saint Louis, MO, USA
| | | | | | | | | | - Marcus Watkins
- Research coordinator of medical oncology, Department of Medicine, Division of Hematology and Oncology, Washington University School of Medicine, Saint Louis, MO, USA
| | - Cara Shirai
- Instructor of pathology and immunology, Department of Pathology and Immunology, Washington University School of Medicine, Saint Louis, MO, USA
| | - Terence M Myckatyn
- Professor of plastic and reconstructive surgery, Division of Plastic and Reconstruction Surgery, Washington University School of Medicine, Saint Louis, MO, USA
| |
Collapse
|
38
|
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: 7] [Impact Index Per Article: 7.0] [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.
Collapse
|
39
|
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, Panagiotakos D, Swanson EC, Turner SD, Firmani G, Sorotos M. Response to: What Is Missing From the 2022 Practice Recommendation Updates From the World Consensus Conference on BIA-ALCL? Aesthet Surg J 2023; 43:NP138-NP140. [PMID: 36419172 DOI: 10.1093/asj/sjac305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 11/17/2022] [Accepted: 11/17/2022] [Indexed: 11/25/2022] Open
Affiliation(s)
- Fabio Santanelli di Pompeo
- Full professor of plastic surgery, Faculty of Medicine and Psychology, Sapienza University of Rome, Department NESMOS, Sant'Andrea Hospital, Rome, Italy
| | - Mark W Clemens
- Associate professor of plastic surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA, and a breast surgery section editor for Aesthetic Surgery Journal
| | - Michael Atlan
- Associate professor of plastic surgery, Aesthetic Plastic Reconstructive Unit/CHU TENON PARIS - APHP, Université Pierre et Marie Curie, Paris, France. Université Pierre et Marie Curie, UPMC PARIS VI, Paris, France
| | | | - Peter G Cordeiro
- Professor of surgery, Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Daphne De Jong
- Full professor of pathology, Amsterdam UMC-Vrije Universiteit Amsterdam, Department of Pathology and Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Arianna Di Napoli
- Associate professor of pathology, Pathology Unit, Department of Clinical and Molecular Medicine, Sapienza University, Sant'Andrea Hospital, Rome, Italy
| | - Dennis Hammond
- Plastic surgeon in private practice in Grand Rapids, MI, USA
| | - Cara L Haymaker
- Assistant professor of immunology, Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Steven M Horwitz
- Professor of medicine, Lymphoma Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Kelly Hunt
- Professor of surgery, Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Peter Lennox
- Division head, Department of Surgery, Division of Plastic and Reconstructive Surgery, University of British Columbia, Vancouver, British Columbia, Canada, and a clinical editor for Aesthetic Surgery Journal
| | | | - Roberto N Miranda
- Associate professor of hematopathology, Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Alexandre M Munhoz
- Professor of plastic surgery, Plastic Surgery Department, Hospital Moriah, Hospital Sírio-Libanês, Higienópolis, São Paulo, Brazil
| | - Demosthenes Panagiotakos
- Professor in biostatistics, research methods, and epidemiology, School of Health Sciences and Education, Harokopio University in Athens, Athens, Greece
| | | | - Suzanne D Turner
- Professor of cellular and molecular tumour biology, Division of Cellular and Molecular Pathology, Department of Pathology, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Guido Firmani
- Plastic surgery resident, Faculty of Medicine and Psychology, Sapienza University of Rome, Department NESMOS, Sant'Andrea Hospital, Rome, Italy
| | - Michail Sorotos
- Assistant professor of plastic surgery, Faculty of Medicine and Psychology, Sapienza University of Rome, Department NESMOS, Sant'Andrea Hospital, Rome, Italy
| |
Collapse
|
40
|
Lewis NE, Sardana R, Dogan A. Mature T-cell and NK-cell lymphomas: updates on molecular genetic features. Int J Hematol 2023; 117:475-491. [PMID: 36637656 DOI: 10.1007/s12185-023-03537-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 12/15/2022] [Accepted: 01/06/2023] [Indexed: 01/14/2023]
Abstract
Mature T-cell and NK-cell lymphomas are a heterogeneous group of rare and typically aggressive neoplasms. Diagnosis and subclassification have historically relied primarily on the integration of clinical, histologic, and immunophenotypic features, which often overlap. The widespread application of a variety of genomic techniques in recent years has provided extensive insight into the pathobiology of these diseases, allowing for more precise diagnostic classification, improved prognostication, and development of novel therapies. In this review, we summarize the genomic features of the most common types of mature T-cell and NK-cell lymphomas with a particular focus on the contribution of genomics to biologic insight, classification, risk stratification, and select therapies in the context of the recently published International Consensus and updated World Health Organization classification systems.
Collapse
Affiliation(s)
- Natasha E Lewis
- Hematopathology Service, Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
| | - Rohan Sardana
- Hematopathology Service, Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Ahmet Dogan
- Hematopathology Service, Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| |
Collapse
|
41
|
Cappelli S, Marchesi F, Clementi M, Perracchio L, Palombi F, Pelle F, Botti C, Costantini M. Reverse strategy to locally advanced breast implant-associated anaplastic large cell lymphoma: A case report. Front Oncol 2023; 12:1062389. [PMID: 36703782 PMCID: PMC9872134 DOI: 10.3389/fonc.2022.1062389] [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: 10/05/2022] [Accepted: 12/14/2022] [Indexed: 01/11/2023] Open
Abstract
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare T-cell lymphoma associated with textured breast implants. The most common presentation is a periprosthetic seroma that occurs at least 1 year after an aesthetic or reconstructive implantation, and in these cases, the surgical treatment seems to be successful. More rarely, BIA-ALCL presents with locally advanced mass-formed disease and a related regional lymph node involvement. In all these cases with worse prognosis, a multidisciplinary approach is required, including adjuvant chemotherapy, radiation therapy, and surgery. We present a clinical case of a 49-year-old woman who developed on the left side of the breast a mass-formed stage 3 BIA-ALCL 15 years after a bilateral breast augmentation with textured silicone implant. Our multidisciplinary team (MDT) scheduled the patient for a "reverse-strategy" sequential approach consisting of induction chemotherapy, hematopoietic stem cell mobilization, and harvest followed by autologous stem cell transplant (ASCT). After 100 days from the stem cell transplant, the patient showed a complete pathologic response and was a candidate for radical surgery. She underwent removal of both implants with total en bloc capsulectomy. On the left site, the periprosthetic mass was also en bloc removed. We did not perform any axillary dissection. Our surgical and hemato-oncological teams followed the patient every 3 months, and no local or systemic recurrences were observed 24 months after surgery. This case report has demonstrated the effectiveness of neoadjuvant chemotherapy as part of a "reverse strategy" in selected cases of advanced-stage BIA-ALCL in which it was not possible to perform an immediate radical surgery. Furthermore, in our case, the de-escalation strategy adopted permitted a less demolitic surgery with good functional and aesthetic results.
Collapse
Affiliation(s)
- Sonia Cappelli
- Department of Surgery, Division of Breast Surgery, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Rome, Italy
| | - Francesco Marchesi
- Hematology Unit, Department of Research and Clinical Oncology, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Rome, Italy
| | - Marco Clementi
- Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, L’Aquila, Italy,*Correspondence: Marco Clementi,
| | - Letizia Perracchio
- Pathology Department, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Rome, Italy
| | - Francesca Palombi
- Hematology Unit, Department of Research and Clinical Oncology, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Rome, Italy
| | - Fabio Pelle
- Department of Surgery, Division of Breast Surgery, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Rome, Italy
| | - Claudio Botti
- Department of Surgery, Division of Breast Surgery, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Rome, Italy
| | - Maurizio Costantini
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Rome, Italy
| |
Collapse
|
42
|
Silveira LDHJ, de Oliveira VS, Pinheiro RF. Breast implant-associated - Anaplastic Large Cell Lymphoma: a call for disease awareness. Hematol Transfus Cell Ther 2023; 45:124-126. [PMID: 34598910 PMCID: PMC9938461 DOI: 10.1016/j.htct.2021.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/04/2021] [Accepted: 06/21/2021] [Indexed: 02/06/2023] Open
|
43
|
de Leval L, Feldman AL, Pileri S, Nakamura S, Gaulard P. Extranodal T- and NK-cell lymphomas. Virchows Arch 2023; 482:245-264. [PMID: 36336765 PMCID: PMC9852223 DOI: 10.1007/s00428-022-03434-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 10/12/2022] [Accepted: 10/15/2022] [Indexed: 11/09/2022]
Abstract
Non-cutaneous extranodal NK/T cell lymphoproliferations constitute a heterogenous group of rare neoplasms, occurring primarily in the gastro-intestinal tract, nasal area, spleen, and liver. Their nomenclature refers to their usual clinical presentation and predilection for specific anatomic sites-i.e. extranodal NK/T-cell lymphoma, nasal-type, hepatosplenic T-cell lymphoma, primary intestinal T-cell lymphomas, indolent lymphoproliferative disorders of the gastrointestinal tract, and breast implant-associated anaplastic large cell lymphoma. Extranodal tissues may also be involved by T-cell leukemias, or other entities usually presenting as nodal diseases. Primary extranodal entities range from indolent to highly aggressive diseases. Here, we will review the clinicopathologic features of the pertinent entities including the recent advances in their molecular and genetic characterization, with an emphasis on the changes introduced in the 2022 International Consensus Classification of lymphoid neoplasms, and highlight the diagnostic criteria helpful to sort out the distinction with potential mimickers.
Collapse
Affiliation(s)
- Laurence de Leval
- grid.8515.90000 0001 0423 4662Institute of Pathology, Department of Laboratory Medicine and Pathology, Lausanne University Hospital and Lausanne University, 25 rue du Bugnon, CH- 1011 Lausanne, Switzerland
| | - Andrew L. Feldman
- grid.66875.3a0000 0004 0459 167XDepartment of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN USA
| | - Stefano Pileri
- grid.15667.330000 0004 1757 0843Haematopathology Division, IRCCS, Istituto Europeo Di Oncologia, IEO, Milano, Italy
| | - Shigeo Nakamura
- grid.437848.40000 0004 0569 8970Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Philippe Gaulard
- grid.412116.10000 0004 1799 3934Department of Pathology, University Hospital Henri Mondor, AP-HP, Créteil, France ,grid.462410.50000 0004 0386 3258Inserm U955, Faculty of Medicine, IMRB, University of Paris-Est Créteil, Créteil, France
| |
Collapse
|
44
|
Murga-Zamalloa C, Inamdar K. Classification and challenges in the histopathological diagnosis of peripheral T-cell lymphomas, emphasis on the WHO-HAEM5 updates. Front Oncol 2022; 12:1099265. [PMID: 36605429 PMCID: PMC9810276 DOI: 10.3389/fonc.2022.1099265] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
Mature T-cell lymphomas represent neoplastic expansions of T-cell lymphocytes with a post-thymic derivation. Most of these tumors feature aggressive clinical behavior and challenging histopathological diagnosis and classification. Novel findings in the genomic landscape of T-cell lymphomas are helping to improve the understanding of the biology and the molecular mechanisms that underly its clinical behavior. The most recent WHO-HAEM5 classification of hematolymphoid tumors introduced novel molecular and histopathological findings that will aid in the diagnostic classification of this group of neoplasms. The current review article summarizes the most relevant diagnostic features of peripheral T-cell lymphomas with an emphasis on the updates that are incorporated at the WHO-HAEM5.
Collapse
Affiliation(s)
- Carlos Murga-Zamalloa
- Department of Pathology, University of Illinois at Chicago, Chicago, IL, United States,*Correspondence: Carlos Murga-Zamalloa,
| | - Kedar Inamdar
- Department of Pathology, Henry Ford Hospital, Detroit, MI, United States
| |
Collapse
|
45
|
Demko N, Safran T, Vorstenbosch J, Michel RP. Breast Implanted-Associated Anaplastic Large Cell Lymphoma: A Case of Advanced Disease with Flow Cytometric Findings. Int J Surg Pathol 2022; 31:464-471. [PMID: 36357370 PMCID: PMC10173349 DOI: 10.1177/10668969221102551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Breast implant-associated anaplastic large cell lymphoma (breast implant-associated ALCL) is a recently described, distinct clinicopathological entity associated with macrotextured breast implants. The diagnostic workup of a patient suspected to have breast implant-associated ALCL includes cytological assessment of effusions and tissue biopsies of any masses or enlarged lymph nodes, with morphologic and immunophenotypic evaluation and possible flow cytometric and molecular testing. We report the case of a woman found to have breast implant-associated ALCL on fine needle aspirate and core biopsy, who on surgical resection, had extensive local disease with involvement of the resection margins and lymph nodes, requiring systemic treatment. We focus on the flow cytometric findings that identified a population of large cells on the CD30/side scatter dot plot and whose immunophenotype was consistent with breast implant-associated ALCL, highlighting the value of flow cytometry as an adjunct to morphological and immunophenotypic evaluation.
Collapse
Affiliation(s)
- Nadine Demko
- Department of Pathology, McGill University, Montréal, QC, Canada
| | - Tyler Safran
- Division of Plastic & Reconstructive Surgery, Department of Surgery, McGill University Health Centre, Montréal, QC, Canada
| | - Joshua Vorstenbosch
- Division of Plastic & Reconstructive Surgery, Department of Surgery, McGill University Health Centre, Montréal, QC, Canada
| | - René P. Michel
- Department of Pathology, McGill University, Montréal, QC, Canada
| |
Collapse
|
46
|
Salgarello M, Pino VS, Pagliara DM, Visconti G. Preventing Soft Tissue Complications in Secondary Aesthetic Breast Surgery Using Indocyanin Green Angiography. Aesthet Surg J 2022; 43:665-672. [PMID: 36242548 PMCID: PMC10184940 DOI: 10.1093/asj/sjac261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/26/2022] [Accepted: 09/28/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Secondary cosmetic breast surgery after primary augmentation with implant can be associated with an increased risk of adverse events. Partial/complete nipple areolar complex (NAC) necrosis is particularly feared. In this preliminary study, the authors propose the use of Indocyanine Green (ICG) angiography in order to assess the blood supply of breast tissue after implant removal. OBJECTIVES The main objective is to prevent skin and gland necrosis in revision breast surgery. METHODS We performed a retrospective comparative analysis of 33 patients undergoing secondary breast surgery between 2018 and 2021 by a single surgeon (M.S.). Breast tissue perfusion was assessed in 16 patients by intraoperative ICG-angiography at the end of implant removal and possible capsulectomy. Non-stained/non-fluorescent areas were judged to be low perfusion areas and were excised with short scar mastopexy. RESULTS In the ICG-angiography group, 7 patients (44%) showed an area of poor perfusion along the inferior pole, all of these patients underwent subglandular breast augmentation. Resection of the poor perfusion areas allowed an uneventful postoperative course. In the non ICG-angiography group (17 patients), 5 patients experienced vertical scar dehiscence/necrosis. We found a statistically significant association between non-ICG angiography group and vertical scar dehiscence/necrosis, and also between vertical scar dehiscence/necrosis and subglandular implant placement (P-value = 0.04). CONCLUSIONS Safer secondary surgery can be offered to patients undergoing secondary aesthetic breast procedures, especially when the first augmentation surgery is unknown e.g. implant plane, type of pedicle used, the implant is large and subglandular, and capsulectomy is performed.
Collapse
Affiliation(s)
- Marzia Salgarello
- Department of Plastic Surgery, Dipartimento per la Salute della Donna, del Bambino e di Sanità Pubblica - Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS - Università Cattolica del "Sacro Cuore" Rome, Italy
| | - Valentina Sara Pino
- Department of Plastic Surgery, Dipartimento per la Salute della Donna, del Bambino e di Sanità Pubblica - Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS - Università Cattolica del "Sacro Cuore" Rome, Italy
| | | | - Giuseppe Visconti
- Department of Plastic Surgery, Dipartimento per la Salute della Donna, del Bambino e di Sanità Pubblica - Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS - Università Cattolica del "Sacro Cuore" Rome, Italy
| |
Collapse
|
47
|
Naga HI, Mellia JA, Basta MN, Morris MP, Christopher AN, Campbell FM, Sommers K, Levinson H, Nelson JA, Fischer JP. Breast Implant-Associated Anaplastic Large-Cell Lymphoma: Updated Systematic Review and Analysis of Treatment Strategies. Plast Reconstr Surg 2022; 150:762-769. [PMID: 35862104 PMCID: PMC9551598 DOI: 10.1097/prs.0000000000009538] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Although guidelines have been published on treatment of breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL), there has been no comprehensive analysis of BIA-ALCL treatment variation based on the available literature. The authors sought to assess current treatment strategies of BIA-ALCL relative to current guidelines. METHODS Database searches were conducted in June of 2020. Included articles were case reports and case series with patient-level data. Collected variables included clinicopathologic features, implant characteristics, diagnostic tests, ALCL characteristics, treatment, and details of follow-up and outcome. Treatment data from before and after 2017 were compared with National Cancer Center Network guidelines. RESULTS A total of 89 publications were included and 178 cases of BIA-ALCL were identified. Most patients presented with seroma ( n = 114, 70.4 percent), followed by a mass ( n = 14, 8.6 percent), or both ( n = 23, 14.2 percent). Treatment included en bloc capsulectomy of the affected implant in 122 out of 126 cases with treatment details provided (96.8 percent). Radiation therapy was given in 38 cases (30.2 percent) and chemotherapy was given in 71 cases (56.3 percent). Practitioners used less chemotherapy for local disease after treatment guideline publication in 2017 ( p < 0.001), whereas treatment for advanced disease remained unchanged ( p = 0.3). There were 10 recurrences and eight fatalities attributable to BIA-ALCL, which were associated with advanced presentation (29 versus 2.1 percent; OR, 19.4; 95 percent CI, 3.9 to 96.3; p < 0.001). CONCLUSIONS BIA-ALCL remains a morbid but treatable condition. Current guidelines focus treatment for local disease and reduce nonsurgical interventions with radiation or chemotherapy. Patients presenting with advanced BIA-ALCL experience higher rates of recurrence and mortality.
Collapse
Affiliation(s)
- Hani I. Naga
- Division of Plastic Surgery, Duke University, Durham, NC
- Division of Plastic Surgery, University of Pennsylvania, Philadelphia, PA
| | - Joseph A. Mellia
- Division of Plastic Surgery, University of Pennsylvania, Philadelphia, PA
| | - Marten N. Basta
- Division of Plastic Surgery, University of Pennsylvania, Philadelphia, PA
| | - Martin P. Morris
- Division of Plastic Surgery, University of Pennsylvania, Philadelphia, PA
| | | | - Frank M. Campbell
- Biomedical Library, Perelman School of Medicine, University of Pennsylvania, PA
| | | | - Howard Levinson
- Division of Plastic Surgery, University of Pennsylvania, Philadelphia, PA
- Plastic Surgery Foundation, Arlington Heights, IL
| | - Jonas A. Nelson
- Plastic and Reconstructive Surgical Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - John P. Fischer
- Division of Plastic Surgery, University of Pennsylvania, Philadelphia, PA
| |
Collapse
|
48
|
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: 2] [Impact Index Per Article: 1.0] [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.
Collapse
|
49
|
Campo E, Jaffe ES, Cook JR, Quintanilla-Martinez L, Swerdlow SH, Anderson KC, Brousset P, Cerroni L, de Leval L, Dirnhofer S, Dogan A, Feldman AL, Fend F, Friedberg JW, Gaulard P, Ghia P, Horwitz SM, King RL, Salles G, San-Miguel J, Seymour JF, Treon SP, Vose JM, Zucca E, Advani R, Ansell S, Au WY, Barrionuevo C, Bergsagel L, Chan WC, Cohen JI, d'Amore F, Davies A, Falini B, Ghobrial IM, Goodlad JR, Gribben JG, Hsi ED, Kahl BS, Kim WS, Kumar S, LaCasce AS, Laurent C, Lenz G, Leonard JP, Link MP, Lopez-Guillermo A, Mateos MV, Macintyre E, Melnick AM, Morschhauser F, Nakamura S, Narbaitz M, Pavlovsky A, Pileri SA, Piris M, Pro B, Rajkumar V, Rosen ST, Sander B, Sehn L, Shipp MA, Smith SM, Staudt LM, Thieblemont C, Tousseyn T, Wilson WH, Yoshino T, Zinzani PL, Dreyling M, Scott DW, Winter JN, Zelenetz AD. The International Consensus Classification of Mature Lymphoid Neoplasms: a report from the Clinical Advisory Committee. Blood 2022; 140:1229-1253. [PMID: 35653592 PMCID: PMC9479027 DOI: 10.1182/blood.2022015851] [Citation(s) in RCA: 574] [Impact Index Per Article: 287.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 05/18/2022] [Indexed: 11/20/2022] Open
Abstract
Since the publication of the Revised European-American Classification of Lymphoid Neoplasms in 1994, subsequent updates of the classification of lymphoid neoplasms have been generated through iterative international efforts to achieve broad consensus among hematopathologists, geneticists, molecular scientists, and clinicians. Significant progress has recently been made in the characterization of malignancies of the immune system, with many new insights provided by genomic studies. They have led to this proposal. We have followed the same process that was successfully used for the third and fourth editions of the World Health Organization Classification of Hematologic Neoplasms. The definition, recommended studies, and criteria for the diagnosis of many entities have been extensively refined. Some categories considered provisional have now been upgraded to definite entities. Terminology for some diseases has been revised to adapt nomenclature to the current knowledge of their biology, but these modifications have been restricted to well-justified situations. Major findings from recent genomic studies have impacted the conceptual framework and diagnostic criteria for many disease entities. These changes will have an impact on optimal clinical management. The conclusions of this work are summarized in this report as the proposed International Consensus Classification of mature lymphoid, histiocytic, and dendritic cell tumors.
Collapse
Affiliation(s)
- Elias Campo
- Haematopathology Section, Hospital Clínic of Barcelona, Institut d'Investigaciones Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona, Centro de Investigación Biomédica en Red de Cancer (CIBERONC), Barcelona, Spain
| | - Elaine S Jaffe
- Hematopathology Section, Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | - James R Cook
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH
| | - Leticia Quintanilla-Martinez
- Institute of Pathology and Neuropathology, Eberhard Karls University of Tübingen and Comprehensive Cancer Center, University Hospital Tübingen, Tübingen, Germany
| | - Steven H Swerdlow
- Department of Pathology, University of Pittsburgh School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | | | - Pierre Brousset
- Department of Pathology, Institut Universitaire du Cancer de Toulouse-Oncopole, and Laboratoire d'Excellence Toulouse Cancer, Toulouse, France
| | - Lorenzo Cerroni
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - Laurence de Leval
- Institute of Pathology, Department of Laboratory Medicine and Pathology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Stefan Dirnhofer
- Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Ahmet Dogan
- Laboratory of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andrew L Feldman
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Falko Fend
- Institute of Pathology and Neuropathology, Eberhard Karls University of Tübingen and Comprehensive Cancer Center, University Hospital Tübingen, Tübingen, Germany
| | | | - Philippe Gaulard
- Department of Pathology, University Hospital Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France
- Mondor Institute for Biomedical Research, INSERM U955, Faculty of Medicine, University of Paris-Est Créteil, Créteil, France
| | - Paolo Ghia
- Strategic Research Program on Chronic Lymphocytic Leukemia, Division of Experimental Oncology, IRCCS Ospedale San Raffaele and Università Vita-Salute San Raffaele, Milan, Italy
| | - Steven M Horwitz
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Rebecca L King
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Gilles Salles
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jesus San-Miguel
- Clínica Universidad de Navarra, Centro de Investigación Médica Aplicada, Instituto de Investigación Sanitaria de Navarra, CIBERONC, Pamplona, Spain
| | - John F Seymour
- Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, VIC, Australia
| | | | - Julie M Vose
- Division of Hematology-Oncology, Department of Internal Medicine, University of Nebraska Medical Center, University of Nebraska, Omaha, NE
| | - Emanuele Zucca
- Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, and Institute of Oncology Research, Università della Svizzera Italiana, Bellinzona, Switzerland
| | - Ranjana Advani
- Stanford Cancer Center, Blood and Marrow Transplant Program, Stanford University, Stanford, CA
| | - Stephen Ansell
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Wing-Yan Au
- Blood-Med Clinic, Hong Kong, People's Republic of China
| | - Carlos Barrionuevo
- Department of Pathology, Instituto Nacional de Enfermedades Neoplásicas, Faculty of Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Leif Bergsagel
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Phoenix, AZ
| | - Wing C Chan
- Department of Pathology, City of Hope National Medical Center, Duarte, CA
| | - Jeffrey I Cohen
- Medical Virology Section, Laboratory of Infectious Diseases, National Institutes of Health, National Institute of Allergy and Infectious Diseases, Bethesda, MD
| | - Francesco d'Amore
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
| | - Andrew Davies
- Cancer Research UK Centre, Centre for Cancer Immunology, Faculty of Medicine, Southampton General Hospital, University of Southampton, Southampton, United Kingdom
| | - Brunangelo Falini
- Institute of Hematology and Center for Hemato-Oncology Research, Hospital of Perugia, University of Perugia , Perugia, Italy
| | - Irene M Ghobrial
- Dana-Farber Cancer Institute, Boston, MA
- Harvard Medical School, Harvard University, Boston, MA
| | - John R Goodlad
- National Health Service Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - John G Gribben
- Department of Haemato-Oncology, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Eric D Hsi
- Department of Pathology, Wake Forest School of Medicine, Wake Forest University, Winston-Salem, NC
| | - Brad S Kahl
- Oncology Division, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO
| | - Won-Seog Kim
- Hematology and Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Shaji Kumar
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | | | - Camille Laurent
- Department of Pathology, Institut Universitaire du Cancer de Toulouse-Oncopole, and Laboratoire d'Excellence Toulouse Cancer, Toulouse, France
| | - Georg Lenz
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Muenster, Muenster, Germany
| | - John P Leonard
- Weill Department of Medicine, Weill Medical College, Cornell University, New York, NY
| | - Michael P Link
- Department of Pediatrics, Division of Pediatric Hematology-Oncology, Stanford University School of Medicine, Stanford University, Stanford, CA
| | - Armando Lopez-Guillermo
- Department of Hematology, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Maria Victoria Mateos
- Department of Hematology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Centro de Investigación del Cancer, Universidad de Salamanca, Salamanca, Spain
| | - Elizabeth Macintyre
- Laboratoire d'Onco-Hématologie, AP-HP, Hôpital Necker-Enfants Malades, Université de Paris Cité and Institut Necker-Enfants Malades, Paris, France
| | - Ari M Melnick
- Division of Hematology and Oncology, Weill Medical College, Cornell University, New York, NY
| | - Franck Morschhauser
- Department of Hematology, Centre Hospitalier Universitaire de Lille, University Lille, Lille, France
| | - Shigeo Nakamura
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Marina Narbaitz
- Department of Pathology, Instituto de Investigaciones Hematológicas, Academia Nacional de Medicina and Fundacion para combatir la leucemia (FUNDALEU), Buenos Aires, Argentina
| | - Astrid Pavlovsky
- Fundación para Combatir la Leucemia (FUNDALEU), Centro de Hematología Pavlovsky, Buenos Aires, Argentina
| | - Stefano A Pileri
- Haematopathology Division, IRCCS, Istituto Europeo di Oncologia, Milan, Italy
| | - Miguel Piris
- Jiménez Díaz Foundation University Hospital, Universidad Autónoma de Madrid, Madrid, Spain
| | - Barbara Pro
- Division of Hematology and Oncology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Vincent Rajkumar
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Steven T Rosen
- Beckman Research Institute, and Department of Hematology & Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - Birgitta Sander
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Laurie Sehn
- Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, BC, Canada
| | | | - Sonali M Smith
- Section of Hematology/Oncology, University of Chicago, Chicago, IL
| | - Louis M Staudt
- Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Catherine Thieblemont
- Service Hémato-Oncologie, AP-HP, Hôpital Saint-Louis, Paris, France
- DMU-DHI, Université de Paris-Paris Diderot, Paris, France
| | - Thomas Tousseyn
- Department of Pathology, Universitair Ziekenhuis Leuven Hospitals, Leuven, Belgium
| | - Wyndham H Wilson
- Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Tadashi Yoshino
- Department of Pathology, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Pier-Luigi Zinzani
- Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seragnoli", Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
| | - Martin Dreyling
- Department of Medicine III, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - David W Scott
- Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Jane N Winter
- Feinberg School of Medicine, Northwestern University, Chicago, IL; and
| | - Andrew D Zelenetz
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Medical College, Cornell University, New York, NY
| |
Collapse
|
50
|
Sharma K, Gilmour A, Jones G, O'Donoghue JM, Clemens MW. A Systematic Review of Outcomes Following Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL). JPRAS Open 2022; 34:178-188. [PMID: 36340855 PMCID: PMC9634150 DOI: 10.1016/j.jpra.2022.08.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 08/31/2022] [Indexed: 12/04/2022] Open
Abstract
Background Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) has increasingly become a significant concern for patients. Focus thus far has been on understanding pathogenesis and establishing treatment pathways. There has been less attention on the assessment of long-term treatment outcomes. The purpose of this study was to perform a systematic review to assess published data on treatment outcomes for BIA-ALCL. Methods Using PRISMA guidelines, a systematic search of the literature was carried out from January 1997 to January 2021 using the Web of Science (PubMed) and Ovid Medline. Included in the review were any studies on the management and follow-up of patients, including disease status at a minimum of 18 months following treatment. Results A total of 39 articles matched the inclusion criteria. However, 94% of patients were managed with explantation and capsulectomy. Then, 39% of patients had adjuvant chemotherapy, 19% radiotherapy, 6% autologous stem cell transplant, and 4% immunotherapy. The mean follow-up was 19 months (range 3–36 months), and 69% of patients were reported to be alive at 18 months. The mainstay of treatment was surgical – en bloc capsulectomy with adjuvant treatment for advanced disease. Conclusions Robust survival data based on high-level evidence are challenging to establish in BIA-ALCL. Early diagnosis and en bloc capsulectomy with negative margins, whilst considering the need for adjuvant treatment, particularly targeted immune therapy in advanced disease represents the consistent forms of treatment. National databases, prospective studies, and treatment of patients in tertiary centres are all recommended to improve the quality of the research available in the management of BIA-ALCL.
Collapse
Affiliation(s)
- Kavita Sharma
- The Canniesburn Plastic Surgery Unit, Glasgow Royal Infirmary, UK
- Author Correspondence: Miss Kavita Sharma, Canniesburn Plastic Surgery Unit, Glasgow Royal Infirmary, 84 Castle Street, G4 0SF.
| | - Adam Gilmour
- The Canniesburn Plastic Surgery Unit, Glasgow Royal Infirmary, UK
| | | | - Joseph M. O'Donoghue
- The Royal Victoria Infirmary, The Newcastle Upon Tyne Hospitals, NHS Foundation Trust, UK
| | - Mark W. Clemens
- The MD Anderson Cancer Center, University of Texas, Houston, Texas, USA
| |
Collapse
|