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McGuire PA, Glicksman C, McCarthy C, Spiegel A. Separating Myth from Reality in Breast Implants: An Overview of 30 Years of Experience. Plast Reconstr Surg 2023; 152:801e-807e. [PMID: 37010472 DOI: 10.1097/prs.0000000000010488] [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: 04/04/2023]
Abstract
SUMMARY The purpose of this article is to review the pivotal events in the history of breast implants in the United States, including the events leading to the U.S. Food and Drug Administration moratorium on the use of silicone gel implants and subsequent approval; the emergence of breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL); and persistent concerns about an association between breast implants, autoimmune disease, and systemic symptoms. This article reviews the medical literature to outline our current knowledge on BIA-ALCL; offers recommendations for diagnosis and management of symptomatic and asymptomatic patients with textured implants; and reviews the science of potential associations of implants with autoimmune and systemic symptoms. The authors hope to help patients separate myths from reality and make educated decisions on having breast implants placed or removed.
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Affiliation(s)
| | | | - Colleen McCarthy
- the Department of Surgery, Memorial Sloan Kettering Cancer Center
| | - Aldona Spiegel
- The Center for Breast Restoration, Weill Cornell Medical School, Houston Methodist Academic Institute, and Division of Surgical Innovation, Houston Methodist Hospital
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2
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Safari A, Hamza S, Paton D. A rare case: synchronous ipsilateral breast implant-associated anaplastic large cell lymphoma and invasive ductal carcinoma. J Surg Case Rep 2023; 2023:rjad338. [PMID: 37305344 PMCID: PMC10256625 DOI: 10.1093/jscr/rjad338] [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: 05/12/2023] [Accepted: 05/22/2023] [Indexed: 06/13/2023] Open
Abstract
A 78-year-old female with a history of cosmetic breast implants presented with unilateral breast enlargement and was subsequently diagnosed with stage IA breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) as well as stage IB ipsilateral synchronous invasive ductal carcinoma (IDC). Her assessment included bilateral breast ultrasounds,mammograms and MRIs with right-sided fine needle aspiration of peri-implant fluid, core biopsy of right breast mass and a whole-body positron emission tomography scan. She was surgically treated with bilateral capsulectomy, implant removal and mastectomy. No adjuvant treatment was required for the BIA-ALCL. The IDC required adjuvant chemotherapy, radiotherapy and endocrine therapy. This rare case highlights the paramount importance of thorough evaluation of suspected BIA-ALCL patients for synchronous breast pathologies. We conclude with a concise summary of the salient points on evaluation and management of BIA-ALCL for surgeons.
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Affiliation(s)
- Aroosha Safari
- Correspondence address. Department of General Surgery, Fiona Stanley Hospital, Perth, WA 6150, Australia. Tel: +61452466634; E-mail:
| | - Saud Hamza
- Breast Assessment Centre, Fiona Stanley Hospital, Perth, WA, Australia
| | - David Paton
- Pathology Department, Fiona Stanley Hospital, Perth, WA, Australia
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3
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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.
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4
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Santanelli di Pompeo F, Paolini G, Firmani G, Sorotos M. From Breast Implant to Rough Implant Associated-Anaplastic Large Cell Lymphoma (RIA-ALCL). Aesthet Surg J 2022; 42:NP445-NP446. [PMID: 35022649 PMCID: PMC9117088 DOI: 10.1093/asj/sjac005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Fabio Santanelli di Pompeo
- Faculty of Medicine and Psychology, Sapienza University of Rome, Department NESMOS - Sant’Andrea Hospital, Via di Grottarossa, Rome, Italy
| | - Guido Paolini
- Faculty of Medicine and Psychology, Sapienza University of Rome, Department NESMOS - Sant’Andrea Hospital, Via di Grottarossa, Rome, Italy
| | - Guido Firmani
- Faculty of Medicine and Psychology, Sapienza University of Rome, Department NESMOS - Sant’Andrea Hospital, Via di Grottarossa, Rome, Italy
| | - Michail Sorotos
- Faculty of Medicine and Psychology, Sapienza University of Rome, Department NESMOS - Sant’Andrea Hospital, Via di Grottarossa, Rome, Italy
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5
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Yoo H, Park JU, Chang H. Comprehensive Evaluation of the Current Knowledge on Breast Implant Associated-Anaplastic Large Cell Lymphoma. Arch Plast Surg 2022; 49:141-149. [PMID: 35832665 PMCID: PMC9045542 DOI: 10.1055/s-0042-1744422] [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] [Indexed: 11/08/2022] Open
Abstract
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a recently spotlighted T-cell origin non-Hodgkin's lymphoma with an increasing incidence of over 800 cases and 33 deaths reported worldwide. Development of BIA-ALCL is likely a complex process involving many factors, such as the textured implant surface, bacterial biofilm growth, immune response, and patient genetics. As the incidence of BIA-ALCL is expected to increase, it is important for all surgeons and physicians to be aware of this disease entity and acquire thorough knowledge of current evidence-based guidelines and recommendations. Early detection, accurate diagnosis, and appropriate treatment are the foundations of current care.
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Affiliation(s)
- Hyokyung Yoo
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ji-Ung Park
- Department of Plastic and Reconstructive Surgery, Seoul National University Boramae Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hak Chang
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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6
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FISHER RJ, PAREKH KP, HARSTEN R, IDAEWOR P, SAAD ABDALLA AL-ZAWI A, CHICKEN W. Breast implant-associated anaplastic large cell lymphoma: case report and literature review. Chirurgia (Bucur) 2022. [DOI: 10.23736/s0394-9508.20.05227-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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7
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Locke MB. Commentary on: Granzyme B Is a Biomarker for Suspicion of Malignant Seromas Around Breast Implants. Aesthet Surg J 2021; 41:1365-1366. [PMID: 33547889 DOI: 10.1093/asj/sjaa409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Michelle B Locke
- Department of Plastic, Reconstructive and Hand Surgery, Counties Manukau District Health Board, Auckland, New Zealand
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8
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Stonesifer CJ, Grimes JM, Garcia-Saleem TJ, Niedt GW, Kadin ME, Geskin LJ. Stenotrophomonas maltophilia-associated primary cutaneous anaplastic large-cell lymphoma. JAAD Case Rep 2021; 16:77-81. [PMID: 34541271 PMCID: PMC8435984 DOI: 10.1016/j.jdcr.2021.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Connor J Stonesifer
- Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Joseph M Grimes
- Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | | | - George W Niedt
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
| | - Marshall E Kadin
- Department of Pathology and Laboratory Medicine, Warren Alpert School of Medicine at Brown University, Providence, Rhode Island.,Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts
| | - Larisa J Geskin
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
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9
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Hallab NJ, Samelko L, Hammond D. Particulate Debris Released From Breast Implant Surfaces Is Highly Dependent on Implant Type. Aesthet Surg J 2021; 41:NP782-NP793. [PMID: 33564817 DOI: 10.1093/asj/sjab051] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Although breast implants (BIs) have never been safer, factors such as implant debris may influence complications such as chronic inflammation and illness such as ALCL (anaplastic large cell lymphoma). Do different types of BIs produce differential particulate debris? OBJECTIVES The aim of this study was to quantify, investigate, and characterize the size, amount, and material type of both loosely bound and adherent surface particles on 5 different surface types of commercial BIs. METHODS Surface particles from BIs of 5 surface types (n = 5/group), Biocell, Microcell, Siltex, Smooth, SmoothSilk, and Traditional-Smooth, were: (1) removed by a rinsing procedure and (2) removed with ultrapure adhesive carbon tabs. Particles were characterized (ASTM 1877-16) by scanning electron microscopy and energy-dispersive X-ray chemical analysis. RESULTS Particles rinsed from Biocell, Microcell and Siltex were <1 μm in diameter whereas SmoothSilk and Traditional-Smooth surfaces had median sizes >1 μm (range, 0.4-2.7 μm). The total mass of particles rinsed from the surfaces indicated Biocell had >5-fold more particulate compared with all other implants, and >30-fold more than SmoothSilk or Traditional-Smooth implants (>100-fold more for post-rinse adhesion analysis). Energy-dispersive X-ray analysis indicated that the particulate material for Biocell, Microcell, and Siltex was silicone (>50%), whereas particulates from SmoothSilk and Traditional-Smooth implants were predominantly carbon-based polymers, eg, polycarbonate-urethane, consistent with packaging (and were detected on all implant types). Generally, SmoothSilk and Traditional-Smooth implant groups released >10-fold fewer particles than Biocell, Microcell, and Siltex surfaces. Pilot ex vivo tissue analysis supported these findings. CONCLUSIONS Particulate debris released from BIs are highly dependent on the type of implant surface and are a likely key determinant of in vivo performance. LEVEL OF EVIDENCE: 5
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Affiliation(s)
- Nadim James Hallab
- Department of Orthopedic Surgery, University of Illinois in Chicago, Chicago, IL, USA
| | - Lauryn Samelko
- Department of Orthopedic Surgery, University of Illinois in Chicago, Chicago, IL, USA
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10
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Tripodi D, Amabile MI, Varanese M, D'Andrea V, Sorrenti S, Cannistrà C. Large cell anaplastic lymphoma associated with breast implant: a rare case report presentation and discussion of possible management. Gland Surg 2021; 10:2076-2080. [PMID: 34268093 DOI: 10.21037/gs-20-853] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 03/19/2021] [Indexed: 11/06/2022]
Abstract
Anaplastic large cell lymphomas (ALCL) are a rare type of primary breast lymphoma. The association between breast implants and ALCL was first described in 1997. Breast implant associated (BIA)-ALCL arises from the inflammatory T cells surrounding the fibrous capsule, and most tumors are in situ. Here we present the case of a 60-year-old woman with ALCL following bilateral silicone breast prosthesis implantation for aesthetic reason. The patient presented at our observation 7 years following the first surgery reporting a sport trauma in the right thoracic region with breast enlargement and tenderness, complaining breast pain at the palpation of the right breast. Imaging study showed a right fluid collection surrounding the affected breast implant. For this reason, the patient underwent bilateral complete capsulectomy (surgical specimen histologically analyzed and resulted negative for ALCL) and implantation of new breast silicone prosthesis. In 10 months, a progressive relapse of the symptoms with a right peri-implant fluid collection restauration was documented and bilateral surgical removal of breast prostheses with right peri-implant capsular biopsy were performed. The histological analysis of the peri-implant capsule laid for ALCL cellules and a new radical surgical excision of bilateral periprothesic capsule was performed followed by adjuvant radiotherapy for a skin relapse of the disease with a subsequent complete remission. No further relapse was observed afterwards. This clinical case raised a series of diagnostic and therapeutic issues highlighting similarities with previous BIA-ALCL reports, but also some peculiarities that deserve to be further investigated and described in order to make an early recognition of the disease for the proper management and treatment of the patient. Due to the rarity of these tumors, rapidly diagnosing a BIA-ALCL case, not neglecting other associated symptoms or signs, is essential to ensure timely and safe treatment.
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Affiliation(s)
- Domenico Tripodi
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Maria Ida Amabile
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Marzia Varanese
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Vito D'Andrea
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Salvatore Sorrenti
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Claudio Cannistrà
- Centre Hospitalier Universitaire Bichat Claude-Bernard, Paris, France
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11
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Abstract
ABSTRACT Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a recently recognized malignancy of T-lymphocytes that is linked to certain types of textured breast implants. Although rare, the increasing awareness of the disease is resulting in more case reports and heightened anxiety in patients with textured breast implants. This review aims to summarize the available BIA-ALCL data, including the existing theories of etiopathogenesis, the diagnostic work-up for BIA-ALCL patients, BIA-ALCL treatment recommendations, the epidemiologic challenges, and the current opinions surrounding the use of textured breast implants.
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Affiliation(s)
- Alyson Skelly
- From the Tufts University School of Medicine, Boston
| | - Lifei Guo
- Division of Plastic Surgery, Lahey Hospital & Medical Center, Burlington, MA
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12
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Etiology of Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL): Current Directions in Research. Cancers (Basel) 2020; 12:cancers12123861. [PMID: 33371292 PMCID: PMC7765924 DOI: 10.3390/cancers12123861] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 12/16/2020] [Indexed: 02/07/2023] Open
Abstract
Simple Summary The first report of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) was in 1997. Although BIA-ALCL develops around breast implants, it is considered a cancer of the immune system and not a cancer of the breast ducts or lobules. Nearly all confirmed cases to date have been associated with textured surface (versus smooth surface) breast implants. As physicians have become more aware of BIA-ALCL, so has the number of reported cases, although the number of cases remains low. In most instances, patients have an excellent prognosis following removal of the breast implant and its surrounding fibrous capsule. Many theories on factors that trigger the development of BIA-ALCL, such as the presence of bacteria, have been proposed. However, the sequence(s) of events that follow the initial triggering event(s) have not been fully determined. This article summarizes the current scientific knowledge on the development of BIA-ALCL. Abstract Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a CD30-positive, anaplastic lymphoma kinase-negative T-cell lymphoma. Where implant history is known, all confirmed cases to date have occurred in patients with exposure to textured implants. There is a spectrum of disease presentation, with the most common occurring as a seroma with an indolent course. A less common presentation occurs as locally advanced or, rarely, as metastatic disease. Here we review the immunological characteristics of BIA-ALCL and potential triggers leading to its development. BIA-ALCL occurs in an inflammatory microenvironment with significant lymphocyte and plasma cell infiltration and a prominent Th1/Th17 phenotype in advanced disease. Genetic lesions affecting the JAK/STAT signaling pathway are commonly present. Proposed triggers for the development of malignancy include mechanical friction, silicone implant shell particulates, silicone leachables, and bacteria. Of these, the bacterial hypothesis has received significant attention, supported by a plausible biologic model. In this model, bacteria form an adherent biofilm in the favorable environment of the textured implant surface, producing a bacterial load that elicits a chronic inflammatory response. Bacterial antigens, primarily of Gram-negative origin, may trigger innate immunity and induce T-cell proliferation with subsequent malignant transformation in genetically susceptible individuals. Although much remains to be elucidated regarding the multifactorial origins of BIA-ALCL, future research should focus on prevention and treatment strategies, recognizing susceptible populations, and whether decreasing the risk of BIA-ALCL is possible.
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13
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Henning C, Wang J, Swift R, Eades B, Spektor TM, Berenson JR. Removal of a Silicone Gel Breast Implant in a Multiple Myeloma Patient Improved Disease Status: A Case Report. Case Rep Oncol 2020; 13:1103-1108. [PMID: 33082755 PMCID: PMC7548844 DOI: 10.1159/000508494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 05/06/2020] [Indexed: 11/19/2022] Open
Abstract
A 52-year-old African-American woman with a prior history of monoclonal gammopathy of undetermined significance (MGUS) developed infiltrating ductal carcinoma of the left breast. Following a mastectomy, she underwent reconstruction with a silicone gel breast implant. Three years later, her MGUS had progressed to active multiple myeloma (MM). She had a minimal response after two different regimens of bortezomib-based treatments and monthly zoledronic acid, and was placed on maintenance therapy with bortezomib, intravenous dexamethasone, and oral methylprednisolone, as well as ongoing monthly zoledronic acid. After 1 year of this maintenance therapy, during which her myeloma markers remained unchanged, she had her silicone implant replaced with saline. Despite no change in her myeloma treatment, her laboratory values began to steadily improve following removal of the silicone implant. Her M-protein decreased from 2.14 to 0.83 g/dL and her IgG levels from 3,330 to 1,210 mg/dL following replacement of her silicone implant with saline. To our knowledge, this is the first report in which removal of silicone implants improved the clinical status of a patient with MM following a year of maintenance therapy during which the patient's myeloma laboratory values remained unchanged. Further studies are warranted to determine if silicone breast implant removal can, in fact, improve MM patients' disease status.
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Affiliation(s)
- Chace Henning
- Institute for Myeloma & Bone Cancer Research, West Hollywood, California, USA
| | - James Wang
- Institute for Myeloma & Bone Cancer Research, West Hollywood, California, USA
| | - Regina Swift
- Institute for Myeloma & Bone Cancer Research, West Hollywood, California, USA
| | - Benjamin Eades
- Institute for Myeloma & Bone Cancer Research, West Hollywood, California, USA
| | | | - James R Berenson
- Institute for Myeloma & Bone Cancer Research, West Hollywood, California, USA.,Oncotherapeutics, West Hollywood, California, USA
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14
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Fleming D, Stone J, Tansley P. Spontaneous Regression and Resolution of Breast Implant-Associated Anaplastic Large Cell Lymphoma: Implications for Research, Diagnosis and Clinical Management. Aesthetic Plast Surg 2020; 44:1109-1115. [PMID: 32766915 DOI: 10.1007/s00266-020-01810-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 12/17/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND First described in 1997, breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) was recognised by the World Health Organisation in 2016 as a specific disease. It typically presents as a late seromacontaining atypical, monoclonal T cells which are CD30+ and anaplastic lymphoma kinase negative. Until recently, it was thought that the disease was very rare. However, it is being diagnosed increasingly frequently with 56 cases confirmed in Australia by September 2017 and the estimated incidence revised from 1 in 300,000 to between 1 in 1000 and 1 in 10,000 patients with bilateral implants. There is debate about the spectrum of BIA-ALCL. According to the current WHO classification, BIA-ALCL is a cancer in all cases. Treatment guidelines require that it is treated urgently with a minimum of bilateral removal of implants and capsulectomies. Whilst acknowledging the disease has been under diagnosed in the past, with some notable exceptions the BIA-ALCL literature has given scant attention to the epidemiological evidence. Now that it is known that the disease may occur in up to 1 in 1000 patients with a median of 7.5 years from implantation to diagnosis, understanding it in its epidemiological context is imperative. The epidemiology of cancer and lymphoma in women with breast implants strongly suggests that most patients do not have a cancer that will inevitably progress without treatment but instead a self-limiting lympho-proliferative disorder. Although the possibility of spontaneous regression has been raised and the observation made that treatment delay did not seem to increase the risk of spread, the main objection to the lympho-proliferative hypothesis has been the lack of documented cases of spontaneous regression or resolution. Because all cases currently are considered malignant and treated urgently, only case report evidence, interpreted in the proper epidemiological context, is likely to be available to challenge this thinking. METHODS AND RESULTS New observations and interpretation of the epidemiology of BIA-ALCL are made. These are supported by the presentation of two cases, which to the best of our knowledge comprise the first documented evidence of spontaneous regression and spontaneous resolution of confirmed BIA-ALCL. CONCLUSIONS The epidemiology of the disease strongly suggests that the vast majority of cases are not a cancer that will inevitably progress without treatment. The findings presented in the manuscript provide supportive clinical evidence. Consequently, an alternative view of BIA-ALCL with implications for research, diagnosis and clinical management needs to be considered. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Daniel Fleming
- Cosmetic Surgery Institute of Australia, PO Box 213, Fortitude Valley, Brisbane, QLD, 4006, Australia.
| | - Jason Stone
- QML Pathology, 1 Riverview Place, Metroplex on Gateway, Murarrie, QLD, 4172, Australia
| | - Patrick Tansley
- NorthEast Plastic Surgery, Wickham House, Level 1 155 Wickham Terrace, Spring Hill, Brisbane, QLD, 4000, Australia
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15
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Zaveri S, Yao A, Schmidt H. Breast Implant-Associated Anaplastic Large Cell Lymphoma Following Gender Reassignment Surgery: A Review of Presentation, Management, and Outcomes in the Transgender Patient Population. Eur J Breast Health 2020; 16:162-166. [PMID: 32656514 DOI: 10.5152/ejbh.2020.5480] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 05/30/2020] [Indexed: 01/13/2023]
Abstract
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare peripheral T-cell lymphoma with approximately 650-700 reported cases worldwide. The incidence, however, is increasing as more practitioners become aware of the diagnosis, and recent studies show that early diagnosis and treatment is critical to improve prognosis. There have been four cases of BIA-ALCL in total reported in the transgender population in the literature. These reported cases were reviewed in detail to determine presentation and management of BIA-ALCL in transgender patients compared to the larger population of BIA-ALCL patients. This review highlights BIA-ALCL in transgender women, a population that is often excluded from breast screening and follow-up. Transgender women may not routinely go through the same post-operative follow-up protocols as patients with breast implants for breast cancer reconstruction and can thus be at risk for delayed recognition and diagnosis. BIA-ALCL is a rare complication of breast implantation, and it is important to counsel all patients undergoing implant placement, including transgender women, on its risk.
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Affiliation(s)
- Shruti Zaveri
- Department of Surgery, The Mount Sinai Hospital, New York, NY, USA
| | - Alice Yao
- Division of Plastic and Reconstructive Surgery, Department of Surgery, The Mount Sinai Hospital, New York, NY, USA
| | - Hank Schmidt
- Dubin Breast Center, Tisch Cancer Institute, The Mount Sinai Hospital, New York, NY, USA
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16
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Akdeniz Dogan Z, Miranda RN, Iyer S, Steiner RE, Singh P, Clemens MW. Anaplastic Large Cell Lymphoma of the Breast Arising in a Burn Cicatrix. Aesthet Surg J 2020; 40:NP159-NP163. [PMID: 31495882 PMCID: PMC7453096 DOI: 10.1093/asj/sjz245] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Anaplastic large cell lymphoma (ALCL) is a T cell lymphoma characterized by large anaplastic cells with diffuse and uniform CD30 reactivity. Here, we report a patient with no prior implant history who developed anaplastic lymphoma kinase-1-negative ALCL within a burn cicatrix on a breast. We hypothesize that the chronic inflammation caused by burn injury and the patient's history of immunosuppression secondary to organ transplantation may have contributed to development of ALCL in this patient. This report supports the essential role of chronic inflammation in the development of ALCL in the breast. Level of Evidence: 5.
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Affiliation(s)
| | | | | | | | - Prachee Singh
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - Mark W Clemens
- University of Texas MD Anderson Cancer Center, Houston, TX
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17
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Hanson SE, Hassid VJ, Branch-Brooks C, Liu J, Kadin ME, Miranda R, Butler CE, Clemens MW. Validation of a CD30 Enzyme-Linked Immunosorbant Assay for the Rapid Detection of Breast Implant-Associated Anaplastic Large Cell Lymphoma. Aesthet Surg J 2020; 40:149-153. [PMID: 30789639 DOI: 10.1093/asj/sjy327] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is an uncommon type of non-Hodgkin lymphoma occurring in the fluid or capsule adjacent to textured breast implants. Diagnosis of BIA-ALCL of symptomatic patients requires demonstration of large anaplastic cells with uniform expression of CD30 protein on immunohistochemistry. OBJECTIVES The authors investigated a novel, rapid, office-based, and economic in-situ enzyme-linked immunosorbent assay (ELISA) for screening BIA-ALCL patients. METHODS A commercially available in-situ ELISA was standardized and validated for patients with confirmed BIA-ALCL diagnosis with clinical isolates. A panel of 9 pathologically confirmed BIA-ALCL patients was screened by serum, plasma, and periprosthetic effusion specimens and compared against serum, plasma, and nonneoplastic delayed seromas in 7 control patients. Statistical analysis demonstrated assay consistency and reliability. RESULTS All BIA-ALCL effusions demonstrated CD30 ELISA detection at full and all serial concentrations. BIA-ALCL serum specimens and all control specimens were negative at full concentration and serial dilutions (1:100, 1:250, 1:500, and 1:1000). BIA-ALCL plasma specimens were weakly positive at full concentration and revealed no activity with serial dilution. CONCLUSIONS This is the first study to demonstrate a viable alternative to CD30 immunohistochemistry for the screening of BIA-ALCL. Our study demonstrates 100% sensitivity in seroma fluid with no detectable CD30 in benign seroma samples. A CD30 ELISA represents a novel, low-cost screening test, which may be used to screen suspicious aspirations of delayed periprosthetic fluid collections in an office-based setting. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Summer E Hanson
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Victor J Hassid
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Cynthia Branch-Brooks
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jun Liu
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Marshall E Kadin
- Department of Dermatology, Roger Williams Medical Center, Providence, RI
| | - Roberto Miranda
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Charles E Butler
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
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Julien LA, Michel RP, Auger M. Breast implant-associated anaplastic large cell lymphoma and effusions: A review with emphasis on the role of cytopathology. Cancer Cytopathol 2020; 128:440-451. [PMID: 31899606 DOI: 10.1002/cncy.22233] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 12/09/2019] [Accepted: 12/12/2019] [Indexed: 12/27/2022]
Abstract
Breast implants are surgically implanted by the hundreds of thousands every year worldwide for reconstructive or aesthetic purposes. Complications related to breast implants include early and late effusions that are often submitted for cytopathological analysis, particularly to exclude the possibility of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), a rare disease that generally follows an indolent clinical course, although it is becoming clearer that a subset of patients with adverse features have a poorer prognosis. Since a late-onset breast implant-associated effusion is the most common initial presentation of BIA-ALCL, cytopathological analysis of these effusions is considered the cornerstone and gold standard for rapid, efficient, reliable diagnosis and is critical for appropriate management and treatment. The National Comprehensive Cancer Network recently published clinical guidelines for the diagnosis and management of BIA-ALCL and stresses the essential role of cytopathological analysis, although it remains a matter of debate if all seromas should undergo immunocytochemistry or flow cytometry, particularly for assessment of expression of CD30 irrespective of morphological appearance on cytology. Herein, we review the current knowledge on BIA-ALCL, review the key cytological findings of reactive and malignant effusions related to breast implants, and present a comprehensive cytopathological workup with the presence of atypical cells as the key and pivotal element triggering further ancillary studies. We believe this approach will ensure appropriate and cost-effective management of effusion specimens from breast implants.
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Affiliation(s)
| | - René P Michel
- Department of Pathology, McGill University, Montreal, Canada
| | - Manon Auger
- Department of Pathology, McGill University, Montreal, Canada
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19
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Does Breast Implant–Associated ALCL Begin as a Lymphoproliferative Disorder? Plast Reconstr Surg 2020; 145:30e-38e. [DOI: 10.1097/prs.0000000000006390] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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20
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Gardani M, Bellini E, Villani G, Orsi N, Palli D. Breast implant‐associated anaplastic large cell lymphoma: A rare case report of lymphoma in the form of a pericapsular solid formation. Breast J 2019; 26:247-251. [DOI: 10.1111/tbj.13541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 06/21/2019] [Accepted: 06/24/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Marco Gardani
- Department of Surgery Breast Unit Guglielmo da Saliceto Hospital Piacenza Italy
- Department of Medicine and Surgery Plastic Surgery Division University of Parma Parma Italy
- Cutaneous, Mini‐invasive, Regenerative and Plastic Surgery Unit Parma University Hospital Parma Italy
| | - Elisa Bellini
- Department of Medicine and Surgery Plastic Surgery Division University of Parma Parma Italy
- Cutaneous, Mini‐invasive, Regenerative and Plastic Surgery Unit Parma University Hospital Parma Italy
| | - Gabriele Villani
- Radiology‐Mammography screening center Guglielmo da saliceto Hospital Piacenza Italy
| | - Nicola Orsi
- Clinical pathology‐Pathological anatomy Guglielmo da Saliceto Hospital Piacenza Italy
| | - Dante Palli
- Department of Surgery Breast Unit Guglielmo da Saliceto Hospital Piacenza Italy
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21
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Gunawardana RT, Dessauvagie BF, Taylor DB. Breast implant-associated anaplastic large cell lymphoma, an under-recognised entity. J Med Imaging Radiat Oncol 2019; 63:630-638. [PMID: 31173460 DOI: 10.1111/1754-9485.12905] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 04/19/2019] [Indexed: 11/30/2022]
Abstract
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare form of T-cell lymphoma, recently linked to the use of certain types of breast implants. Although rare, BIA-ALCL is being increasingly recognised and radiologists can play an important role in its early diagnosis. BIA-ALCL is thought to be related to chronic inflammation from indolent infection of the biofilm surrounding implants leading to malignant transformation of activated T cells in genetically susceptible individuals. Clinical features include breast enlargement or asymmetry, discomfort, heaviness and/or a palpable mass in the context of long-standing implant(s). Ultrasound is the primary imaging modality, and the presence of more than a trace of peri-implant fluid should prompt consideration of aspiration for cytology, flow cytometry and microbiological analysis. This article reviews the clinical, imaging and pathology features of BIA-ALCL. In addition, the current recommended management guidelines for suspected cases are discussed.
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Affiliation(s)
- Ruvini Thashila Gunawardana
- Department of Diagnostic and Interventional Radiology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Benjamin F Dessauvagie
- Anatomical Pathology, PathWest Laboratory Medicine W.A., Fiona Stanley Hospital, Murdoch, Western Australia, Australia.,Division of Pathology and Laboratory Medicine, Medical School University of Western Australia, Crawley, Western Australia, Australia
| | - Donna B Taylor
- Department of Diagnostic and Interventional Radiology, Royal Perth Hospital, Perth, Western Australia, Australia.,Division of Surgery, Medical School University of Western Australia, Crawley, Western Australia, Australia
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22
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Clinicopathologic Features and Prognostic Impact of Lymph Node Involvement in Patients With Breast Implant-associated Anaplastic Large Cell Lymphoma. Am J Surg Pathol 2019; 42:293-305. [PMID: 29194092 DOI: 10.1097/pas.0000000000000985] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Breast implant-associated anaplastic large cell lymphoma (BI-ALCL) is a rare T-cell lymphoma that arises around breast implants. Most patients manifest with periprosthetic effusion, whereas a subset of patients develops a tumor mass or lymph node involvement (LNI). The aim of this study is to describe the pathologic features of lymph nodes from patients with BI-ALCL and assess the prognostic impact of LNI. Clinical findings and histopathologic features of lymph nodes were assessed in 70 patients with BI-ALCL. LNI was defined by the histologic demonstration of ALCL in lymph nodes. Fourteen (20%) patients with BI-ALCL had LNI, all lymph nodes involved were regional, the most frequent were axillary (93%). The pattern of involvement was sinusoidal in 13 (92.9%) cases, often associated with perifollicular, interfollicular, and diffuse patterns. Two cases had Hodgkin-like patterns. The 5-year overall survival was 75% for patients with LNI and 97.9% for patients without LNI at presentation (P=0.003). Six of 49 (12.2%) of patients with tumor confined by the capsule had LNI, compared with LNI in 8/21 (38%) patients with tumor beyond the capsule. Most patients with LNI achieved complete remission after various therapeutic approaches. Two of 14 (14.3%) patients with LNI died of disease compared with 0/56 (0%) patients without LNI. Twenty percent of patients with BI-ALCL had LNI by lymphoma, most often in a sinusoidal pattern. We conclude that BI-ALCL beyond capsule is associated with a higher risk of LNI. Involvement of lymph nodes was associated with decreased overall survival. Misdiagnosis as Hodgkin lymphoma is a pitfall.
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Quesada AE, Medeiros LJ, Clemens MW, Ferrufino-Schmidt MC, Pina-Oviedo S, Miranda RN. Breast implant-associated anaplastic large cell lymphoma: a review. Mod Pathol 2019; 32:166-188. [PMID: 30206414 DOI: 10.1038/s41379-018-0134-3] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 05/31/2018] [Accepted: 06/02/2018] [Indexed: 12/23/2022]
Abstract
Breast implant-associated anaplastic large cell lymphoma is a newly recognized provisional entity in the 2017 revision of the World Health Organization Classification of Tumors of Hematopoietic and Lymphoid Tissues. It is an uncommon, slow growing T-cell lymphoma with morphology and immunophenotype similar to anaplastic lymphoma kinase-negative anaplastic large cell lymphoma. However, the presentation and treatment are unique. Breast implant-associated anaplastic large cell lymphoma often presents as a unilateral effusion confined to the capsule of a textured-surface breast implant, a median time of 9 years after the initial implants have been placed. Although it follows an indolent clinical course, breast implant-associated anaplastic large cell lymphoma has the potential to form a mass, to invade locally through the capsule into breast parenchyma or soft tissue and/or to spread to regional lymph nodes. In most cases, an explantation with a complete capsulectomy removing all disease, without chemotherapy is considered to be curative and confers an excellent event free and overall survival. Here we provide a comprehensive review of breast implant-associated anaplastic large cell lymphoma, including history, epidemiology, clinical features, imaging and pathology findings, pathologic handling, pathogenic mechanisms, model for progression, therapy and outcomes as well as an analysis of causality between breast implants and anaplastic large cell lymphoma.
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Affiliation(s)
- Andrés E Quesada
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - L Jeffrey Medeiros
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mark W Clemens
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Sergio Pina-Oviedo
- Department of Pathology and Laboratory Services, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Roberto N Miranda
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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24
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Kadin ME. What Cytokines Can Tell Us About the Pathogenesis of Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL). Aesthet Surg J 2019; 39:S28-S35. [PMID: 30715174 DOI: 10.1093/asj/sjy250] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Cytokines, their receptors, and downstream signaling partners, especially JAK1/2 and STAT3, are key biomarkers in lymphoproliferative disorders including systemic anaplastic large cell lymphoma (ALCL). Here we review their role in breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). Early results suggest that, in addition to CD30, IL-9, IL-10, and IL-13 can distinguish malignant from benign seromas. IL-6 is increased in both benign and malignant seromas. IFNγ may identify a subset of BIA-ALCL with a different clinical course. Immunohistochemical detection of nuclear transcription factors-which regulate cytokine signaling-and phosphorylated janus kinases/signal transducers and activators of transcription can inform the identification and malignant potential of CD30+ cells. The innate immune response is the first line of defense against microbes suspected to initiate BIA-ALCL. Innate lymphoid cells are grouped according to the cytokines they produce and could potentially be identified as precursors to BIA-ALCL. Cytokines modulate the tumor microenvironment and hence the pathology of BIA-ALCL such as the influx of eosinophils and capsular fibrosis mediated by IL-13. The plasticity of T cells and innate immune cells theoretically can enable therapeutic manipulations toward a less aggressive phenotype. Cytokine receptors targeted in clinical trials of inflammatory and autoimmune disorders could afford opportunities for immunotherapy of BIA-ALCL.
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Affiliation(s)
- Marshall E Kadin
- Professor of Dermatology, Boston University School of Medicine and Roger Williams Medical Center, Providence, RI
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25
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Hallab NJ, Samelko L, Hammond D. The Inflammatory Effects of Breast Implant Particulate Shedding: Comparison With Orthopedic Implants. Aesthet Surg J 2019; 39:S36-S48. [PMID: 30715176 PMCID: PMC6355107 DOI: 10.1093/asj/sjy335] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Currently, there is a dearth of information regarding the degree of particle shedding from breast implants (BIs) and what are the general biological consequences of BI debris. Thus, it is unclear to what degree BI debris compromises the long-term biological performance of BIs. For orthopedic implants, it is well established that the severity of biological reactivity to implant debris governs long-term clinical performance. Orthopedic implant particulate debris is generally in the range of 0.01 to 100 μm in diameter. Implant debris-induced bioreactivity/inflammation is mostly a peri-implant phenomenon caused by local innate immune cells (eg, macrophages) that produce proinflammatory cytokines such as tumor necrosis factor-α, interleukin-1β, interleukin-6, and prostaglandin 2 (PGE2). In orthopedics, there have been few systemic concerns associated with polymeric implant debris (like silicone) other than documented dissemination to remote organs (eg, liver, spleen, etc.) with no known associated pathogenicity. This is not true of metal implant debris where normal (well-functioning) implants can induce systemic reactions such as delayed type hypersensitivity. Diagnostic analysis of orthopedic tissues has focused on innate (macrophage mediated) and adaptive (lymphocyte-mediated hypersensitivity) immune responses. Orthopedic implant debris-associated lymphocyte cancers have not been reported in over 40 years of orthopedic literature. Adaptive immune responses such as hypersensitivity reactions to orthopedic implant debris have been dominated by certain implant types that produce specific kinds of debris (eg, metal-on-metal total joint prostheses). Orthopedic hypersensitivity responses and atypical BI bioreactivity such as BI-associated anaplastic large cell lymphoma share crossover markers for diagnosis. Differentiating normal innate immune reactivity to particles from anaplastic large cell lymphoma reactions from delayed type hypersensitivity reactions to BI-associated implant debris remains unclear but vital to patients and surgeons.
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Affiliation(s)
- Nadim James Hallab
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL
| | - Lauryn Samelko
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL
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26
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Broggi G, Motta F, Angilello A, Bortolussi C, Meli G, Magro G, Vecchio GM. Breast implant-associated anaplastic large cell lymphoma with lymph node localization: case report and review of literature. ANZ J Surg 2018; 89:1679-1682. [PMID: 30294931 DOI: 10.1111/ans.14839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 07/27/2018] [Accepted: 08/04/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Giuseppe Broggi
- Department of Medical and Surgical Sciences and Advanced Technologies, G.F. Ingrassia, Anatomic Pathology, University of Catania, Catania, Italy
| | - Fabio Motta
- Department of Medical and Surgical Sciences and Advanced Technologies, G.F. Ingrassia, Anatomic Pathology, University of Catania, Catania, Italy
| | - Andrea Angilello
- Department of Surgical Sciences, Organ Transplantation and Advanced Technologies, A.O.U. Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy
| | - Carlo Bortolussi
- Department of Surgical Sciences, Organ Transplantation and Advanced Technologies, A.O.U. Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy
| | - Gaetano Meli
- Division of Radiology, 'Policlinico Vittorio Emanuele' University Hospital, University of Catania, Catania, Italy
| | - Gaetano Magro
- Department of Medical and Surgical Sciences and Advanced Technologies, G.F. Ingrassia, Anatomic Pathology, University of Catania, Catania, Italy
| | - Giada M Vecchio
- Department of Medical and Surgical Sciences and Advanced Technologies, G.F. Ingrassia, Anatomic Pathology, University of Catania, Catania, Italy
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27
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Fleming D, Stone J, Tansley P. Spontaneous Regression and Resolution of Breast Implant-Associated Anaplastic Large Cell Lymphoma: Implications for Research, Diagnosis and Clinical Management. Aesthetic Plast Surg 2018; 42:672-678. [PMID: 29445921 PMCID: PMC5945759 DOI: 10.1007/s00266-017-1064-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 12/17/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND First described in 1997, breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) was recognised by the World Health Organisation in 2016 as a specific disease. It typically presents as a late seroma-containing atypical, monoclonal T cells which are CD30+ and anaplastic lymphoma kinase negative. Until recently, it was thought that the disease was very rare. However, it is being diagnosed increasingly frequently with 56 cases confirmed in Australia by September 2017 and the estimated incidence revised from 1 in 300,000 to between 1 in 1000 and 1 in 10,000 patients with bilateral implants. There is debate about the spectrum of BIA-ALCL. According to the current WHO classification, BIA-ALCL is a cancer in all cases. Treatment guidelines require that it is treated urgently with a minimum of bilateral removal of implants and capsulectomies. Whilst acknowledging the disease has been under diagnosed in the past, with some notable exceptions the BIA-ALCL literature has given scant attention to the epidemiological evidence. Now that it is known that the disease may occur in up to 1 in 1000 patients with a median of 7.5 years from implantation to diagnosis, understanding it in its epidemiological context is imperative. The epidemiology of cancer and lymphoma in women with breast implants strongly suggests that most patients do not have a cancer that will inevitably progress without treatment but instead a self-limiting lympho-proliferative disorder. Although the possibility of spontaneous regression has been raised and the observation made that treatment delay did not seem to increase the risk of spread, the main objection to the lympho-proliferative hypothesis has been the lack of documented cases of spontaneous regression or resolution. Because all cases currently are considered malignant and treated urgently, only case report evidence, interpreted in the proper epidemiological context, is likely to be available to challenge this thinking. METHODS AND RESULTS New observations and interpretation of the epidemiology of BIA-ALCL are made. These are supported by the presentation of two cases, which to the best of our knowledge comprise the first documented evidence of spontaneous regression and spontaneous resolution of confirmed BIA-ALCL. CONCLUSIONS The epidemiology of the disease strongly suggests that the vast majority of cases are not a cancer that will inevitably progress without treatment. The findings presented in the manuscript provide supportive clinical evidence. Consequently, an alternative view of BIA-ALCL with implications for research, diagnosis and clinical management needs to be considered. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Daniel Fleming
- Cosmetic Surgery Institute of Australia, PO Box 213, Fortitude Valley, Brisbane, QLD, 4006, Australia.
| | - Jason Stone
- QML Pathology, 1 Riverview Place, Metroplex on Gateway, Murarrie, QLD, 4172, Australia
| | - Patrick Tansley
- NorthEast Plastic Surgery, Wickham House, Level 1 155 Wickham Terrace, Spring Hill, Brisbane, QLD, 4000, Australia
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Montes-Mojarro IA, Steinhilber J, Bonzheim I, Quintanilla-Martinez L, Fend F. The Pathological Spectrum of Systemic Anaplastic Large Cell Lymphoma (ALCL). Cancers (Basel) 2018; 10:cancers10040107. [PMID: 29617304 PMCID: PMC5923362 DOI: 10.3390/cancers10040107] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 03/30/2018] [Accepted: 04/02/2018] [Indexed: 12/11/2022] Open
Abstract
Anaplastic large cell lymphoma (ALCL) represents a group of malignant T-cell lymphoproliferations that share morphological and immunophenotypical features, namely strong CD30 expression and variable loss of T-cell markers, but differ in clinical presentation and prognosis. The recognition of anaplastic lymphoma kinase (ALK) fusion proteins as a result of chromosomal translocations or inversions was the starting point for the distinction of different subgroups of ALCL. According to their distinct clinical settings and molecular findings, the 2016 revised World Health Organization (WHO) classification recognizes four different entities: systemic ALK-positive ALCL (ALK+ ALCL), systemic ALK-negative ALCL (ALK− ALCL), primary cutaneous ALCL (pC-ALCL), and breast implant-associated ALCL (BI-ALCL), the latter included as a provisional entity. ALK is rearranged in approximately 80% of systemic ALCL cases with one of its partner genes, most commonly NPM1, and is associated with favorable prognosis, whereas systemic ALK− ALCL shows heterogeneous clinical, phenotypical, and genetic features, underlining the different oncogenesis between these two entities. Recognition of the pathological spectrum of ALCL is crucial to understand its pathogenesis and its boundaries with other entities. In this review, we will focus on the morphological, immunophenotypical, and molecular features of systemic ALK+ and ALK− ALCL. In addition, BI-ALCL will be discussed.
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Affiliation(s)
- Ivonne A Montes-Mojarro
- Institute of Pathology and Neuropathology and Comprehensive Cancer Center Tübingen, Eberhard-Karls-University, Liebermeisterstraße 8, 72076 Tübingen, Germany.
| | - Julia Steinhilber
- Institute of Pathology and Neuropathology and Comprehensive Cancer Center Tübingen, Eberhard-Karls-University, Liebermeisterstraße 8, 72076 Tübingen, Germany.
| | - Irina Bonzheim
- Institute of Pathology and Neuropathology and Comprehensive Cancer Center Tübingen, Eberhard-Karls-University, Liebermeisterstraße 8, 72076 Tübingen, Germany.
| | - Leticia Quintanilla-Martinez
- Institute of Pathology and Neuropathology and Comprehensive Cancer Center Tübingen, Eberhard-Karls-University, Liebermeisterstraße 8, 72076 Tübingen, Germany.
| | - Falko Fend
- Institute of Pathology and Neuropathology and Comprehensive Cancer Center Tübingen, Eberhard-Karls-University, Liebermeisterstraße 8, 72076 Tübingen, Germany.
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29
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Patzelt M, Zarubova L, Klener P, Barta J, Benkova K, Brandejsova A, Trneny M, Gürlich R, Sukop A. Anaplastic Large-Cell Lymphoma Associated with Breast Implants: A Case Report of a Transgender Female. Aesthetic Plast Surg 2018; 42:451-455. [PMID: 29101436 DOI: 10.1007/s00266-017-1012-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Accepted: 10/18/2017] [Indexed: 11/28/2022]
Abstract
Breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) is a rare peripheral T cell lymphoma. BIA-ALCL is a disease of the fibrous capsule surrounding the implant and occurs in patients after both breast reconstruction and augmentation. More than 300 cases have been reported so far, including two in a transgender patient. Here we describe BIA-ALCL presented with a mass in a transgender patient and the first case of BIA-ALCL in the Czech Republic. In 2007, a 33-year-old transgender male to female underwent bilateral breast augmentation as a part of his transformation to female. In June 2014, the patient developed a 5-cm tumorous mass in her left breast. Magnetic resonance imaging of the chest revealed a ruptured implant and a tumorous mass penetrating into the capsule and infiltrating the pectoral muscle. An R0 surgery was indicated-the implant, silicone gel and capsule were removed, and the tumorous mass was resected together with a part of the pectoral muscle. Histology revealed anaplastic large-cell lymphoma. The patient underwent standard staging procedures for lymphoma including a bone marrow trephine biopsy, which confirmed stage IE. The patient was treated with the standard chemotherapy for systemic ALCL-6 cycles of CHOP-21. The patient was tumor-free at the 2-year follow-up. BIA-ALCL has been reported mostly in women who received implants for either reconstructive or aesthetic augmentation. This is the third report of BIA-ALCL in a transgender person, the first in the Czech Republic. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Matej Patzelt
- Department of Plastic Surgery, Royal Vinohrady Teaching Hospital, Srobarova 1150/50, 100 34, Prague, Czech Republic
- Third Faculty of Medicine, Charles University, Ruska 87, 100 00, Prague, Czech Republic
| | - Lucie Zarubova
- Department of Plastic Surgery, Royal Vinohrady Teaching Hospital, Srobarova 1150/50, 100 34, Prague, Czech Republic.
- Department of General Surgery, Royal Vinohrady Teaching Hospital, Srobarova 1150/50, 100 34, Prague, Czech Republic.
| | - Pavel Klener
- First Medical Department of Hematology, Charles University General, U Nemocnice 499/2, 128 08, Prague, Czech Republic
- Institute of Pathological Physiology, First Faculty of Medicine, Charles University, Katerinska 32, 121 08, Prague, Czech Republic
| | - Josef Barta
- Department of Radiology, Royal Vinohrady Teaching Hospital, Srobarova 1150/50, 100 34, Prague, Czech Republic
| | - Kamila Benkova
- Department of Pathology in Prague, AeskuLab Pathology, Evropska 2589/33b, 100 06, Prague, Czech Republic
| | - Adrianna Brandejsova
- Department of Plastic Surgery, Royal Vinohrady Teaching Hospital, Srobarova 1150/50, 100 34, Prague, Czech Republic
| | - Marek Trneny
- First Medical Department of Hematology, Charles University General, U Nemocnice 499/2, 128 08, Prague, Czech Republic
| | - Robert Gürlich
- Third Faculty of Medicine, Charles University, Ruska 87, 100 00, Prague, Czech Republic
- Department of General Surgery, Royal Vinohrady Teaching Hospital, Srobarova 1150/50, 100 34, Prague, Czech Republic
| | - Andrej Sukop
- Department of Plastic Surgery, Royal Vinohrady Teaching Hospital, Srobarova 1150/50, 100 34, Prague, Czech Republic
- Third Faculty of Medicine, Charles University, Ruska 87, 100 00, Prague, Czech Republic
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30
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Hatem J, Tobey JD, Solomon MP, Yu GH. FNA of peri-implant seroma of the breast. Cytopathology 2018; 29:300-302. [PMID: 29405522 DOI: 10.1111/cyt.12521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2017] [Indexed: 12/29/2022]
Affiliation(s)
- J Hatem
- Cytopathology Section, Department of Pathology & Laboratory Medicine, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - J D Tobey
- Breast Imaging Division, Department of Radiology, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - M P Solomon
- Department of Surgery, Pennsylvania Hospital, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - G H Yu
- Cytopathology Section, Department of Pathology & Laboratory Medicine, University of Pennsylvania Health System, Philadelphia, PA, USA
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31
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Abstract
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is an uncommon neoplasia occurring in women with either cosmetic or reconstructive breast implants. The actual knowledge about BIA-ALCL deriving from the literature presents several limits, and it remains difficult to make inferences about BIA-ALCL epidemiology, cause, and pathogenesis. This is the reason why the authors decided to organize an evidence-based consensus conference during the Maurizio Bruno Nava (MBN 2016) Aesthetic Breast Meeting held in Milan in December of 2016. Twenty key opinion leaders in the field of plastic surgery from all over the world have been invited to express and discuss their opinion about some key questions on BIA-ALCL, trying to reach a consensus about BIA-ALCL cause, pathogenesis, diagnosis, and treatment in light of the actual best evidence.
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32
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Alsadi A, Lin D, Alnajar H, Brickman A, Martyn C, Gattuso P. Hematologic Malignancies Discovered on Investigation of Breast Abnormalities. South Med J 2017; 110:614-620. [PMID: 28973700 DOI: 10.14423/smj.0000000000000710] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Hematological malignancies of the breast share a presentation similar to primary breast carcinomas but differ substantially in therapeutic approach and clinical outcomes. In this study, we investigate the frequency of hematological malignancies, their relative primary and secondary occurrences, and further characterize the distinct histopathologies of these malignancies with a special focus on lymphomas. To our knowledge this is one of the largest and most comprehensive studies of breast hematologic malignancies. METHODS We conducted a retrospective review of our institution's pathology database for hematologic neoplasms diagnosed in breast tissue during a period of 22 years (1992-2014). Clinical characteristics, patient history, histologic subtype, and patient outcomes were analyzed. RESULTS We identified 52 cases; 46 lymphomas, 4 plasmacytomas, and 2 myeloid sarcomas. The lymphoma cases were 15 diffuse large B-cell lymphomas (DLBCLs), 14 follicular lymphomas (FLs), 8 marginal zone lymphomas (MZLs), 2 anaplastic large T-cell lymphomas, 2 peripheral T-cell lymphomas-not otherwise specified, 1 each of small lymphocytic lymphoma, Burkitt lymphoma, mantle cell lymphoma, B-cell lymphoblastic lymphoma, and T-cell lymphoblastic lymphoma. In total, 30 cases were primary and 22 cases were secondary to the breast. Primary lymphomas accounted for 60% of lymphomas. Most FLs and almost all MZLs were primary. CONCLUSIONS Primary hematological malignancies of the breast are more common than secondary: 58 % versus 42%. This finding is more evident in lymphomas: 63% versus 37%. The most common hematological malignancy in our study was DLBCL, followed by FL and MZL. Most FLs and almost all MZLs were primary. At the same time, the percentage of primary DLBCLs in our study is lower than the percentage reported in previous studies. We suggest that this could be the result of transformation from low-grade lymphomas. Although rare, hematological malignancies of the breast warrant a higher level of clinical suspicion as they present similarly to breast carcinomas but require a substantially different therapeutic approach.
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Affiliation(s)
- Alaa Alsadi
- From the Department of Pathology, Rush University Medical Center, Chicago, Illinois
| | - Dianna Lin
- From the Department of Pathology, Rush University Medical Center, Chicago, Illinois
| | - Hussein Alnajar
- From the Department of Pathology, Rush University Medical Center, Chicago, Illinois
| | - Arlen Brickman
- From the Department of Pathology, Rush University Medical Center, Chicago, Illinois
| | - Colin Martyn
- From the Department of Pathology, Rush University Medical Center, Chicago, Illinois
| | - Paolo Gattuso
- From the Department of Pathology, Rush University Medical Center, Chicago, Illinois
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Breast Implant–Associated Anaplastic Large Cell Lymphoma in Australia and New Zealand. Plast Reconstr Surg 2017; 140:645-654. [DOI: 10.1097/prs.0000000000003654] [Citation(s) in RCA: 246] [Impact Index Per Article: 35.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Chernova NG, Zvonkov EE, Kovrigina AM, Sudarikov AB, Badmazhapova DS, Gabeeva NG, Obukhova TN, Karagyulyan SR, Savchenko VG. [Breast implant-associated anaplastic large-cell lymphoma: A case report and a review of literature]. TERAPEVT ARKH 2017; 89:93-98. [PMID: 28766547 DOI: 10.17116/terarkh201789793-98] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Breast implant-associated anaplastic large-cell lymphoma will be identified as a separate nosological entity in the 2017 adapted WHO classification due to differences in its clinical presentations, pathogenesis, and prognosis with those of nodal and cutaneous anaplastic large-cell lymphomas. The paper gives a review of the literature and describes the authors' own clinical case of common breast implant-associated anaplastic large-cell lymphoma involving breast tissue, axillary lymph nodes, anterior chest muscles, and bone marrow. The treatment policy chosen by the authors could achieve complete remission.
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Affiliation(s)
- N G Chernova
- National Research Center for Hematology, Ministry of Health of Russia, Moscow, Russia
| | - E E Zvonkov
- National Research Center for Hematology, Ministry of Health of Russia, Moscow, Russia
| | - A M Kovrigina
- National Research Center for Hematology, Ministry of Health of Russia, Moscow, Russia
| | - A B Sudarikov
- National Research Center for Hematology, Ministry of Health of Russia, Moscow, Russia
| | - D S Badmazhapova
- National Research Center for Hematology, Ministry of Health of Russia, Moscow, Russia
| | - N G Gabeeva
- National Research Center for Hematology, Ministry of Health of Russia, Moscow, Russia
| | - T N Obukhova
- National Research Center for Hematology, Ministry of Health of Russia, Moscow, Russia
| | - S R Karagyulyan
- National Research Center for Hematology, Ministry of Health of Russia, Moscow, Russia
| | - V G Savchenko
- National Research Center for Hematology, Ministry of Health of Russia, Moscow, Russia
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35
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Shahriari N, Ferenczi K, Heald PW. Breast implant-associated anaplastic large cell lymphoma: A review and assessment of cutaneous manifestations. Int J Womens Dermatol 2017; 3:140-144. [PMID: 28831423 PMCID: PMC5555281 DOI: 10.1016/j.ijwd.2017.05.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 05/12/2017] [Accepted: 05/21/2017] [Indexed: 12/25/2022] Open
Abstract
One newly recognized form of T-cell lymphoma is breast implant-associated anaplastic large cell lymphoma (biALCL), which appears in close proximity to breast implants. The number of reported cases of biALCL is increasing and warrants careful attention by clinicians to more effectively diagnose and treat affected individuals. As pertinent to dermatologists, the objective of this paper is to present the associated cutaneous features of this clinical entity along with the pathogenesis, management, and clinical outcomes. biALCL is a T-cell lymphoma in which malignant T-cells are characterized by large pleomorphic and anaplastic morphology and immunoreactivity for CD30, similar to primary cutaneous anaplastic large cell lymphomas (pcALCL). It has a favorable clinical outcome like nonimplant-associated pcALCL and involves the fibrous capsule around the implant, which creates an immunologically privileged site with a peri-implant effusion (seroma). More rare presentations are of a solitary mass. Appropriate management of biALCL is the complete surgical removal of the implant and total capsulectomy. Dermatologists should be aware of the occurrence of this entity in patients who have breast implants because patients may present specifically for breast-related cutaneous findings or have incidental cutaneous changes noted during a skin examination. The recognition and timely diagnosis of biALCL is critical to prevent progression to more advanced disease, ensure adequate treatment with removal of the implant, and avoid unnecessary aggressive systemic chemotherapy.
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Affiliation(s)
- N Shahriari
- Department of Dermatology, University of Connecticut Health Center, Farmington, CT
| | - K Ferenczi
- Department of Dermatology, University of Connecticut Health Center, Farmington, CT
| | - P W Heald
- Department of Dermatology, University of Connecticut Health Center, Farmington, CT
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36
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Deva AK. Commentary on: CD30+ T Cells in Late Seroma May Not Be Diagnostic of Breast Implant-Associated Anaplastic Large Cell Lymphoma. Aesthet Surg J 2017; 37:779-781. [PMID: 28402407 DOI: 10.1093/asj/sjx030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- Anand K Deva
- Professor Deva is a Co-director of the Surgical Infection Research Group, Macquarie University, Sydney, Australia
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37
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Armitage JO. The aggressive peripheral T-cell lymphomas: 2017. Am J Hematol 2017; 92:706-715. [PMID: 28516671 DOI: 10.1002/ajh.24791] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 05/11/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND T-cell lymphomas make up approximately 10%-15% of lymphoid malignancies. The frequency of these lymphomas varies geographically, with the highest incidence in parts of Asia. DIAGNOSIS The diagnosis of aggressive peripheral T-cell lymphoma (PTCL) is usually made using the World Health Organization classification. The ability of hematopathologists to reproducibly diagnose aggressive PTCL is lower than that for aggressive B-cell lymphomas, with a range of 72%-97% for the aggressive PTCLs. Risk Stratification: Patients with aggressive PTCL are staged using the Ann Arbor Classification. Although somewhat controversial, positron emission tomography scans seem to be useful as they are in aggressive B-cell lymphomas. The specific subtype of aggressive PTCL is an important risk factor with the best survival seen in anaplastic large-cell lymphoma-particularly young patients with the anaplastic lymphoma kinase positive subtype. RISK-ADAPTED THERAPY Anaplastic large-cell lymphoma is the only subgroup to have a good response to a CHOP-like regimen. Angioimmunoblastic T-cell lymphoma has a prolonged disease-free survival in only ∼20% of patients, but younger patients who have an autotransplant in remission seem to do better. PTCL-not otherwise specified is not one disease. Anthracycline-containing regimens have disappointing results, and a new approach is needed. Natural killer/T-cell lymphoma localized to the nose and nasal sinuses seems to be best treated with radiotherapy-containing regimens and the majority of patients are cured. Enteropathy-associated PTCL and hepatosplenic PTCL are rare disorders with a generally poor response to therapy although selected patients with enteropathy- associated PTCL seem to benefit from intensive therapy.
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Affiliation(s)
- James O. Armitage
- The Joe Shapiro Professor of Medicine, University of Nebraska Medical Center, 986840 Nebraska Medical Center, Omaha; NE 68198
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38
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Breast implant-associated anaplastic large cell lymphoma vs. anaplastic large cell lymphoma in a patient with breast implant effusion history: a diagnostic dilemma. J Hematop 2017. [DOI: 10.1007/s12308-017-0289-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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39
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Ramos-Gallardo G, Cuenca-Pardo J, Rodríguez-Olivares E, Iribarren-Moreno R, Contreras-Bulnes L, Vallarta-Rodríguez A, Kalixto-Sanchez M, Hernández C, Ceja-Martinez R, Torres-Rivero C. Breast Implant and Anaplastic Large Cell Lymphoma Meta-Analysis. J INVEST SURG 2016; 30:56-65. [DOI: 10.1080/08941939.2016.1215576] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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40
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Ladani S, Valassiadou K, Griffin Y, Miall F. Use of 18F-fludeoxyglucose positron emission tomography-CT in the management of breast implant-associated anaplastic large cell lymphoma. BJR Case Rep 2016; 2:20150424. [PMID: 30459981 PMCID: PMC6243353 DOI: 10.1259/bjrcr.20150424] [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: 10/28/2015] [Revised: 02/28/2016] [Accepted: 03/08/2016] [Indexed: 11/05/2022] Open
Abstract
The prognosis and preferred management of breast implant-associated anaplastic large cell lymphoma is dependent on whether lymphoproliferative cells are confined to within the fibrous capsule, in an effusion or lining the fibrous capsule, or if there is spread beyond the capsule in the form of a mass lesion. We describe a case where 18F-fludeoxyglucose positron emission tomography-CT was used to confirm localized disease and guide management decisions.
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Affiliation(s)
- Sapna Ladani
- Department of Haematology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Kalliope Valassiadou
- Department of Breast Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Yvette Griffin
- Department of Radiology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Fiona Miall
- Department of Haematology, University Hospitals of Leicester NHS Trust, Leicester, UK
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41
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Alcalá R, Llombart B, Lavernia J, Traves V, Guillén C, Sanmartín O. Skin involvement as the first manifestation of breast implant-associated anaplastic large cell lymphoma. J Cutan Pathol 2016; 43:602-608. [DOI: 10.1111/cup.12697] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 07/15/2015] [Accepted: 07/25/2015] [Indexed: 12/11/2022]
Affiliation(s)
- Rebeca Alcalá
- Department of Dermatology; Instituto Valenciano de Oncología; Valencia Spain
| | - Beatriz Llombart
- Department of Dermatology; Instituto Valenciano de Oncología; Valencia Spain
| | - Javier Lavernia
- Department of Oncology; Instituto Valenciano de Oncología; Valencia Spain
| | - Víctor Traves
- Department of Pathology; Instituto Valenciano de Oncología; Valencia Spain
| | - Carlos Guillén
- Department of Dermatology; Instituto Valenciano de Oncología; Valencia Spain
| | - Onofre Sanmartín
- Department of Dermatology; Instituto Valenciano de Oncología; Valencia Spain
- Department of Dermatology; Catholic University of Valencia ‘San Vicente Mártir’; Valencia Spain
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42
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Laurent C, Delas A, Gaulard P, Haioun C, Moreau A, Xerri L, Traverse-Glehen A, Rousset T, Quintin-Roue I, Petrella T, Emile JF, Amara N, Rochaix P, Chenard-Neu MP, Tasei AM, Menet E, Chomarat H, Costes V, Andrac-Meyer L, Michiels JF, Chassagne-Clement C, de Leval L, Brousset P, Delsol G, Lamant L. Breast implant-associated anaplastic large cell lymphoma: two distinct clinicopathological variants with different outcomes. Ann Oncol 2015; 27:306-14. [PMID: 26598546 DOI: 10.1093/annonc/mdv575] [Citation(s) in RCA: 155] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 11/11/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND ALK-negative anaplastic large cell lymphoma associated with breast implant (i-ALCL) has been recently recognized as a distinct entity. Among 43 830 lymphomas registered in the French Lymphopath network since 2010, 300 breast lymphomas comprising 25 peripheral T-cell lymphomas (PTCL) were reviewed. Among PTCL, ALK-negative ALCL was the most frequent and all of them were associated with breast implants. PATIENTS AND METHODS Since 2010, all i-ALCL cases were collected from different institutions through Lymphopath. Immuno-morphologic features, molecular data and clinical outcome of 19 i-ALCLs have been retrospectively analyzed. RESULTS The median age of the patients was 61 years and the median length between breast implant and i-ALCL was 9 years. Most implants were silicone-filled and textured. Implant removal was performed in 17 out of 19 patients with additional treatment based on mostly CHOP or CHOP-like chemotherapy regimens (n = 10/19) or irradiation (n = 1/19). CHOP alone or ABVD following radiation without implant removal have been given in two patients. The two clinical presentations, i.e. effusion and less frequently tumor mass correlated with distinct histopathologic features: in situ i-ALCL (anaplastic cell proliferation confined to the fibrous capsule) and infiltrative i-ALCL (pleomorphic cells massively infiltrating adjacent tissue with eosinophils and sometimes Reed-Sternberg-like cells mimicking Hodgkin lymphoma). Malignant cells were CD30-positive, showed a variable staining for EMA and were ALK negative. Most cases had a cytotoxic T-cell immunophenotype with variable T-cell antigen loss and pSTAT3 nuclear expression. T-cell receptor genes were clonally rearranged in 13 out of 13 tested cases. After 18 months of median follow-up, the 2-year overall survival for in situ and infiltrative i-ALCL was 100% and 52.5%, respectively. CONCLUSIONS In situ i-ALCLs have an indolent clinical course and generally remain free of disease after implant removal. However, infiltrative i-ALCLs could have a more aggressive clinical course that might require additional therapy to implant removal.
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Affiliation(s)
- C Laurent
- Department of Pathology, Institut Universitaire du Cancer-Oncopole, Toulouse INSERM, U.1037, Centre de recherche en cancérologie de Toulouse-Purpan, Toulouse
| | - A Delas
- Department of Pathology, Institut Universitaire du Cancer-Oncopole, Toulouse
| | - P Gaulard
- Department of Pathology, AP-HP, Groupe hospitalier Henri Mondor-Albert Chenevier, Créteil INSERM U955, Université Paris-Est, Créteil
| | - C Haioun
- INSERM U955, Université Paris-Est, Créteil Lymphoid Malignancies Unit, AP-HP, Groupe hospitalier Henri Mondor-Albert Chenevier, Créteil
| | - A Moreau
- Department of Pathology, Centre Hospitalier Hôtel Dieu, Nantes
| | - L Xerri
- Department of Pathology, Institut Paoli-Calmettes, Marseille
| | | | - T Rousset
- Department of Pathology, Hôpital Gui de Chauliac-Saint Eloi, Montpellier
| | - I Quintin-Roue
- Department of Pathology, Centre Hospitalier de Brest, Brest, France
| | - T Petrella
- Département de Pathologie, Montréal, Canada
| | - J F Emile
- Department of Pathology, Hôpital Ambroise Paré, Boulogne
| | - N Amara
- Department of Pathology, Institut Universitaire du Cancer-Oncopole, Toulouse
| | - P Rochaix
- Department of Pathology, Institut Universitaire du Cancer-Oncopole, Toulouse
| | | | - A M Tasei
- Department of Pathology, Centre Hospitalier Henri Duffaut, Avignon
| | - E Menet
- Department of Pathology, Hôpital René Huguenin, Saint Cloud
| | | | - V Costes
- Department of Pathology, Hôpital Gui de Chauliac-Saint Eloi, Montpellier
| | | | - J F Michiels
- Department of Pathology, Centre Hospitalier Pasteur L'Archet, Nice
| | | | - L de Leval
- Pathology institut of Lausanne, Centre Hospitalier Universitaire Vaudois, Suisse, Lausanne, Switzerland
| | - P Brousset
- Department of Pathology, Institut Universitaire du Cancer-Oncopole, Toulouse INSERM, U.1037, Centre de recherche en cancérologie de Toulouse-Purpan, Toulouse
| | - G Delsol
- Department of Pathology, Institut Universitaire du Cancer-Oncopole, Toulouse INSERM, U.1037, Centre de recherche en cancérologie de Toulouse-Purpan, Toulouse
| | - L Lamant
- Department of Pathology, Institut Universitaire du Cancer-Oncopole, Toulouse INSERM, U.1037, Centre de recherche en cancérologie de Toulouse-Purpan, Toulouse
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Bizjak M, Selmi C, Praprotnik S, Bruck O, Perricone C, Ehrenfeld M, Shoenfeld Y. Silicone implants and lymphoma: The role of inflammation. J Autoimmun 2015; 65:64-73. [PMID: 26330346 DOI: 10.1016/j.jaut.2015.08.009] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 08/14/2015] [Accepted: 08/17/2015] [Indexed: 12/18/2022]
Abstract
The risk of hematological malignancies is mainly determined by genetic background, age, sex, race and ethnicity, geographic location, exposure to certain chemicals and radiation; along with the more recently proposed immune factors such as chronic inflammation, immunodeficiencies, autoimmunity, and infections. Paradigmatic examples include the development of lymphoma in Sjögren's syndrome and Hashimoto thyroiditis, gastric MALT lymphoma in Helicobacter pylori infection, or lymphomas associated with infections by Epstein-Barr virus, human herpes virus 8 (HHV 8) and leukemia/lymphoma virus 1 (HTLV-1). A growing number of reports indicates an increased risk of lymphoma, particularly of the anaplastic large cell (ALCL) type. The implants, specifically those used in the past, elicit chronic stimulation of the immune system against the prosthetic material. This is particularly the case in genetically susceptible hosts. We suggest that polyclonal activation may result in monoclonality in those at risk hosts, ultimately leading to lymphoma. We suggest that patients with an inflammatory response against silicone implants be monitored carefully.
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Affiliation(s)
- Mojca Bizjak
- The Zabludowicz Center for Autoimmune Diseases, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Carlo Selmi
- Rheumatology and Clinical Immunology, Humanitas Research Hospital, Milan, Italy; BIOMETRA Department, University of Milan, Milan, Italy
| | - Sonja Praprotnik
- Department of Rheumatology, University Medical Centre, Ljubljana, Slovenia
| | - Or Bruck
- The Zabludowicz Center for Autoimmune Diseases, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Carlo Perricone
- The Zabludowicz Center for Autoimmune Diseases, Chaim Sheba Medical Center, Tel-Hashomer, Israel; Rheumatology, Department of Medicine, Sapienza Univerisity of Rome, Rome, Italy
| | - Michael Ehrenfeld
- The Zabludowicz Center for Autoimmune Diseases, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Yehuda Shoenfeld
- The Zabludowicz Center for Autoimmune Diseases, Chaim Sheba Medical Center, Tel-Hashomer, Israel; Incumbent of the Laura Schwarz-kipp Chair for Research of Autoimmune Diseases, Sackler Faculty of Medicine, Tel-Aviv University, Israel.
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Abstract
Till date, there is only one reported case of breast implant–associated ALK-negative anaplastic large cell lymphoma (ALCL) with an axillary presentation that followed an aggressive behavior. We report the case of a 50-year-old female presenting with an axillary lymphadenopathy 8 years after breast prostheses implantation. Clinical examination, ultrasound, and magnetic resonance imaging detected no mammary lesions. The lymph node showed intrasinusoidal infiltration by large pleomorphic cells expressing CD30 and lacking ALK-immunoreactivity. Tumor staging was negative. Cells with identical features were found in the ipsilateral periprosthetic capsule. The patient was treated with CHOP and radiotherapy, and she is alive without evidence of disease after a 30-month follow-up. The diagnosis of an ALK-negative ALCL in an axillary lymph node of a patient with ipsilateral breast prosthesis and negative staging should prompt removal of the implant with capsulectomy, since the pathological study of this specimen allows the correct diagnosis with important prognostic implications.
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45
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Zimmerman A, Locke FL, Emole J, Rosa M, Horna P, Hoover S, Dayicioglu D. Recurrent Systemic Anaplastic Lymphoma Kinase–Negative Anaplastic Large Cell Lymphoma Presenting as a Breast Implant–Associated Lesion. Cancer Control 2015; 22:369-73. [DOI: 10.1177/107327481502200317] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Amanda Zimmerman
- Division of Plastic Surgery, Department of Surgery, University of South Florida Morsani College of Medicine, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Frederick L. Locke
- Departments of Blood & Marrow Transplantation, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Josephine Emole
- Hematology/Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Marilin Rosa
- Anatomic Pathology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
- Women's Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Pedro Horna
- Pathology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Susan Hoover
- Breast Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Deniz Dayicioglu
- Plastic Surgery, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
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46
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Armitage JO. The aggressive peripheral T-cell lymphomas: 2015. Am J Hematol 2015; 90:665-73. [PMID: 26031230 DOI: 10.1002/ajh.24076] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 05/27/2015] [Indexed: 12/16/2022]
Abstract
BACKGROUND T-cell lymphomas make up approximately 10%-15% of lymphoid malignancies. The frequency of these lymphomas varies geographically, with the highest incidence in parts of Asia. DIAGNOSIS The diagnosis of aggressive peripheral T-cell lymphoma (PTCL) is usually made using the World Health Organization classification. The ability of hematopathologists to reproducibly diagnosis aggressive PTCL is lower than that for aggressive B-cell lymphomas, with a range of 72%-97% for the aggressive PTCLs. RISK STRATIFICATION Patients with aggressive PTCL are staged using the Ann Arbor Classification. Although somewhat controversial, positron emission tomography scans seem to be useful as they are in aggressive B-cell lymphomas. The most commonly used prognostic index is the International Prognostic Index. The specific subtype of aggressive PTCL is an important risk factor, with the best survival seen in anaplastic large-cell lymphoma-particularly young patients with the anaplastic lymphoma kinase positive subtype. RISK-ADAPTED THERAPY Anaplastic large-cell lymphoma is the only subgroup to have a good response to a CHOP-like regimen. Angioimmunoblastic T-cell lymphoma has a prolonged disease-free survival in only ~20% of patients, but younger patients who have an autotransplant in remission seem to do better. PTCL-not otherwise specified is not one disease. Anthracycline-containing regimens have disappointing results, and a new approach is needed. Natural killer/T-cell lymphoma localized to the nose and nasal sinuses seems to be best treated with radiotherapy-containing regimens. Enteropathy-associated PTCL and hepatosplenic PTCL are rare disorders with a generally poor response to therapy, although selected patients with enteropathy-associated PTCL seem to benefit from intensive therapy.
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47
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Rupani A, Frame JD, Kamel D. Lymphomas Associated with Breast Implants: A Review of the Literature. Aesthet Surg J 2015; 35:533-44. [PMID: 26116741 DOI: 10.1093/asj/sjv016] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Recently there have been concerns raised about anaplastic large cell lymphoma (ALCL) associated with breast implants. OBJECTIVES The main aim of this article was to review and analyze the published literature specifically for hematopoietic malignancies associated with breast implants and postulate a hypothesis for their etiology and pathogenesis. METHODS The PubMed database was searched using key words "lymphoma" and "breast implants" for published papers and abstracts on implant-associated hematopoietic malignancies. RESULTS The authors found 83 published cases reported of lymphomas associated with breast implants in the medical literature. The reported cases involved various subtypes of lymphomas and the majority were ALCL, of which 66 were confirmed as ALK negative; however there was no association with any particular type of implant. The more aggressive cases and reported low death rate appeared to be related to the presence of breast masses at the time of presentation rather than effusion. The remaining reports were occasional case reports of T-cell lymphoma, follicular lymphoma, marginal zone B-cell lymphoma, primary effusion lymphoma and lymphoplasmacytic lymphoma. CONCLUSIONS Considering the many thousands of women that have breast implants every year; the compiled data show that there is a very small risk of developing lymphoma. Increased awareness of association between implants and ALCL is needed globally and prospective patients considering breast implants should be fully informed of the risk. As the behavior of ALCL in these cases was indolent as compared with other primary breast lymphomas, it could suggest an abnormal reactive process. LEVEL OF EVIDENCE 3
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Affiliation(s)
- Asha Rupani
- Dr Rupani is a Specialist Registrar and Dr Kamel is a Consultant Histopathologist, Department of Histopathology, Broomfield Hospital, Chelmsford, United Kingdom. Dr Frame is a Professor of Aesthetic Plastic Surgery at the Post Graduate Medical Institute, Anglia Ruskin University (Chelmsford and Cambridge), Chelmsford, United Kingdom
| | - James D Frame
- Dr Rupani is a Specialist Registrar and Dr Kamel is a Consultant Histopathologist, Department of Histopathology, Broomfield Hospital, Chelmsford, United Kingdom. Dr Frame is a Professor of Aesthetic Plastic Surgery at the Post Graduate Medical Institute, Anglia Ruskin University (Chelmsford and Cambridge), Chelmsford, United Kingdom
| | - Dia Kamel
- Dr Rupani is a Specialist Registrar and Dr Kamel is a Consultant Histopathologist, Department of Histopathology, Broomfield Hospital, Chelmsford, United Kingdom. Dr Frame is a Professor of Aesthetic Plastic Surgery at the Post Graduate Medical Institute, Anglia Ruskin University (Chelmsford and Cambridge), Chelmsford, United Kingdom
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Montgomery-Goecker C, Fuda F, Krueger JE, Chen W. Immunophenotypic characteristics of breast implant-associated anaplastic large-cell lymphoma by flow cytometry. CYTOMETRY PART B-CLINICAL CYTOMETRY 2015; 88:291-3. [DOI: 10.1002/cyto.b.21222] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | - Franklin Fuda
- Department of Pathology; University of Texas Southwestern Medical Center; Dallas Texas
| | | | - Weina Chen
- Department of Pathology; University of Texas Southwestern Medical Center; Dallas Texas
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Xu J, Wei S. Breast implant-associated anaplastic large cell lymphoma: review of a distinct clinicopathologic entity. Arch Pathol Lab Med 2014; 138:842-6. [PMID: 24878027 DOI: 10.5858/arpa.2013-0068-rs] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Primary breast anaplastic large cell lymphoma (ALCL) is rare but is more commonly seen in patients with implants; fewer than 50 cases of breast implant-associated ALCL have been reported in the English language literature. Breast implant-associated ALCL is not a disease of the breast parenchyma, but instead is a disease of the fibrous capsule surrounding the implant. The patients usually present with an effusion around the implant and, rarely, with a solid mass. Morphologically, the neoplastic cells are large, epithelioid, and pleomorphic, with abundant cytoplasm, vesicular irregular nuclei, and frequent mitoses. Occasional "hallmark" cells may be present. The lesional cells typically show strong and diffuse immunoreactivity for CD30 and often express T-cell markers, cytotoxic-associated antigens, and epithelial membrane antigen. Almost all reported cases are negative for anaplastic lymphoma kinase. Molecular genetic analyses have demonstrated T-cell receptor gene rearrangements. The differential diagnosis essentially includes poorly differentiated carcinoma, other lymphomas, and chronic inflammation. Once a diagnosis of lymphoma is established, it is important to exclude systemic anaplastic lymphoma kinase-negative ALCL involving the breast, primary cutaneous ALCL, and other CD30(+) lymphoproliferative disorders. The patients with effusion-associated ALCL often have an indolent course and excellent prognosis, responding well to excision of the fibrous capsule around the implant (capsulectomy) and implant removal. In contrast, patients who present with a distinct mass may have a more aggressive course and poor prognosis, requiring chemotherapy and/or radiation therapy.
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Affiliation(s)
- Jie Xu
- From the Department of Pathology, University of Alabama at Birmingham
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Chai SM, Kavangh S, Ooi SS, Sterrett GF, Cull G, Plunkett M, Spagnolo D, Amanuel B, Joske D, Leslie C, Barham T, Frost F. Anaplastic large-cell lymphoma associated with breast implants: A unique entity within the spectrum of peri-implant effusions. Diagn Cytopathol 2014; 42:929-38. [DOI: 10.1002/dc.23152] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Revised: 03/09/2014] [Accepted: 03/13/2014] [Indexed: 12/17/2022]
Affiliation(s)
- Siaw Ming Chai
- Department of Anatomical Pathology, PathWest Laboratory Medicine; QEII Medical Centre; Nedlands Western Australia Australia
| | - Simon Kavangh
- Department of Haematology; Sir Charles Gairdner Hospital; Nedlands Western Australia Australia
| | - Sin Sin Ooi
- Department of Anatomical Pathology, PathWest Laboratory Medicine; QEII Medical Centre; Nedlands Western Australia Australia
| | - Gregory F. Sterrett
- Department of Anatomical Pathology, PathWest Laboratory Medicine; QEII Medical Centre; Nedlands Western Australia Australia
- School of Pathology and Laboratory Medicine; University of Western Australia; Crawley Western Australia Australia
| | - Gavin Cull
- Department of Haematology; Sir Charles Gairdner Hospital; Nedlands Western Australia Australia
| | - Myfanwy Plunkett
- Department of Anatomical Pathology, PathWest Laboratory Medicine; QEII Medical Centre; Nedlands Western Australia Australia
| | - Dominic Spagnolo
- Department of Anatomical Pathology, PathWest Laboratory Medicine; QEII Medical Centre; Nedlands Western Australia Australia
- School of Pathology and Laboratory Medicine; University of Western Australia; Crawley Western Australia Australia
| | - Benhur Amanuel
- Department of Anatomical Pathology, PathWest Laboratory Medicine; QEII Medical Centre; Nedlands Western Australia Australia
- School of Pathology and Laboratory Medicine; University of Western Australia; Crawley Western Australia Australia
| | - David Joske
- Department of Haematology; Sir Charles Gairdner Hospital; Nedlands Western Australia Australia
- School of Pathology and Laboratory Medicine; University of Western Australia; Crawley Western Australia Australia
| | - Connull Leslie
- Department of Anatomical Pathology, PathWest Laboratory Medicine; QEII Medical Centre; Nedlands Western Australia Australia
| | - Tony Barham
- Perth Medical Laboratories; Fremantle Western Australia Australia
| | - Felicity Frost
- Department of Anatomical Pathology, PathWest Laboratory Medicine; QEII Medical Centre; Nedlands Western Australia Australia
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