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Santanelli di Pompeo F, Sorotos M, Clemens MW, Firmani G, Athanasopoulos E, Arctander K, Berenguer B, Bozikov K, Cardoso A, Nord ÅE, Filip C, Georgeskou Romania A, Heitman C, Kaarela O, Kolenda M, Hamdi M, Lantieri L, Lumenta D, Mercer N, Ruegg E, Santanelli di Pompeo F, Stanec Z, Van Der Hulst R, Vranckx JJ. Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL): Review of Epidemiology and Prevalence Assessment in Europe. Aesthet Surg J 2021; 41:1014-1025. [PMID: 33022037 DOI: 10.1093/asj/sjaa285] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) epidemiologic studies focus on incidence and risk estimates. OBJECTIVES The aim of this study was to perform a thorough literature review, and to provide an accurate estimate of BIA-ALCL prevalence in Europe. METHODS We searched PubMed, Web of Science, SCOPUS, and Google Scholar databases to identify publications reporting BIA-ALCL epidemiology. Research was conducted between November 2019 and August 2020. European prevalence was assessed as the ratio between pathology-confirmed cases and breast implant-bearing individuals. The Committee on Device Safety and Development (CDSD) collected data from national plastic surgery societies, health authorities, and disease-specific registries to calculate the numerator. The denominator was estimated by combining European demographic data with scientific reports. RESULTS Our research identified 507 articles: 106 were excluded for not being relevant to BIA-ALCL. From the remaining 401 articles, we selected 35 that discussed epidemiology and 12 reviews. The CDSD reported 420 cases in Europe, with an overall prevalence of 1:13,745 cases in the 28 member states of the European Union (EU-28). Countries where specific measures have been implemented to tackle BIA-ALCL account for 61% of the EU-28 population and actively reported 382 cases with an overall prevalence of 1:9121. CONCLUSION Countries where specific measures have been implemented show a higher prevalence of BIA-ALCL compared with the European mean, suggesting that these countries have improved the detection of the condition and reduced underreporting, which affects the numerator value. Other nations should adopt projections based on these measures to avoid underestimating how widespread BIA-ALCL is. LEVEL OF EVIDENCE: 4
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Affiliation(s)
| | - Michail Sorotos
- Department of Medicine, Surgery and Dentistry, PhD School of Translational Medicine of Development and Active Ageing, Università degli Studi di Salerno, Salerno, Italy
| | - Mark W Clemens
- Department of Plastic Surgery, M.D. Anderson Cancer Center, TX, USA
| | - Guido Firmani
- School of Medicine and Psychology, Sapienza University, Rome, Italy
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12
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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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de Boer M, van der Sluis WB, de Boer JP, Overbeek LIH, van Leeuwen FE, Rakhorst HA, van der Hulst RRWJ, Hijmering NJ, Bouman MB, de Jong D. Breast Implant-Associated Anaplastic Large-Cell Lymphoma in a Transgender Woman. Aesthet Surg J 2017; 37:NP83-NP87. [PMID: 29036941 DOI: 10.1093/asj/sjx098] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) is a rare but serious complication in patients with breast implants, Patients are at risk of BIA-ALCL whether they receive breast implants for cosmetic reasons or for reconstructive purposes after surgery for breast cancer or prophylactic mastectomy. During the past decade, an increased number of reports have addressed BIA-ALCL. Herein, we describe BIA-ALCL in a transgender woman. The patient received breast implants as part of her gender transition and was diagnosed with BIA-ALCL 20 years later. The patient underwent several revisional operations in the 20 years after her primary breast surgery to treat unexplained pain with low-grade fever, severe capsular contracture (Baker grade III-IV), and several instances of implant rupture. In July 2016, the patient presented to our office with "late-onset" periprosthetic seroma 5 years after her last revisional breast surgery. She was diagnosed with BIA-ALCL without capsular invasion based on results of cytologic analysis of the periprosthetic seroma and histologic evaluation of the periprosthetic capsule. This diagnosis was verified further by results of immunohistochemical testing, which indicated expression of CD30 and T-cell markers in the periprosthetic seroma only. Our intentions with this case report are to demonstrate that all patients who undergo breast implantation, including transgender women, are at risk of BIA-ALCL and to highlight the importance of cytomorphologic and immunohistochemical screening of seroma fluid in patients with late-onset periprosthetic seroma. LEVEL OF EVIDENCE 5.
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Affiliation(s)
- Mintsje de Boer
- Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Center, Maastricht, the Netherlands. Department of Plastic, Reconstructive, and Hand Surgery, VU University Medical Center, Amsterdam, the Netherlands. Department of Oncology, Netherlands Cancer Institute, Amsterdam. Dutch Nationwide Network and Registry of Histo- and Cytopathology, Houten, the Netherlands. Division of Epidemiology, Netherlands Cancer Institute, Amsterdam. Department of Plastic, Reconstructive, and Hand Surgery, MST, Enschede, the Netherlands, Dutch Society of Plastic Surgery. Division of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Center. Department of Pathology, VU University Medical Center. Department of Plastic, Reconstructive, and Hand Surgery, VU University Medical Center. Center of Expertise on Gender Dysphoria at the VU University Medical Center. Division of Pathology, VU University Medical Center. Dutch BIA-ALCL Consortium
| | - Wouter B van der Sluis
- Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Center, Maastricht, the Netherlands. Department of Plastic, Reconstructive, and Hand Surgery, VU University Medical Center, Amsterdam, the Netherlands. Department of Oncology, Netherlands Cancer Institute, Amsterdam. Dutch Nationwide Network and Registry of Histo- and Cytopathology, Houten, the Netherlands. Division of Epidemiology, Netherlands Cancer Institute, Amsterdam. Department of Plastic, Reconstructive, and Hand Surgery, MST, Enschede, the Netherlands, Dutch Society of Plastic Surgery. Division of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Center. Department of Pathology, VU University Medical Center. Department of Plastic, Reconstructive, and Hand Surgery, VU University Medical Center. Center of Expertise on Gender Dysphoria at the VU University Medical Center. Division of Pathology, VU University Medical Center. Dutch BIA-ALCL Consortium
| | - Jan P de Boer
- Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Center, Maastricht, the Netherlands. Department of Plastic, Reconstructive, and Hand Surgery, VU University Medical Center, Amsterdam, the Netherlands. Department of Oncology, Netherlands Cancer Institute, Amsterdam. Dutch Nationwide Network and Registry of Histo- and Cytopathology, Houten, the Netherlands. Division of Epidemiology, Netherlands Cancer Institute, Amsterdam. Department of Plastic, Reconstructive, and Hand Surgery, MST, Enschede, the Netherlands, Dutch Society of Plastic Surgery. Division of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Center. Department of Pathology, VU University Medical Center. Department of Plastic, Reconstructive, and Hand Surgery, VU University Medical Center. Center of Expertise on Gender Dysphoria at the VU University Medical Center. Division of Pathology, VU University Medical Center. Dutch BIA-ALCL Consortium
| | - Lucy I H Overbeek
- Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Center, Maastricht, the Netherlands. Department of Plastic, Reconstructive, and Hand Surgery, VU University Medical Center, Amsterdam, the Netherlands. Department of Oncology, Netherlands Cancer Institute, Amsterdam. Dutch Nationwide Network and Registry of Histo- and Cytopathology, Houten, the Netherlands. Division of Epidemiology, Netherlands Cancer Institute, Amsterdam. Department of Plastic, Reconstructive, and Hand Surgery, MST, Enschede, the Netherlands, Dutch Society of Plastic Surgery. Division of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Center. Department of Pathology, VU University Medical Center. Department of Plastic, Reconstructive, and Hand Surgery, VU University Medical Center. Center of Expertise on Gender Dysphoria at the VU University Medical Center. Division of Pathology, VU University Medical Center. Dutch BIA-ALCL Consortium
| | - Flora E van Leeuwen
- Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Center, Maastricht, the Netherlands. Department of Plastic, Reconstructive, and Hand Surgery, VU University Medical Center, Amsterdam, the Netherlands. Department of Oncology, Netherlands Cancer Institute, Amsterdam. Dutch Nationwide Network and Registry of Histo- and Cytopathology, Houten, the Netherlands. Division of Epidemiology, Netherlands Cancer Institute, Amsterdam. Department of Plastic, Reconstructive, and Hand Surgery, MST, Enschede, the Netherlands, Dutch Society of Plastic Surgery. Division of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Center. Department of Pathology, VU University Medical Center. Department of Plastic, Reconstructive, and Hand Surgery, VU University Medical Center. Center of Expertise on Gender Dysphoria at the VU University Medical Center. Division of Pathology, VU University Medical Center. Dutch BIA-ALCL Consortium
| | - Hinne A Rakhorst
- Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Center, Maastricht, the Netherlands. Department of Plastic, Reconstructive, and Hand Surgery, VU University Medical Center, Amsterdam, the Netherlands. Department of Oncology, Netherlands Cancer Institute, Amsterdam. Dutch Nationwide Network and Registry of Histo- and Cytopathology, Houten, the Netherlands. Division of Epidemiology, Netherlands Cancer Institute, Amsterdam. Department of Plastic, Reconstructive, and Hand Surgery, MST, Enschede, the Netherlands, Dutch Society of Plastic Surgery. Division of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Center. Department of Pathology, VU University Medical Center. Department of Plastic, Reconstructive, and Hand Surgery, VU University Medical Center. Center of Expertise on Gender Dysphoria at the VU University Medical Center. Division of Pathology, VU University Medical Center. Dutch BIA-ALCL Consortium
| | - René R W J van der Hulst
- Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Center, Maastricht, the Netherlands. Department of Plastic, Reconstructive, and Hand Surgery, VU University Medical Center, Amsterdam, the Netherlands. Department of Oncology, Netherlands Cancer Institute, Amsterdam. Dutch Nationwide Network and Registry of Histo- and Cytopathology, Houten, the Netherlands. Division of Epidemiology, Netherlands Cancer Institute, Amsterdam. Department of Plastic, Reconstructive, and Hand Surgery, MST, Enschede, the Netherlands, Dutch Society of Plastic Surgery. Division of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Center. Department of Pathology, VU University Medical Center. Department of Plastic, Reconstructive, and Hand Surgery, VU University Medical Center. Center of Expertise on Gender Dysphoria at the VU University Medical Center. Division of Pathology, VU University Medical Center. Dutch BIA-ALCL Consortium
| | - Nathalie J Hijmering
- Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Center, Maastricht, the Netherlands. Department of Plastic, Reconstructive, and Hand Surgery, VU University Medical Center, Amsterdam, the Netherlands. Department of Oncology, Netherlands Cancer Institute, Amsterdam. Dutch Nationwide Network and Registry of Histo- and Cytopathology, Houten, the Netherlands. Division of Epidemiology, Netherlands Cancer Institute, Amsterdam. Department of Plastic, Reconstructive, and Hand Surgery, MST, Enschede, the Netherlands, Dutch Society of Plastic Surgery. Division of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Center. Department of Pathology, VU University Medical Center. Department of Plastic, Reconstructive, and Hand Surgery, VU University Medical Center. Center of Expertise on Gender Dysphoria at the VU University Medical Center. Division of Pathology, VU University Medical Center. Dutch BIA-ALCL Consortium
| | - Mark-Bram Bouman
- Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Center, Maastricht, the Netherlands. Department of Plastic, Reconstructive, and Hand Surgery, VU University Medical Center, Amsterdam, the Netherlands. Department of Oncology, Netherlands Cancer Institute, Amsterdam. Dutch Nationwide Network and Registry of Histo- and Cytopathology, Houten, the Netherlands. Division of Epidemiology, Netherlands Cancer Institute, Amsterdam. Department of Plastic, Reconstructive, and Hand Surgery, MST, Enschede, the Netherlands, Dutch Society of Plastic Surgery. Division of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Center. Department of Pathology, VU University Medical Center. Department of Plastic, Reconstructive, and Hand Surgery, VU University Medical Center. Center of Expertise on Gender Dysphoria at the VU University Medical Center. Division of Pathology, VU University Medical Center. Dutch BIA-ALCL Consortium
| | - Daphne de Jong
- Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Center, Maastricht, the Netherlands. Department of Plastic, Reconstructive, and Hand Surgery, VU University Medical Center, Amsterdam, the Netherlands. Department of Oncology, Netherlands Cancer Institute, Amsterdam. Dutch Nationwide Network and Registry of Histo- and Cytopathology, Houten, the Netherlands. Division of Epidemiology, Netherlands Cancer Institute, Amsterdam. Department of Plastic, Reconstructive, and Hand Surgery, MST, Enschede, the Netherlands, Dutch Society of Plastic Surgery. Division of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Center. Department of Pathology, VU University Medical Center. Department of Plastic, Reconstructive, and Hand Surgery, VU University Medical Center. Center of Expertise on Gender Dysphoria at the VU University Medical Center. Division of Pathology, VU University Medical Center. Dutch BIA-ALCL Consortium
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