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D’Orsi G, Giacalone M, Calicchia A, Gagliano E, Vannucchi L, Vanni G, Buonomo OC, Cervelli V, Longo B. BIA-ALCL and BIA-SCC: Updates on Clinical Features and Genetic Mutations for Latest Recommendations. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:793. [PMID: 38792976 PMCID: PMC11122735 DOI: 10.3390/medicina60050793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 05/03/2024] [Accepted: 05/07/2024] [Indexed: 05/26/2024]
Abstract
Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) and Breast Implant-Associated Squamous Cell Carcinoma (BIA-SCC) are emerging neoplastic complications related to breast implants. While BIA-ALCL is often linked to macrotextured implants, current evidence does not suggest an implant-type association for BIA-SCC. Chronic inflammation and genetics have been hypothesized as key pathogenetic players, although for both conditions, the exact mechanisms and specific risks related to breast implants are yet to be established. While the genetic alterations in BIA-SCC are still unknown, JAK-STAT pathway activation has been outlined as a dominant signature of BIA-ALCL. Recent genetic investigation has uncovered various molecular players, including MEK-ERK, PI3K/AKT, CDK4-6, and PDL1. The clinical presentation of BIA-ALCL and BIA-SCC overlaps, including most commonly late seroma and breast swelling, warranting ultrasound and cytological examinations, which are the first recommended steps as part of the diagnostic work-up. While the role of mammography is still limited, MRI and CT-PET are recommended according to the clinical presentation and for disease staging. To date, the mainstay of treatment for BIA-ALCL and BIA-SCC is implant removal with en-bloc capsulectomy. Chemotherapy and radiation therapy have also been used for advanced-stage BIA-ALCL and BIA-SCC. In-depth characterization of the tumor genetics is key for the development of novel therapeutic strategies, especially for advanced stage BIA-ALCL and BIA-SCC, which show a more aggressive course and poor prognosis.
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Affiliation(s)
- Gennaro D’Orsi
- PhD School of Applied Medical-Surgical Sciences, Tor Vergata University of Rome, Via Montpellier 1, 00133 Rome, Italy
| | - Martina Giacalone
- Plastic and Reconstructive Surgery at Department of Surgical Science, Tor Vergata University of Rome, Via Montpellier 1, 00133 Rome, Italy
| | - Alessio Calicchia
- Plastic and Reconstructive Surgery at Department of Surgical Science, Tor Vergata University of Rome, Via Montpellier 1, 00133 Rome, Italy
| | - Elettra Gagliano
- Plastic and Reconstructive Surgery at Department of Surgical Science, Tor Vergata University of Rome, Via Montpellier 1, 00133 Rome, Italy
| | - Lisa Vannucchi
- Plastic and Reconstructive Surgery at Department of Surgical Science, Tor Vergata University of Rome, Via Montpellier 1, 00133 Rome, Italy
| | - Gianluca Vanni
- Division of Breast Unit, Department of Surgical Sciences, School of Medicine and Surgery, Tor Vergata University of Rome, Via Montpellier 1, 00133 Rome, Italy
| | - Oreste Claudio Buonomo
- Division of Breast Unit, Department of Surgical Sciences, School of Medicine and Surgery, Tor Vergata University of Rome, Via Montpellier 1, 00133 Rome, Italy
| | - Valerio Cervelli
- Plastic and Reconstructive Surgery at Department of Surgical Science, Tor Vergata University of Rome, Via Montpellier 1, 00133 Rome, Italy
| | - Benedetto Longo
- Plastic and Reconstructive Surgery at Department of Surgical Science, Tor Vergata University of Rome, Via Montpellier 1, 00133 Rome, Italy
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2
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Vinci V, Belgiovine C, Janszen G, Agnelli B, Pellegrino L, Calcaterra F, Cancellara A, Ciceri R, Benedetti A, Cardenas C, Colombo F, Supino D, Lozito A, Caimi E, Monari M, Klinger FM, Riccipetitoni G, Raffaele A, Comoli P, Allavena P, Mavilio D, Di Landro L, Klinger M, Rusconi R. Breast implant surface topography triggers a chronic-like inflammatory response. Life Sci Alliance 2024; 7:e202302132. [PMID: 38383454 PMCID: PMC10881835 DOI: 10.26508/lsa.202302132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 02/12/2024] [Accepted: 02/13/2024] [Indexed: 02/23/2024] Open
Abstract
Breast implants are extensively employed for both reconstructive and esthetic purposes. However, the safety of breast implants with textured surfaces has been questioned, owing to a potential correlation with anaplastic large-cell lymphoma and the recurrence of breast cancer. This study investigates the immune response elicited by different prosthetic surfaces, focusing on the comparison between macrotextured and microtextured breast implants. Through the analysis of intraoperatively harvested periprosthetic fluids and cell culture experiments on surface replicas, we demonstrate that macrotextured surfaces elicit a more pronounced chronic-like activation of leucocytes and an increased release of inflammatory cytokines, in contrast to microtextured surfaces. In addition, in vitro fluorescent imaging of leucocytes revealed an accumulation of lymphocytes within the cavities of the macrotextured surfaces, indicating that the physical entrapment of these cells may contribute to their activation. These findings suggest that the topography of implant surfaces plays a significant role in promoting a chronic-like inflammatory environment, which could be a contributing factor in the development of lymphomas associated with a wide range of implantable devices.
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Affiliation(s)
- Valeriano Vinci
- IRCCS Humanitas Research Hospital, Rozzano, Italy
- https://ror.org/020dggs04 Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Cristina Belgiovine
- IRCCS Humanitas Research Hospital, Rozzano, Italy
- https://ror.org/00s6t1f81 Department of Clinical, Surgical, Diagnostics and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Gerardus Janszen
- Department of Aerospace Science and Technology, Politecnico di Milano, Milan, Italy
| | - Benedetta Agnelli
- https://ror.org/020dggs04 Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Luca Pellegrino
- https://ror.org/020dggs04 Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Francesca Calcaterra
- IRCCS Humanitas Research Hospital, Rozzano, Italy
- https://ror.org/00wjc7c48 Department of Medical Biotechnologies and Translational Medicine, University of Milan, Milan, Italy
| | - Assunta Cancellara
- IRCCS Humanitas Research Hospital, Rozzano, Italy
- https://ror.org/00wjc7c48 Department of Medical Biotechnologies and Translational Medicine, University of Milan, Milan, Italy
| | - Roberta Ciceri
- IRCCS Humanitas Research Hospital, Rozzano, Italy
- https://ror.org/00wjc7c48 Department of Medical Biotechnologies and Translational Medicine, University of Milan, Milan, Italy
| | - Alessandra Benedetti
- Department of Aerospace Science and Technology, Politecnico di Milano, Milan, Italy
| | | | | | | | - Alessia Lozito
- https://ror.org/020dggs04 Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Edoardo Caimi
- https://ror.org/020dggs04 Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Marta Monari
- IRCCS Humanitas Research Hospital, Rozzano, Italy
| | | | - Giovanna Riccipetitoni
- https://ror.org/00s6t1f81 Department of Clinical, Surgical, Diagnostics and Pediatric Sciences, University of Pavia, Pavia, Italy
- Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | | | - Paola Allavena
- IRCCS Humanitas Research Hospital, Rozzano, Italy
- https://ror.org/020dggs04 Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Domenico Mavilio
- IRCCS Humanitas Research Hospital, Rozzano, Italy
- https://ror.org/00wjc7c48 Department of Medical Biotechnologies and Translational Medicine, University of Milan, Milan, Italy
| | - Luca Di Landro
- Department of Aerospace Science and Technology, Politecnico di Milano, Milan, Italy
| | - Marco Klinger
- IRCCS Humanitas Research Hospital, Rozzano, Italy
- https://ror.org/00wjc7c48 Department of Medical Biotechnologies and Translational Medicine, University of Milan, Milan, Italy
| | - Roberto Rusconi
- IRCCS Humanitas Research Hospital, Rozzano, Italy
- https://ror.org/020dggs04 Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
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3
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Foppiani JA, Raska O, Taritsa I, Hernandez Alvarez A, Lee D, Escobar-Domingo MJ, Berger J, Klener P, Schuster KA, Abdo D, Clemens MW, Lin SJ. Incidental Bystander or Essential Culprit: A Systematic Review of Bacterial Significance in the Pathogenesis of Breast Implant-Associated Anaplastic Large Cell Lymphoma. Int J Mol Sci 2023; 25:355. [PMID: 38203524 PMCID: PMC10778958 DOI: 10.3390/ijms25010355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 12/18/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024] Open
Abstract
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a distinct subtype of T-cell non-Hodgkin lymphoma that arises in the context of prolonged exposure to textured breast implants. The intent of this manuscript is to explore whether the bacterial presence in biofilms on these implants is a mere incidental finding or plays a pivotal role in the pathogenesis of BIA-ALCL. Our goal is to delineate the extent of bacterial involvement, offering insights into potential underlying mechanisms, and establishing future research priorities aimed at resolving the remaining uncertainties surrounding this complex association. A comprehensive systematic review of several databases was performed. The search strategy was designed and conducted by an experienced librarian using controlled vocabulary with keywords. The electronic search identified 442 publications. After evaluation, six studies from 2015 to 2021 were included, encompassing 201 female patients aged 23 to 75. The diagnosis span post-implantation ranged from 53 to 135.6 months. Studies consistently found bacteria near breast implants in both BIA-ALCL cases and controls, with varied microbial findings. Both BIA-ALCL cases and controls exhibited the presence of specific bacteria, including Pseudomonas aeruginosa, Klebsiella oxytoca, Staphylococcus aureus, and Ralstonia spp., without any statistically significant differences between groups. The use of antiseptic and antimicrobial agents during implant insertion did not demonstrate any impact on reducing or altering the risk of developing BIA-ALCL. Our systematic review reveals that the current evidence is inadequate to link bacterial etiology as a central factor in the development of BIA-ALCL. The limitations in the existing data prevent a complete dismissal of the role of biofilms in its pathogenesis. The observed gap in knowledge underscores the need for more focused and comprehensive research, which should be structured in a multi-faceted approach. Initially, this involves the utilization of sophisticated genomic and proteomic methods. Following this, it is crucial to delve into the study of immunological reactions specifically induced by biofilms. Finally, this research should incorporate extended observational studies, meticulously tracking the evolution of biofilm development and its correlation with the emergence of BIA-ALCL. In light of the inconclusive nature of current findings, further investigation is not only justified but urgently needed to clarify these unresolved issues.
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Affiliation(s)
- Jose A. Foppiani
- Division of Plastic Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA; (J.A.F.); (I.T.); (A.H.A.); (D.L.); (M.J.E.-D.); (K.A.S.); (S.J.L.)
- Institute of Pathological Physiology, First Faculty of Medicine, Charles University, 12108 Prague, Czech Republic
| | - Otakar Raska
- Institute of Pathological Physiology, First Faculty of Medicine, Charles University, 12108 Prague, Czech Republic
| | - Iulianna Taritsa
- Division of Plastic Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA; (J.A.F.); (I.T.); (A.H.A.); (D.L.); (M.J.E.-D.); (K.A.S.); (S.J.L.)
| | - Angelica Hernandez Alvarez
- Division of Plastic Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA; (J.A.F.); (I.T.); (A.H.A.); (D.L.); (M.J.E.-D.); (K.A.S.); (S.J.L.)
| | - Daniela Lee
- Division of Plastic Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA; (J.A.F.); (I.T.); (A.H.A.); (D.L.); (M.J.E.-D.); (K.A.S.); (S.J.L.)
| | - Maria J. Escobar-Domingo
- Division of Plastic Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA; (J.A.F.); (I.T.); (A.H.A.); (D.L.); (M.J.E.-D.); (K.A.S.); (S.J.L.)
| | | | - Pavel Klener
- Institute of Pathological Physiology, First Faculty of Medicine, Charles University, 12108 Prague, Czech Republic
- First Department of Internal Medicine, Department of Hematology, First Faculty of Medicine Charles University, General University Hospital, 12808 Prague, Czech Republic
| | - Kirsten A. Schuster
- Division of Plastic Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA; (J.A.F.); (I.T.); (A.H.A.); (D.L.); (M.J.E.-D.); (K.A.S.); (S.J.L.)
| | - Daoud Abdo
- Institute of Pathological Physiology, First Faculty of Medicine, Charles University, 12108 Prague, Czech Republic
| | - Mark W. Clemens
- MD Anderson Cancer Center, The University of Texas, Houston, TX 77030, USA;
| | - Samuel J. Lin
- Division of Plastic Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA; (J.A.F.); (I.T.); (A.H.A.); (D.L.); (M.J.E.-D.); (K.A.S.); (S.J.L.)
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4
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Swanson E. Breast Implant-Associated Anaplastic Large-Cell Lymphoma: Finding Fault Comes Full Circle. Ann Plast Surg 2023; 91:634-637. [PMID: 37651688 DOI: 10.1097/sap.0000000000003684] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Affiliation(s)
- Eric Swanson
- Dr Swanson is a plastic surgeon in private practice in Leawood, Kansas
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Deva AK. Commentary on: BIA-ALCL Epidemiology in an Aesthetic Breast Surgery Cohort of 1501 Patients. Aesthet Surg J 2023; 43:1269-1272. [PMID: 37366560 DOI: 10.1093/asj/sjad199] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 06/19/2023] [Accepted: 06/20/2023] [Indexed: 06/28/2023] Open
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6
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The Role of Microorganisms in the Development of Breast Implant-Associated Anaplastic Large Cell Lymphoma. Pathogens 2023; 12:pathogens12020313. [PMID: 36839585 PMCID: PMC9961223 DOI: 10.3390/pathogens12020313] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/06/2023] [Accepted: 02/13/2023] [Indexed: 02/16/2023] Open
Abstract
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a variant of anaplastic large cell lymphoma (ALCL) associated with textured-surface silicone breast implants. Since first being described in 1997, over 1100 cases have been currently reported worldwide. A causal relationship between BIA-ALCL and textured implants has been established in epidemiological studies, but a multifactorial process is likely to be involved in the pathogenesis of BIA-ALCL. However, pathophysiologic mechanisms remain unclear. One of the hypotheses that could explain the link between textured implants and BIA-ALCL consists in the greater tendency of bacterial biofilm in colonizing the surface of textured implants compared to smooth implants, and the resulting chronic inflammation which, in predisposed individuals, may lead to tumorigenesis. This review summarizes the existing evidence on the role of micro-organisms and rough surface implants in the development of BIA-ALCL. It also provides insights into the most updated clinical practice knowledge about BIA-ALCL, from clinical presentation and investigation to treatment and outcomes.
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7
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Clinical recommendations for diagnosis and treatment according to current updated knowledge on BIA-ALCL. Breast 2022; 66:332-341. [PMID: 36502569 PMCID: PMC9763507 DOI: 10.1016/j.breast.2022.11.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 11/20/2022] [Accepted: 11/28/2022] [Indexed: 12/05/2022] Open
Abstract
Shared strategies and correct information are essential to guide physicians in the management of such an uncommon disease as Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL). A systematic review of the literature was performed to collect the most relevant evidence on BIA-ALCL reported cases. A panel of multidisciplinary experts discussed the scientific evidence on BIA-ALCL, and updated consensus recommendations were developed through the Delphi process. The lastest reported Italian incidence of BIA-ALCL is 3.5 per 100.000 implanted patients (95% CI, 1.36 to 5.78), and the disease counts over 1216 cases worldwide as of June 2022. The most common presentation symptom is a late onset seroma followed by a palpable breast mass. In the event of a suspicious case, ultrasound-guided fine-needle aspiration should be the first step in evaluation, followed by cytologic and immunohistochemical examination. In patients with confirmed diagnosis of BIA-ALCL confined to the capsule, the en-bloc capsulectomy should be performed, followed by immediate autologous reconstruction, while delayed reconstruction applies for disseminate disease or radically unresectable tumor. Nevertheless, a multidisciplinary team approach is essential for the correct management of this pathology.
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8
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Lee SW, Johnson EL, Chediak JA, Shin H, Wang Y, Phillips KS, Ren D. High-Throughput Biofilm Assay to Investigate Bacterial Interactions with Surface Topographies. ACS APPLIED BIO MATERIALS 2022; 5:3816-3825. [PMID: 35816421 PMCID: PMC9382637 DOI: 10.1021/acsabm.2c00367] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
![]()
The specific topography of biomaterials plays an important
role
in their biological interactions with cells and thus the safety of
medical implants. Antifouling materials can be engineered with topographic
features to repel microbes. Meanwhile, undesired topographies of implants
can cause complications such as breast implant-associated anaplastic
large cell lymphoma (BIA-ALCL). While the cause of BIA-ALCL is not
well understood, it is speculated that textured surfaces are prone
to bacterial biofilm formation as a contributing factor. To guide
the design of safer biomaterials and implants, quantitative screening
approaches are needed to assess bacterial adhesion to different topographic
surface features. Here we report the development of a high-throughput
microplate biofilm assay for such screening. The assay was used to
test a library of polydimethylsiloxane (PDMS) textures composed of
varying sizes of recessive features and distances between features
including those in the range of breast implant textures. Outliers
of patterns prone to bacterial adhesion were further studied using
real-time confocal fluorescence microscopy. The results from these
analyses revealed that surface area itself is a poor predictor for
adhesion, while the size and spacing of topographic features play
an important role. This high-throughput biofilm assay can be applied
to studying bacteria–material interactions and rational development
of materials that inhibit bacterial colonization.
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Affiliation(s)
- Sang Won Lee
- Department of Biomedical and Chemical Engineering, Syracuse University, Syracuse, New York 13244, United States.,Office of Medical Products and Tobacco, Center for Devices and Radiological Health, Office of Science and Engineering Laboratories, Division of Biology, Chemistry, and Materials Science, United States Food and Drug Administration, Silver Spring, Maryland 20993, United States
| | - Erick L Johnson
- Mechanical and Industrial Engineering, Montana State University, Bozeman, Montana 59717, United States
| | - J Alex Chediak
- Office of Medical Products and Tobacco, Center for Devices and Radiological Health, Office of Science and Engineering Laboratories, Division of Biology, Chemistry, and Materials Science, United States Food and Drug Administration, Silver Spring, Maryland 20993, United States.,Department of Mathematical Sciences, California Baptist University, Riverside, California 92504, United States
| | - Hainsworth Shin
- Office of Medical Products and Tobacco, Center for Devices and Radiological Health, Office of Science and Engineering Laboratories, Division of Biology, Chemistry, and Materials Science, United States Food and Drug Administration, Silver Spring, Maryland 20993, United States
| | - Yi Wang
- Office of Medical Products and Tobacco, Center for Devices and Radiological Health, Office of Science and Engineering Laboratories, Division of Biology, Chemistry, and Materials Science, United States Food and Drug Administration, Silver Spring, Maryland 20993, United States
| | - K Scott Phillips
- Office of Medical Products and Tobacco, Center for Devices and Radiological Health, Office of Science and Engineering Laboratories, Division of Biology, Chemistry, and Materials Science, United States Food and Drug Administration, Silver Spring, Maryland 20993, United States
| | - Dacheng Ren
- Department of Biomedical and Chemical Engineering, Syracuse University, Syracuse, New York 13244, United States.,Department of Civil and Environmental Engineering, Syracuse University, Syracuse, New York 13244, United States.,Department of Biology, Syracuse University, Syracuse, New York 13244, United States
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James ER, Miranda RN, Turner SD. Primary Lymphomas of the Breast: A Review. JPRAS Open 2022; 32:127-143. [PMID: 35402679 PMCID: PMC8987598 DOI: 10.1016/j.jpra.2022.01.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 01/10/2022] [Indexed: 11/06/2022] Open
Abstract
Lymphomas of the breast are rare neoplasms that arise from breast lymphoid tissue and are characterised by neoplastic B or T cells. Breast lymphomas arising from B cells include, but are not limited to, diffuse large B cell lymphoma, follicular lymphoma, extra-nodal marginal zone lymphoma and Burkitt lymphoma. Anaplastic large cell lymphoma (ALCL) is of a T cell origin and both anaplastic lymphoma kinase (ALK)-positive and ALK-negative presentations have been noted in the breast. In addition, there is a more recently identified presentation of ALK-negative ALCL that arises around textured breast implants and is usually confined to a periprosthetic fibrous capsule. Here, we discuss the clinical presentations, histological and immunohistochemical features and treatment options for each type of primary breast lymphoma. We hope that this review will highlight the importance of the timely and accurate diagnosis of breast lymphoma in order to tailor the most appropriate treatment. We also wish to raise awareness of the breast implant-associated lymphomas, with the goal of stimulating work that will aid our understanding of their epidemiology and pathogenesis.
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