Breast Imaging After Dark

2021 ◽  
Author(s):  
Deanna L Lane ◽  
Jay R Parikh
Keyword(s):  
Breast Cancer ◽  
Emergency Department ◽  
Breast Imaging ◽  
Breast Implant ◽  
Clinical History ◽  
Large Cell ◽  
Time Interval ◽  
Imaging Evaluation ◽  
Complete Evaluation ◽  
Palpable Mass

Abstract Patients may present to the emergency department with breast complaints due to traumatic or nontraumatic changes in the breast. Benign and malignant breast pathologies may mimic each other both in clinical presentation and imaging appearance. A complex cystic and solid mass seen on ultrasound in a patient with a palpable mass can represent breast cancer, abscess, or hematoma. A unilateral swollen breast may result from inflammatory breast cancer, mastitis, or other benign etiologies; correlation with clinical history, physical exam, and close follow-up are required to ensure complete resolution of symptoms. Uncommon breast entities such as granulomatous mastitis and breast implant–associated anaplastic large-cell lymphoma may cause changes in the appearance of the breast that prompt a patient to seek initial evaluation in the emergency department. Imaging evaluation of the breast in the emergency department is limited, and it is important that patients with a breast complaint be referred to a dedicated breast center for complete evaluation at an appropriate time interval after their discharge from the emergency department.

scholarly journals Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL): Breast Imaging Perspective

2021 ◽  
Author(s):  
Fernando Collado-Mesa
Keyword(s):  
Anaplastic Large Cell Lymphoma ◽  
Breast Imaging ◽  
Cell Lymphoma ◽  
Breast Implant ◽  
Fluid Collection ◽  
Clinical History ◽  
Large Cell ◽  
Skin Lesions ◽  
Large Cell Lymphoma ◽  
One Year

Breast implant-associated anaplastic large cell lymphoma is a rare disease first described in 1997. Since then, its incidence has continued to increase. Current estimated lifetime risk in women with textured breast implants range from 1:1000 to 1:30,000. Most cases present with rapid and dramatic breast swelling resulting from peri-implant fluid collection. Palpable mass, pain, and skin lesions also occur. A high index of suspicion in patients who develop a seroma around the breast implant more than one year after implant placement is required. The combination of clinical history, physical exam findings, and appropriate imaging workup can lead to a timely and accurate diagnosis. The disease has excellent prognosis when it is diagnosed earlier, and complete surgery is performed. Radiologists, particularly those involved in breast imaging, can play an essential role in early diagnosis. This chapter presents an overview of the disease, including relevant imaging findings.

scholarly journals Delay in presentation of acute ischemic stroke in Lahore General Hospital, Lahore

2016 ◽  
Vol 11 (3) ◽  
Author(s):  
Rafiq A Basharat ◽  
Kamran Rashid Mirza ◽  
Muhammad Yousuf Qamar
Keyword(s):  
Emergency Department ◽  
Ischemic Stroke ◽  
Ct Scan ◽  
Acute Ischemic Stroke ◽  
General Hospital ◽  
Clinical History ◽  
Clinical Findings ◽  
Study Data ◽  
Time Interval ◽  
Time Required

Objectives: To find out the time interval from onset of the symptoms to admission in the hospital of patients suffering from acute ischemic stroke, in order to assess the feasibility of thrombolytic therapy in Lahore General Hospital. Design: Hospital-based, prospective and observational study Setting: Lahore General Hospital Lahore. Duration: Six months from January - June 2004. Patients: Seventy two patients with acute ischemic stroke diagnosed on basis of clinical findings and CT scan. Methods: Patients o f a cute ischemic stroke including cerebral infarct, T IA, venous infarct and lacunar infarct were diagnosed on basis of clinical history, examination and CT scan and enrolled in the study. Data was collected on a Performa. Time taken by patients to reach hospital after onset of symptoms, distance of patients` residences from hospital, education level of patients and time required to do a CT scan after arrival of patient in hospital were studied. Results: 54.2% were male and mean age of patients was 60 years. 58 patients had cerebral infarction, TIA`s and venous infarction were 8 and 6 respectively. Delay in presentation was divided in three groups. Within three hours (hrs) 15 (21%) patients arrived. 54 and 18 patients arrived in 3-- 24 hrs group and >24 firs group. Mean distance was roughly 44 km. Mean distance for 0-3hrs, 3-24hrs and >24hrs group was 14, 35, and 85 Km respectively. Average time required to do CT scan was nine hours after arrival of patient in emergency department. Sixty-five percent of patients coming were illiterate. Conclusion: Majority of the patients with ischemic stroke present late to. emergency department. Many factors including distance from hospital, illiteracy, non-availability of ambulance services responsible for it. Evaluation-of patients and provision of urgent CT scan is required. in hospitals.

scholarly journals Breast Implant Associated-Anaplastic Large-Cell Lymphoma (BIA-ALCL): Data Based on the Lymphoma Study Association (LYSA) Registry. Promising Results of Brentuximab Vedotin Combined with Cyclophosphamide, Doxorubicin and Prednisone (BV-CHP) As First Line Treatment for Patient Requiring Chemotherapy

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 1387-1387
Author(s):  
Fabien Le Bras ◽  
Jean Marc Schiano De Colella ◽  
Lucie Oberic ◽  
Emmanuel Itti ◽  
Thua-Ha Dao ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Research Funding ◽  
Clinical Presentation ◽  
Cell Lymphoma ◽  
Breast Implant ◽  
Large Cell ◽  
Histological Subtype ◽  
Tumor Mass

Abstract Background: Breast implant-associated anaplastic large-cell lymphoma (BI-ALCL) is a rare form of T-cell lymphoma arising adjacent to a breast implant, recently recognized as a provisional entity in the 2017 revised World Health Organization (WHO) lymphoma classification. The pathogenesis of this entity remains elusive even if gene alterations in epigenetic modifiers and JAK-STAT signaling are frequent. ECHELON 2 trial (Horwitz S et al. The Lancet 2019) has set BV-CHP as a new standard of treatment for CD30-positive peripheral T-cell lymphoma, mainly in systemic ALCL patients (pts) but not in BIA-ALCL. Our objective is to describe a series of pts with BIA-ALCL included in the LYSA registry focusing on the use of BV CHP as front-line chemotherapy for patient requiring chemotherapy. Methods: since 2016, a national multidisciplinary meeting has been implemented by the French Cancer Agency to better define therapeutic strategies for newly diagnosed cases after histologic confirmation. Meanwhile, BIA-ALCL registry was funded by the LYSA to collect ambispectively, in France and more recently in Belgium, patient clinical data including reasons for breast implantation, implant manufacturer, treatment and outcome. Results: from 2009 to 2021 , 85 pts (73 in France and 12 in Belgium) gave their informed consent to participate to the registry. Median age was 57 years (range 29-82) at diagnosis. In 39 out of 85 pts (45.9%) the first implant followed a mastectomy for breast cancer. In this analysis, only implants in the breast(s) where the lymphoma occurred have been considered. Five pts (5.9%) had bilateral lymphoma and 80 pts had unilateral lymphoma (35 left side and 45 right side), 35 pts were implanted once (41.2%), 35 twice (41.2%) and 15 pts (17.6%) 3 times or more. The median period between first implant and BIA-ALCL diagnosis was 12.2 years (range 4.1-40.5), and 7 years (range 0.2-25.4) from last implant to diagnosis. The clinical presentation was seroma in 64 pts (75.3%), breast tumor mass with or without seroma in 18 pts (21.1%) and 3 pts were diagnosed without any mass or seroma (1 contiguous lymph node involvement, 2 in the context of systematic implant removal). The two main clinical presentation (i.e. seroma and tumor mass) were most often correlated with the two distinct histological subtypes (in "situ/mixed" (n=62) or "infiltrative" (n=21)). For 2 pts, histological subtype was not available. The majority of pts were Ann Arbor stage I-II (n=65, 76.5%), and 18 (21.2%) pts were stage IV. Stage was unknown in 2 pts. Considering available information, almost all patients had at least one silicone-filled (n=76) and at least one textured implant (n=85) with Biocell texturation (n=61, 71.8%). No patient had only smooth implant. Implant removal with total capsulectomy was performed in 66 patients and 25 underwent chemotherapy based on CHOP or CHOP-like (4 to 6 cycles) chemotherapy regimens (n=13), BV-CHP (6 cycles) (n=10) and others (n=2). Among the patients receiving chemotherapy, CR was obtained in 21 pts (84%) and in 2 pts failed to respond (8%). Among the patients treated with BV-CHP, 8 pts achieved CR (80%) and 2 pts were not yet evaluated at the time of analysis. No limiting toxicity was noted. After a median follow-up of 28.6 months, 78 pts are alive and free of evolutive disease and 8 are lost to follow up. Seven pts died, either from lymphoma progression alone (n=2) or associated with concomitant active breast cancer (n=2), one from breast cancer alone, one from lung epidermoid cancer and one due to myocardial infarction. Patients with an "infiltrative" histological subtype have a significantly worse outcome with a 2y-PFS of 73.8% vs 96.7% for other subtypes ("in situ/mixed subtypes") (p=0.0039, HR=5.3) and a 2y-OS of 78.7% vs 100% (p=0.0022, HR=8.5). With a median follow-up of one year, the 10 patients treated with BV-CHP are alive and free of evolutive disease at the time of analysis. Conclusions: We report on the basis of a limited series of patients that 6 cycles of BV-CHP provide an excellent disease control in patients with BIA-ALCL requiring chemotherapy. Confirmation of these results on a larger series of patients with a longer follow-up is needed. Such observation provides basis for a prospective trial in order to determine if treatment with BV-CHP could be installed as a standard of care for higher risk patients with BIA-ALCL, as those presenting with tumor mass and /or infiltrative subtype. Disclosures Le Bras: Novartis: Honoraria; Celgene BMS: Research Funding; Takeda: Honoraria, Research Funding; Kite Gilead: Honoraria. Bachy: Kite, a Gilead Company: Honoraria; Novartis: Honoraria; Daiishi: Research Funding; Roche: Consultancy; Takeda: Consultancy; Incyte: Consultancy. Bonnet: Roche: Consultancy. André: AbbVie: Other: Travel/accomodation/expenses; Roche: Other: Travel/accomodation/expenses, Research Funding; Johnson & Johnson: Research Funding; Celgene: Other: Travel/accomodation/expenses; Bristol-Myers-Squibb: Consultancy, Other: Travel/Accommodations/Expenses; Karyopharm: Consultancy; Gilead: Consultancy, Other: Travel/Accommodations/Expenses; Incyte: Consultancy; Takeda: Consultancy, Research Funding. Haioun: Amgen: Honoraria, Research Funding; Servier: Honoraria, Research Funding; Takeda: Honoraria, Research Funding; Janssen: Honoraria, Research Funding; Gilead: Honoraria, Research Funding; Celgene: Honoraria, Research Funding; F. Hoffmann-La Roche Ltd: Honoraria, Research Funding; Novartis: Honoraria, Research Funding; Miltenyi: Honoraria, Research Funding.

MRI features of breast implant-associated anaplastic large cell lymphoma: a pictorial review

2021 ◽  
pp. 20210093
Author(s):  
Anna Rotili ◽  
Federica Ferrari ◽  
Luca Nicosia ◽  
Filippo Pesapane ◽  
Valentina Tabanelli ◽  
...  
Keyword(s):  
Anaplastic Large Cell Lymphoma ◽  
Breast Imaging ◽  
Cell Lymphoma ◽  
Case Reports ◽  
Breast Implant ◽  
Case Series ◽  
Large Cell ◽  
Pictorial Review ◽  
Mri Features ◽  
Large Cell Lymphoma

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare and newly recognized subtype of T cell Non-Hodgkin Lymphoma (NHLs) associated with breast implants. The mechanism involved in the development of this kind of lymphoma is still uncertain. BIA-ALCL is generally an indolent disease localized to the breast implant and its capsule and effectively treated with capsulectomy alone without chemotherapy. Clinically, BIA-ALCL may typically present a sudden-onset breast-swelling secondary to peri-implant effusion. The minority of BIA-ALCL patients present a more aggressive mass-forming subtype, for which systemic therapy is mandatory. Despite the number of cases has recently increased, BIA-ALCL remains a rare disease described mainly in several case reports and small case series. Breast imaging, including mammography, ultrasound (US) and breast magnetic resonance imaging (MRI) are routinely used in the screening of breast cancer; however, guidelines for the imaging and pathological diagnosis of this disease have only recently been proposed and included in the 2019 National Comprehensive Cancer Network (NCCN) consensus guidelines for BIA-ALCL (REFERENCE). The main purpose of this pictorial is to illustrate the MRI signs of BIA-ALCL and correlate them with the corresponding pathology features in order to improve the knowledge of the principals MRI features of this type of lymphoma.

Breast Implant Associated Anaplastic Large Cell Lymphoma Is More Frequent and Lethal Than Previously Reported

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 4760-4760
Author(s):  
Matthew Carty ◽  
Christiana E. Toomey ◽  
Evan Farkash ◽  
James W. May ◽  
James S. Michaelson ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Registry ◽  
Massachusetts General Hospital ◽  
Medical Center ◽  
Case Reports ◽  
Breast Implant ◽  
Tissue Expander ◽  
Breast Implants ◽  
Large Cell ◽  
Left Breast

Abstract Abstract 4760 Background: Anaplastic large cell lymphoma (ALCL) is a rare disease, comprising 2–3% of all non-Hodgkin lymphomas. Case reports of seroma associated ALCL of the breast in association with silicone breast implants have appeared in the literature since 1997, but no data on the incidence of this complication has been reported. We use three case reports, including two previously published, in conjunction with data derived from three separate entities of Partners HealthCare (Brigham and Women's Hospital; Massachusetts General Hospital; Faulkner Hospital) to establish an incidence estimate for this rare entity. Methods: Individual cases were identified by pathologists, surgeons and medical oncologists. We compared a list of patients from the institutions’ Cancer Registries, with the results of a query we ran on an institution-internal query tool. For MGH patients only, we were also able to compare cancers revealed through a natural language processing search result of institutional pathology reports. Two of the cases were in the overlap of Cancer Registry data, and query results. One case was not contained within these results as it was omitted from the Cancer Registry. Case Presentations: Case 1 was surgically treated for breast cancer and reconstruction at New England Medical Center. At an unknown time relative to her breast cancer and tissue expander placement, she received a McGhan 210 cc textured silicone implant to her left breast. At time of rupture this implant was replaced with a 270 cc McGhan textured silicone implant filled to 295 cc at Newton Wellesley Hospital (NWH). Her surgical course was complicated by recurrent seroma, and she was eventually switched to Mentor smooth implant, with 275 cc implant on the right and 375 filled to 425 cc on the left. However, a biopsy of tissue at the time of this implant revealed ALK-negative ALCL in the left breast. Implants were removed at NWH and she was treated at Massachusetts General Hospital (MGH). After 3 cycles of chemotherapy (CHOP plus radiation) she remains in CR now at 18 months after treatment. Case 2 presented at Brigham and Women's Hospital (BWH) after a surgically treated right breast cancer with recurrence and reconstruction with a McGhan 270 cc textured saline implant. In 2000 the patient presented with erythema at surgical site of her cancer and a biopsy confirmed ALCL. Due to age the patient was treated with radiation alone and this induced a sustained remission of her ALCL. Case 3 originally had bilateral augmentation mammoplasty in 1974 with bilateral McGhan 270cc textured saline implants. She presented at Northwest Medical Center in 2007 with what appeared to be an abscess at her left implant site but was positive for ALCL when biopsied. She was treated with CHOP and radiation at that institution. She recurred in 2008 in the right breast and presented to BWH for treatment. She received ESHAP, then radiation, then gemcitabine, cisplatin, and dexamethasone; despite these treatments, her disease progressed and the patient died this year. Results: A query of the comprehensive electronic health database of the Partners hospitals (RPDR) revealed 9,941 patients at our institutions, who had undergone full or partial reconstruction of the breast, or removal of a breast implant or tissue expander from 1992–2009. Database queries revealed 5778 patients at MGH, 4,968 at BWH, and 4780 at Faulkner Hospital (FH) with non-Hodgkin lymphoma. Cancer Registry data revealed 18 ALCL patients (4 women) at MGH, 73 ALCL patients (24 women) at BWH and 2 ALCL patients at FH (1 woman). Of our three cases one was treated entirely within our core healthcare system, one was referred from another Partners Institution (NWH) and one was referred for tertiary care of her lymphoma. Incidence is established as 2 cases of implant-associated ALCL per 9941 patients or 0.02%. Implant-associated disease comprises 3.2% of all ALCL cases and 10% of ALCLs presenting among women. Conclusions: Incidence of breast implant-associated ALCL may be more common than the rare case reports suggest. Evaluation of late complications of breast implant such as chronic seroma or abscess with consideration of this disease may improve case recognition. The fatality as a result of systemic dissemination of this disease has not previously been reported. Disclosures: No relevant conflicts of interest to declare.

Absence of Anaplastic Large Cell Lymphoma Cases in a Large Cohort of Danish Women with Breast Implants: Results of a Nationwide, Population-Based Study,

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 3689-3689
Author(s):  
Maja Ølholm Vase ◽  
Søren Friis ◽  
Andrea Bautz ◽  
Henrik Toft Sørensen ◽  
Francesco d'Amore
Keyword(s):  
Breast Cancer ◽  
Anaplastic Large Cell Lymphoma ◽  
Cell Lymphoma ◽  
Breast Implant ◽  
Breast Implants ◽  
Large Cell ◽  
Population Based ◽  
Study Cohort ◽  
Population Based Study ◽  
Large Cell Lymphoma

Abstract Abstract 3689 Introduction: An increased risk of alk-negative T- cell anaplastic large cell lymphoma (T-ALCL) in women with silicone breast implants has recently been suggested. Several small series and case-reports have been published, but, so far, only one analytical epidemiological population-based study has specifically addressed this hypothesis (de Jong et al, JAMA, 2008). Methods: We identified a nationwide cohort of Danish women, who underwent breast implant surgery for any reason (cosmetic or reconstruction) at public hospitals or in private clinics. Data including civil registry number and date of surgery were obtained from the Danish National Hospital Register (1977–2009) and from The Danish Registry for Plastic Surgery of the Breast (1999–2009) and eight private clinics of plastic surgery (1973–1995). The civil registry number, assigned to all Danish citizens by the Central Population Registry (CPR), encodes gender and date of birth, and secures valid linkage to population-based registries in Denmark. Identification of lymphoma cases was performed by combined linkages to the Danish Cancer Registry and the Danish Lymphoma Group (LYFO). This combined strategy was applied in order to maximize catchment of incident lymphoma cases (capture-recapture analysis). Results: We identified a cohort of 18,356 women, who underwent breast implant surgery between 1973–2009. The vast majority of breast implants were silicone gel-filled implants. Among study-subjects, 11,380 underwent surgery for strictly cosmetic reasons, while 6,976 received breast implants as part of a breast reconstruction secondary to breast cancer. The number of non-Hodgkin lymphoma (NHL) and T-ALCL cases expected in the general female population of Denmark was 350/year and 10/year in the study period. The total person-years for the study-cohort (162699,5 years)were multiplied by the estimated incidence rates for T-ALCL in the breast (3/100.000.000 person-years)to ascertain the expected number (0,005) of ALCL in the breast among cohort members. The total number of NHL cases observed was 60. There were no cases of ALCL in the study-cohort and none had an implant-near localization. Conclusion: This is a comprehensive epidemiologic study addressing the specific issue of the possible association between T-ALCL and breast implants. Our large nationwide cohort study does not support a major association between T-ALCL lymphomas and breast implants either implanted for cosmetic reasons in otherwise healthy recipients or for reconstructive purposes in women previously treated for breast cancer. Due to the rarity of this condition, additional population-based analyses are needed to further evaluate potential biological procedure-related or implant-specific associations. An extended analysis of pooled data from different Nordic countries is ongoing. Disclosures: No relevant conflicts of interest to declare.

Breast cancer

2018 ◽  
pp. 481-498
Author(s):  
Abdullah Jibawi ◽  
Mohamed Baguneid ◽  
Arnab Bhowmick
Keyword(s):  
Breast Cancer ◽  
Breast Reconstruction ◽  
Breast Imaging ◽  
Palliative Therapy ◽  
Surgical Excision ◽  
Clinical History ◽  
Patient Factors ◽  
Triple Assessment ◽  
Suspicious Breast Lesion ◽  
Pathological Assessment

Breast cancer is the most common cancer affecting women worldwide. Survival at time of detection is high. Clinical presentation ranges from a highly suspicious breast lesion to a completely asymptomatic screen-detected cancer. Triple assessment is the mainstay of diagnosis (clinical history and examination, breast imaging, and pathological assessment of biopsy). All lesions need careful MDT assessment, and a thorough assessment of patient fitness. Surgical excision is the treatment of choice for all operable cancers irrespective of age with consideration of patient factors. Breast reconstruction should be considered at the time of initial decision. Adjuvant, neoadjuvant, and other types of therapy (hormone, biological, etc.) should be planned at the multidisciplinary team meeting. Advanced cases should be considered for the most effective palliative therapy where needed.

scholarly journals Breast implant-associated anaplastic large-cell lymphoma: first case detected in a Japanese breast cancer patient

Breast Cancer ◽  
2020 ◽  
Vol 27 (3) ◽  
pp. 499-504
Author(s):  
Yoko Ohishi ◽  
Aki Mitsuda ◽  
Kozue Ejima ◽  
Hidetomo Morizono ◽  
Tomoyuki Yano ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patient ◽  
Breast Cancer Patient ◽  
Anaplastic Large Cell Lymphoma ◽  
Cell Lymphoma ◽  
Breast Implant ◽  
Large Cell ◽  
First Case ◽  
Large Cell Lymphoma

scholarly journals Case Report: Early Breast Cancer Recurrence Mimicking BIA-ALCL in a Patient With Multiple Breast Procedures

2021 ◽  
Vol 8 ◽  
Author(s):  
Marco Materazzo ◽  
Gianluca Vanni ◽  
Marco Pellicciaro ◽  
Lucia Anemona ◽  
Francesca Servadei ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Breast Reconstruction ◽  
Locoregional Recurrence ◽  
Breast Implant ◽  
Skin Flap ◽  
False Negative ◽  
Cancer Recurrence ◽  
Breast Implants ◽  
Large Cell ◽  
Immediate Breast Reconstruction

Breast reconstruction plays a fundamental role in the therapeutic process of breast cancer treatment and breast implants represents the leading breast reconstruction strategy. Breast Implant Associated-Anaplastic Large Cell Lymphoma (BIA-ALCL), locoregional recurrence in the skin flap, and skin flap necrosis are well-known complications following mastectomy and immediate breast reconstruction (IBR). We report a case of locoregional cancer recurrence in the mastectomy flap mimicking BIA-ALCL, in a patient who underwent 6 breast procedures in four facilities across 15 years including immediate breast reconstruction with macrotextured breast implants. Despite the rate and onset of the disease, clinicians should be aware of BIA-ALCL. Due to the risk of false negative results of fine needle aspiration, clinical suspicion of BIA-ALCL should drive clinicians' choices, aside from cytological results. In the present case, surgical capsulectomy of the abnormal periprosthesic tissue revealed locoregional recurrence.

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