Anaplastic Large Cell Lymphoma and Breast Implants: A Systematic Review

Breast implantation either for cosmetic or reconstructive e purposes is one of the most common procedures performed in plastic surgery. Biofilm infection is hypothesised to be involved in the development of both capsular contracture and anaplastic large cell lymphoma (ALCL). Capsular contracture is one of the principal reasons for breast revision surgery and is characterised by the tightening and hardening of the capsule surrounding the implant, and ALCL is an indolent lymphoma found only in women with textured implants. We describe the types of breast implants available with regard to their surface characteristics of surface area and roughness and how this might contribute to capsular contracture and/or biofilm formation. The pathogenesis of capsular contracture is thought to be due to biofilm formation on the implant, which results in on-going inflammation. We describe the current research into breast implant associated ALCL and how implant properties may affect its pathogenesis, with ALCL only occurring in women with textured implants.

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Breast Implant-Associated Anaplastic Large Cell Lymphoma: A Case Report

Journal of Hematology and Oncology Research ◽

10.14302/issn.2372-6601.jhor-21-3733 ◽

2021 ◽

Vol 4 (1) ◽

pp. 28-34

Author(s):

Kumkum Vadehra ◽

Jennifer Cai ◽

Rashmi Rekha Bhuyan ◽

Ping Ji ◽

Rose Venegas ◽

...

Keyword(s):

Tumor Cells ◽

Anaplastic Large Cell Lymphoma ◽

Cell Lymphoma ◽

Breast Implant ◽

Fluid Collection ◽

Breast Implants ◽

Large Cell ◽

Silicone Implants ◽

Axillary Lymph ◽

Large Cell Lymphoma

Breast implant-associated anaplastic large cell lymphoma (ALCL) is a recently recognized type of T-cell lymphoma that can develop following breast implants, with morphologic and immunophenotypic features indistinguishable from those of ALK-negative ALCL. Here we report a case of a 58-year-old woman with a history of subglandular silicone implants placed for bilateral breast augmentation 25 years ago, who presented with bilateral breast pain and was found to have bilateral Baker Grade III capsular contracture, and heterogenous fluid collection centered near the left third costochondral articulation, a suspicious left chest wall lesion, and left axillary lymphadenopathy on imaging. A left axillary lymph node core biopsy and an aspiration of the fluid were performed, and no malignant cells were identified. The patient underwent bilateral removal of breast implants and total capsulectomies. Microscopic examination of the capsule surrounding the left breast implant revealed large pleomorphic tumor cells in a fibrinous exudate. By immunohistochemistry, the tumor cells were found to be positive for CD3 (subset), CD4, CD7, CD30 (strong and uniform), and CD43, and negative for CD2, CD5, CD8, and ALK1, supporting the diagnosis of breast implant-associated ALCL. No lymphoma cells were identified in the right breast capsule, confirmed by CD30 stain. Breast implant-associated ALCL is a very rare disease that can develop many years after breast implant placement. Proper evaluation with breast imaging and pathologic workup is essential to confirm the diagnosis in suspected cases. Our case highlights that adequate sampling is important in the investigation of patients with suspected breast implant-associated ALCL.

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Anaplastic Large Cell Lymphoma Occurring in Women with Breast Implants

Plastic & Reconstructive Surgery ◽

10.1097/prs.0000000000001033 ◽

2015 ◽

Vol 135 (3) ◽

pp. 695-705 ◽

Cited By ~ 182

Author(s):

Garry S. Brody ◽

Dennis Deapen ◽

Clive R. Taylor ◽

Lauren Pinter-Brown ◽

Sarah Rose House-Lightner ◽

...

Keyword(s):

Anaplastic Large Cell Lymphoma ◽

Cell Lymphoma ◽

Breast Implants ◽

Large Cell ◽

Large Cell Lymphoma

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ALK-1–Negative Anaplastic Large Cell Lymphoma Associated With Breast Implants: A New Clinical Entity

Clinical Breast Cancer ◽

10.1016/j.clbc.2011.03.020 ◽

2011 ◽

Vol 11 (5) ◽

pp. 283-296 ◽

Cited By ~ 50

Author(s):

Davide Lazzeri ◽

Tommaso Agostini ◽

Guido Bocci ◽

Giordano Giannotti ◽

Giovanni Fanelli ◽

...

Keyword(s):

Anaplastic Large Cell Lymphoma ◽

Cell Lymphoma ◽

Breast Implants ◽

Large Cell ◽

Clinical Entity ◽

Large Cell Lymphoma

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Anaplastic Large Cell Lymphoma Associated With Breast Implants

The American Journal of Surgical Pathology ◽

10.1097/pas.0b013e31825749b1 ◽

2012 ◽

Vol 36 (7) ◽

pp. 1000-1008 ◽

Cited By ~ 116

Author(s):

Tariq N. Aladily ◽

L. Jeffrey Medeiros ◽

Mitual B. Amin ◽

Nisreen Haideri ◽

Dongjiu Ye ◽

...

Keyword(s):

Anaplastic Large Cell Lymphoma ◽

Cell Lymphoma ◽

Breast Implants ◽

Large Cell ◽

Large Cell Lymphoma

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Breast Implant-Associated Anaplastic Large Cell Lymphoma in Australia: A Longitudinal Study of Implant and Other Related Risk Factors

Aesthetic Surgery Journal ◽

10.1093/asj/sjz333 ◽

2019 ◽

Vol 40 (8) ◽

pp. 838-846 ◽

Cited By ~ 6

Author(s):

Anna Loch-Wilkinson ◽

Kenneth J Beath ◽

Mark R Magnusson ◽

Rodney Cooter ◽

Karen Shaw ◽

...

Keyword(s):

Confidence Interval ◽

Anaplastic Large Cell Lymphoma ◽

Cell Lymphoma ◽

Early Stage ◽

Breast Implant ◽

Breast Implants ◽

Large Cell ◽

Regulatory Action ◽

Level Of Evidence ◽

Large Cell Lymphoma

Abstract Background Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is an emerging cancer that has been linked to the use of textured devices. The recent increase in number and frequency of cases has led to worldwide regulatory action. Objectives The authors aimed to longitudinally study BIA-ALCL in Australia since the index case was first reported in 2007. Methods Confirmed historical cases were collected and then prospectively analyzed from October 2015 to May 2019. Clinical and implant exposure data were determined and compared with company sales data for 4 devices to generate implant-specific risk. Results A total 104 cases of BIA-ALCL were diagnosed in Australia with exposure to 149 unique breast implants. The mean age of patients was 48.2 years (range, 22.4-78.5 years). They had an average time from implantation to diagnosis of 6.8 years. A total 51.7% of implants utilized in this cohort were Allergan Biocell devices. The indication for implant usage was for primary cosmetic augmentation in 70%, post-breast cancer reconstruction in 23%, and following weight loss/pregnancy in 7%. The majority of women presented with early (stage 1) disease (87.5%). The risk for developing BIA-ALCL ranged from 1 in 1947 sales (95% confidence interval = 1199-3406) for Silimed Polyurethane devices to 1 in 36,730 (95% confidence interval = 12,568-178,107) for Siltex imprinted textured devices. Conclusions Implants with higher surface area/texture seem to be more associated with BIA-ALCL in Australia. Recent regulatory action to suspend, cancel, or recall some of these higher risk devices is supported by these findings. Level of Evidence: 2

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