Description of Two Cases of Anaplastic Large Cell Lymphoma Associated with a Breast Implant

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a recently recognized provisional entity in the 2017 revision of the World Health Organization classification of lymphoid neoplasms. Although the majority of the cases described in the literature demonstrate an effusion confined to the capsule of the breast implant, this rare pathology can also invade the capsule and adjacent tissues and/or involve lymph nodes. We hereby report two new cases of BIA-ALCL in a 58-year-old and a 47-year-old Caucasian female who received a silicone breast implant. The first patient showed a sudden and rapid right breast volume increase 6 years after the implantation surgery. As for the second patient, a left breast volume increase was observed also suddenly and quickly 11 years after surgery. In both cases, an uncompressed mammography was performed allowing a new approach to highlight periprosthetic fluid reaction. Pathologic examination of the fluid collection revealed atypical cells positive for CD30 and CD45 and negative for ALK and CK7. This allowed pathologists to diagnose a breast implant-associated anaplastic large cell lymphoma. Patients were treated with bilateral capsulectomy with no additional local or systemic therapy. The development of breast augmentation may come with an increase in the frequency of this pathology. Radiologists and senologists must therefore be careful when women with breast implants show an increase of breast volume and all cases of BIA-ALCL must be recorded and reported.

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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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Breast Implant–Associated Anaplastic Large-Cell Lymphoma: Current Understanding and Recommendations for Management

Plastic Surgery ◽

10.1177/2292550320925906 ◽

2020 ◽

Vol 28 (2) ◽

pp. 117-126 ◽

Cited By ~ 1

Author(s):

Tessa L. St. Cyr ◽

Barbara A. Pockaj ◽

Donald W. Northfelt ◽

Fiona E. Craig ◽

Mark W. Clemens ◽

...

Keyword(s):

Anaplastic Large Cell Lymphoma ◽

Cell Lymphoma ◽

Breast Implant ◽

Fluid Collection ◽

Breast Implants ◽

Large Cell ◽

Surgical Removal ◽

Stage Disease ◽

Large Cell Lymphoma ◽

Disease Stages

Worldwide, millions of women live with breast implants. Therefore, it is important that physicians be aware of an uncommon but possibly serious complication arising from breast implants: breast implant–associated anaplastic large cell lymphoma (BIA-ALCL). Breast implant–associated anaplastic large-cell lymphoma most commonly presents as a delayed fluid collection around a textured breast implant or as a mass in the capsule surrounding the implant. The exact pathogenesis of the disease remains unclear. The neoplastic cells of BIA-ALCL show strong uniform staining for CD30 and are consistently negative for activin receptor-like kinase 1. Patients with confirmed cases should be referred to a lymphoma specialist or breast medical oncologist for a complete oncologic evaluation before any surgical intervention. For disease confined to the fluid accumulation or capsule, or both, surgical removal of the implant and complete capsulectomy is the preferred treatment. Postoperative chemotherapy or radiation, or both, are not considered necessary for patients with limited-stage disease and are reserved for advanced disease stages. Generally, BIA-ALCL is a local disease that follows an indolent course and has an excellent prognosis. Although complete remission of disease has occurred in patients with BIA-ALCL, median overall survival is reduced. As of March 2018, approximately 529 unique, confirmed BIA-ALCL cases had been reported in 23 countries. To date, 16 patients have died from BIA-ALCL, and all had extracapsular involvement. The aim of this article is to summarize the diagnosis, evaluation, and management of BIA-ALCL, based on established guidelines, for all practitioners who may care for patients with breast implants.

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Finding Consensus After Two Decades of Breast Implant-Associated Anaplastic Large Cell Lymphoma

Seminars in Plastic Surgery ◽

10.1055/s-0039-1696998 ◽

2019 ◽

Vol 33 (04) ◽

pp. 270-278 ◽

Cited By ~ 5

Author(s):

Mark W. Clemens ◽

Ryan C. DeCoster ◽

Berry Fairchild ◽

Alexander A. Bessonov ◽

Fabio Santanelli di Pompeo

Keyword(s):

Anaplastic Large Cell Lymphoma ◽

Cell Lymphoma ◽

Early Stage ◽

Breast Implant ◽

Breast Implants ◽

Large Cell ◽

World Health ◽

Textured Surface ◽

Early Stage Disease ◽

Large Cell Lymphoma

AbstractBreast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is an emerging and indolent, but potentially fatal cancer of the immune system that can develop around textured-surface breast implants. The World Health Organization first recognized BIA-ALCL as a unique clinical entity in 2016. To date, over 600 confirmed cases have been reported worldwide. BIA-ALCL most commonly presents with disease confined to the capsule, as a seroma or a mass adjacent to the implant. While BIA-ALCL has a fairly indolent clinical course, with an excellent prognosis in early stage disease, disseminated cancer and death have also been reported. In this review, the authors focus on the early diagnosis and treatment, including reconstructing the breast following BIA-ALCL, and also discuss recently updated National Comprehensive Cancer Network guidelines. They also review the current epidemiology and risk factors associated with BIA-ALCL. Finally, they discuss important medicolegal considerations and the bioethics surrounding the continued use of textured-surface breast implants.

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Breast implant–associated anaplastic large cell lymphoma: Brief overview of current data and imaging findings

Breast Disease ◽

10.3233/bd-201017 ◽

2021 ◽

pp. 1-7

Author(s):

Fernando Collado-Mesa ◽

Monica M. Yepes ◽

Jose M. Net ◽

Merce Jorda

Keyword(s):

Anaplastic Large Cell Lymphoma ◽

Cell Lymphoma ◽

Imaging Modality ◽

Breast Implant ◽

Fluid Collection ◽

Large Cell ◽

World Health ◽

Imaging Features ◽

Implant Placement ◽

Large Cell Lymphoma

In 2016, the World Health Organization added Breast Implant-Associated Anaplastic Large Cell lymphoma as a provisionally recognized lymphoma to the family of existing Anaplastic Large Cell lymphomas. Current estimates of the lifetime risk of the disease in women with textured breast implants range from 1:1,000 to 1:30,000. The mean interval from implant placement to diagnosis is 10.7 ± 4.6 years and the most common clinical symptom at presentation is breast swelling. A high level of clinical suspicion is recommended in patients presenting with breast symptoms and/or peri-implant fluid collection occurring more than 1 year after breast implant placement. Ultrasound is the imaging modality of choice, with a high sensitivity for peri-implant fluid and a high specificity for peri-implant mass. When ultrasound is inconclusive, breast MRI is indicated. As of today, all confirmed cases have tested positive for CD30 immunohistochemistry and the disease has shown to have an excellent prognosis when it is diagnosed earlier (localized disease), and when complete surgery, consisting of explantation, capsulectomy, and removal of any associated capsule mass, is performed. This overview summarizes the available epidemiological and clinical data of Breast Implant-Associated Anaplastic Large Cell lymphoma, with an emphasis on imaging features.

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A Case Report of Breast Implant–Associated Anaplastic Large-Cell Lymphoma in a PALB2 Mutation–Positive Woman

The American Surgeon ◽

10.1177/00031348211011056 ◽

2021 ◽

pp. 000313482110110

Author(s):

Valentina Bonev

Keyword(s):

Anaplastic Large Cell Lymphoma ◽

Cell Lymphoma ◽

Breast Implant ◽

Breast Implants ◽

Large Cell ◽

World Health ◽

Positive Woman ◽

First Case ◽

Palb2 Mutation ◽

Large Cell Lymphoma

Breast implant–associated anaplastic large-cell lymphoma (BIA-ALCL) is a rare peripheral T-cell lymphoma composed of anaplastic pleomorphic T cells. The first case was reported in 1997 but was not recognized until 2016 by the World Health Organization. The exact incidence is unknown but is estimated to be 0.1 to 0.3 per 100,000 women with implants. Almost every case has been found in women with textured breast implants. The median time of onset after implantation is 10.7 years. Patients presenting with localized disease, most commonly manifesting as breast enlargement, can be managed solely with surgical resection and have a 100% survival rate. This report describes a PALB2 mutation–positive woman with a strong family history of breast cancer who underwent prophylactic bilateral nipple-sparing mastectomy with textured silicone implant placement. She was diagnosed with BIA-ALCL less than 4 years later after seroma aspiration. She was treated with implant removal and capsulectomy; but, surprisingly, final surgical pathology did not show any malignancy.

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The A, B and C’s of Silicone Breast Implants: Anaplastic Large Cell Lymphoma, Biofilm and Capsular Contracture

Materials ◽

10.3390/ma11122393 ◽

2018 ◽

Vol 11 (12) ◽

pp. 2393 ◽

Cited By ~ 19

Author(s):

Maria Mempin ◽

Honghua Hu ◽

Durdana Chowdhury ◽

Anand Deva ◽

Karen Vickery

Keyword(s):

Anaplastic Large Cell Lymphoma ◽

Biofilm Formation ◽

Cell Lymphoma ◽

Breast Implant ◽

Capsular Contracture ◽

Breast Implants ◽

Surface Characteristics ◽

Large Cell ◽

Breast Implantation ◽

Large Cell Lymphoma

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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How I treat breast implant–associated anaplastic large cell lymphoma

Blood ◽

10.1182/blood-2018-03-785972 ◽

2018 ◽

Vol 132 (18) ◽

pp. 1889-1898 ◽

Cited By ~ 25

Author(s):

Neha Mehta-Shah ◽

Mark W. Clemens ◽

Steven M. Horwitz

Keyword(s):

T Cell ◽

Anaplastic Large Cell Lymphoma ◽

Cell Lymphoma ◽

Breast Implant ◽

Large Cell ◽

World Health ◽

Team Approach ◽

Textured Surface ◽

Complete Surgical Excision ◽

Large Cell Lymphoma

Abstract Breast implant–associated anaplastic large cell lymphoma (BIA-ALCL) is a recently described form of T-cell non-Hodgkin lymphoma now formally recognized by the World Health Organization classification of lymphoid neoplasms. The disease most often presents with a delayed seroma around the breast implant, almost exclusively with a textured surface, and manifests with breast pain, swelling or asymmetry, capsular contracture, but can also present with a breast mass, and lymph node involvement. The prognosis of BIA-ALCL is favorable compared with many other subtypes of systemic T-cell lymphoma; however, unlike other non-Hodgkin lymphomas, complete surgical excision for localized disease is an important part of the management of these patients. In this paper, we share our recommendations for a multidisciplinary team approach to the diagnosis, workup, and treatment of BIA-ALCL in line with consensus guidelines by the National Comprehensive Cancer Network.

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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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Epidemiological Profile in Portugal of Breast Implant-Associated Anaplastic Large Cell Lymphoma: A Cross-Sectional Study

Acta Médica Portuguesa ◽

10.20344/amp.14055 ◽

2021 ◽

Vol 34 (13) ◽

Author(s):

Adriana Cunha ◽

Ricardo Horta ◽

Diogo Barreiro

Keyword(s):

Anaplastic Large Cell Lymphoma ◽

Cell Lymphoma ◽

Breast Implant ◽

Breast Implants ◽

Large Cell ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Large Cell Lymphoma ◽

Epidemiological Profile

Introduction: Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare T-cell neoplasm that is predominantly associated with the use of textured implants. Recently, several countries have tried to clarify their epidemiological profile of BIA-ALCL. This study aims to estimate the number of cases of BIA-ALCL in Portugal and to describe the pattern of use of breast implants at a national level.Material and Methods: This is a cross-sectional study including 57 healthcare institutions - 29 public hospitals and 28 private institutions. Each department of Plastic, Reconstructive and Aesthetic Surgery was asked to provide information concerning the main manufacturer(s) and respective device texture of the breast implants used, and to report the number of registered cases of BIA-ALCL.Results: In our study sample, the response rate was 58%. In our sample, most hospitals reported using textured breast implants from Mentor (45.45%), Allergan (42.42%) and Polytech (39.39%). Only one private institution referred using smooth-coated implants from Mentor and Motiva. Despite several hospitals reporting late-onset seromas, there was only one confirmed case of BIA-ALCL after proper investigation with immunohistochemistry and histological procedures.Discussion: BIA-ALCL may represent a shift for surgeons regarding selection of implant type. Smooth-coated implants or autologous tissue represent adequate alternatives that could surpass the risks associated with textured devices.Conclusion: In the future, the creation of a national patient registry and proper recognition of BIA-ALCL by plastic surgeons could be useful tools to clarify the impact of the disease nationally and to mitigate potential risk factors.

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