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

Cell Lymphoma ◽

Breast Implant ◽

Breast Implants ◽

Large Cell ◽

World Health ◽

Positive Woman ◽

First Case ◽

Palb2 Mutation ◽

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.

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

Case Reports in Radiology ◽

10.1155/2019/6137198 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6

Author(s):

Julie Crèvecoeur ◽

Véronique Jossa ◽

Joan Somja ◽

Jean-Claude Parmentier ◽

Jean-Luc Nizet ◽

...

Keyword(s):

Cell Lymphoma ◽

Breast Implant ◽

Fluid Collection ◽

Breast Implants ◽

Large Cell ◽

World Health ◽

Breast Volume ◽

Volume Increase ◽

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.

Breast erythema and nodular skin metastasis as the first manifestation of breast implant-associated anaplastic large cell lymphoma

Rare Tumors ◽

10.1177/20363613211028498 ◽

2021 ◽

Vol 13 ◽

pp. 203636132110284

Author(s):

Noellie Ducastel ◽

Ioana-Mariana Cimpean ◽

Ivan Theate ◽

Olivier Vanhooteghem

Keyword(s):

T Lymphocyte ◽

Cell Lymphoma ◽

Breast Implant ◽

Breast Implants ◽

Large Cell ◽

First Case ◽

Nodular Lesions ◽

Large Cell Lymphoma ◽

The Right

Anaplastic large cell lymphoma (BIA-ALCL) associated with rough textured breast implants was first reported in 1997. It is a non-Hodgkin’s lymphoma originating from a T lymphocyte which occurs on average 10.9 years after placement of the breast implant. BIA-ALCL mainly manifests as a periprosthetic seroma or a mass adjacent to the implant. To our knowledge, we describe the first case of BIA-ALCL with initial presentation by indurate erythematous plates located in both breasts and the progressive appearance of several asymptomatic metastatic nodular lesions that have been appearing on the right arm some weeks later.

Analysis of the Molecular Signature of the Breast Implant-Associated Anaplastic Large Cell Lymphoma in an Asian Patient

Aesthetic Surgery Journal ◽

10.1093/asj/sjaa398 ◽

2020 ◽

Author(s):

Il-Kug Kim ◽

Ki Yong Hong ◽

Choong-kun Lee ◽

Bong Gyu Choi ◽

Hyunjong Shin ◽

...

Keyword(s):

T Cells ◽

Molecular Mechanisms ◽

Cell Lymphoma ◽

Breast Implant ◽

Breast Implants ◽

Large Cell ◽

Genetic Characteristics ◽

First Case ◽

Abstract Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL)—a new category of anaplastic large cell lymphoma associated with textured breast implants—has a distinct variation in incidence and is especially rare in Asia. We report the first case of BIA-ALCL in Korea and present its histological and genetic characteristics. A 44-year-old female patient presented with a typical clinical course and symptoms, including breast augmentation with textured breast implants, late-onset peri-implant effusion, and CD30 +ALK − histology, followed by bilateral implant removal and total capsulectomy. For histological analysis, we performed immunohistochemistry of the bilateral breast capsules. For transcriptome analysis, we identified highly upregulated gene sets using RNA-seq and characterized the lymphoma immune cell components. In the lymphoma-associated capsule, CD30 + cells infiltrated not only the lymphoma lesion but also the peritumoral lesion. The morphologies of the myofibroblasts and vessels in the peritumoral lesion were similar to those in the tumoral lesion. We observed strong activation of the JAK/STAT3 pathway and expression of programmed death ligand-1 (PD-L1) in the lymphoma. Unlike the molecular profiles of BIA-ALCL samples from Caucasian patients—all of which contained activated CD4 + T cells—the Asian patient’s profile was characterized by more abundant CD8 + T cells. This study contributes to a better understanding of the pathogenesis and molecular mechanisms of BIA-ALCL in Asian patients that will ultimately facilitate the development of clinical therapies.

The management of breast implant-associated anaplastic large cell lymphoma in the setting of pregnancy: seeking for clinical practice guidelines

Archives of Plastic Surgery ◽

10.5999/aps.2021.00185 ◽

2021 ◽

Vol 48 (4) ◽

pp. 373-377

Author(s):

Rossella Elia ◽

Michele Maruccia ◽

Aurelia De Pascale ◽

Arianna Di Napoli ◽

Giuseppe Ingravallo ◽

...

Keyword(s):

Cell Lymphoma ◽

Early Stage ◽

Breast Implant ◽

Pregnant Patient ◽

Large Cell ◽

Good Prognosis ◽

World Health ◽

First Case ◽

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 aim of this paper is to report the first case of BIA-ALCL diagnosed in a pregnant patient. It is well known that BIA-ALCL appears as an indolent lymphoma with a good prognosis when diag-nosed at early stages and clinical guidelines for its management have been clearly published. Nevertheless, they lack a standardized approach for BIA-ALCL during pregnancy. With limited experience in our case, treatment has been safely postponed after term without affecting patient’s overall prognosis and without fetal complication. The fact that the disease was diagnosed at an early stage (stage I) undoubtedly influenced the course of treatment. A multidisciplinary approach weighing the risks and benefits of treatment is of paramount importance in order to ensure the best possible outcome for both the mother and her child and clinical update guidelines should be issued.

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):

Cell Lymphoma ◽

Early Stage ◽

Breast Implant ◽

Breast Implants ◽

Large Cell ◽

World Health ◽

Textured Surface ◽

Early Stage Disease ◽

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.

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):

Biofilm Formation ◽

Cell Lymphoma ◽

Breast Implant ◽

Capsular Contracture ◽

Breast Implants ◽

Surface Characteristics ◽

Large Cell ◽

Breast Implantation ◽

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.

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 ◽

Cell Lymphoma ◽

Breast Implant ◽

Fluid Collection ◽

Breast Implants ◽

Large Cell ◽

Silicone Implants ◽

Axillary Lymph ◽

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.

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 ◽

Cell Lymphoma ◽

Breast Implant ◽

Large Cell ◽

World Health ◽

Team Approach ◽

Textured Surface ◽

Complete Surgical Excision ◽

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.

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 ◽

Cell Lymphoma ◽

Early Stage ◽

Breast Implant ◽

Breast Implants ◽

Large Cell ◽

Regulatory Action ◽

Level Of Evidence ◽

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

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):

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.