scholarly journals Complete Surgical Excision Is Essential for the Management of Patients With Breast Implant–Associated Anaplastic Large-Cell Lymphoma

2016 ◽  
Vol 34 (2) ◽  
pp. 160-168 ◽  
Author(s):  
Mark W. Clemens ◽  
L. Jeffrey Medeiros ◽  
Charles E. Butler ◽  
Kelly K. Hunt ◽  
Michelle A. Fanale ◽  
...  
Keyword(s):  
Anaplastic Large Cell Lymphoma ◽  
Cell Lymphoma ◽  
Breast Implant ◽  
Breast Implants ◽  
Surgical Excision ◽  
Large Cell ◽  
Rare Type ◽  
Complete Surgical Excision ◽  
Large Cell Lymphoma

Purpose Breast implant–associated anaplastic large-cell lymphoma (BI-ALCL) is a rare type of T-cell lymphoma that arises around breast implants. The optimal management of this disease has not been established. The goal of this study is to evaluate the efficacy of different therapies used in patients with BI-ALCL to determine an optimal treatment approach. Patients and Methods In this study, we applied strict criteria to pathologic findings, assessed therapies used, and conducted a clinical follow-up of 87 patients with BI-ALCL, including 50 previously reported in the literature and 37 unreported. A Prentice, Williams, and Peterson model was used to assess the rate of events for each therapeutic intervention. Results The median and mean follow-up times were 45 and 30 months, respectively (range, 3 to 217 months). The median overall survival (OS) time after diagnosis of BI-ALCL was 13 years, and the OS rate was 93% and 89% at 3 and 5 years, respectively. Patients with lymphoma confined by the fibrous capsule surrounding the implant had better event-free survival (EFS) and OS than did patients with lymphoma that had spread beyond the capsule (P = .03). Patients who underwent a complete surgical excision that consisted of total capsulectomy with breast implant removal had better OS (P = .022) and EFS (P = .014) than did patients who received partial capsulectomy, systemic chemotherapy, or radiation therapy. Conclusion Surgical management with complete surgical excision is essential to achieve optimal EFS in patients with BI-ALCL.

scholarly journals Chromosome 20 loss is characteristic of breast implant–associated anaplastic large cell lymphoma

Blood ◽  
2020 ◽  
Vol 136 (25) ◽  
pp. 2927-2932
Author(s):  
G. Tjitske Los-de Vries ◽  
Mintsje de Boer ◽  
Erik van Dijk ◽  
Phylicia Stathi ◽  
Nathalie J. Hijmering ◽  
...  
Keyword(s):  
T Cell ◽  
Anaplastic Large Cell Lymphoma ◽  
Cell Lymphoma ◽  
Breast Implant ◽  
Breast Implants ◽  
Large Cell ◽  
Rare Type ◽  
Anaplastic Lymphoma ◽  
Chromosome 20 ◽  
Large Cell Lymphoma

Abstract Breast implant–associated anaplastic large cell lymphoma (BIA-ALCL) is a very rare type of T-cell lymphoma that is uniquely caused by a single environmental stimulus. Here, we present a comprehensive genetic analysis of a relatively large series of BIA-ALCL (n = 29), for which genome-wide chromosomal copy number aberrations (CNAs) and mutational profiles for a subset (n = 7) were determined. For comparison, CNAs for anaplastic lymphoma kinase (ALK)− nodal anaplastic large cell lymphomas (ALCLs; n = 24) were obtained. CNAs were detected in 94% of BIA-ALCLs, with losses at chromosome 20q13.13 in 66% of the samples. Loss of 20q13.13 is characteristic of BIA-ALCL compared with other classes of ALCL, such as primary cutaneous ALCL and systemic type ALK+ and ALK− ALCL. Mutational patterns confirm that the interleukin-6–JAK1–STAT3 pathway is deregulated. Although this is commonly observed across various types of T-cell lymphomas, the extent of deregulation is significantly higher in BIA-ALCL, as indicated by phosphorylated STAT3 immunohistochemistry. The characteristic loss of chromosome 20 in BIA-ALCL provides further justification to recognize BIA-ALCL as a separate disease entity. Moreover, CNA analysis may serve as a parameter for future diagnostic assays for women with breast implants to distinguish seroma caused by BIA-ALCL from other causes of seroma accumulation, such as infection or trauma.

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

Materials ◽  
2018 ◽  
Vol 11 (12) ◽  
pp. 2393 ◽  
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.

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

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.

scholarly journals How I treat breast implant–associated anaplastic large cell lymphoma

Blood ◽  
2018 ◽  
Vol 132 (18) ◽  
pp. 1889-1898 ◽  
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.

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

2019 ◽  
Vol 40 (8) ◽  
pp. 838-846 ◽  
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

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

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.

EP.TH.41Breast Implant-Associated Anaplastic Large Cell Lymphoma

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Parisa Moori ◽  
Fran Ibison ◽  
Deepa Jacob ◽  
Julie Iddon
Keyword(s):  
Anaplastic Large Cell Lymphoma ◽  
Cell Lymphoma ◽  
Breast Implant ◽  
Disease Process ◽  
Breast Implants ◽  
Large Cell ◽  
Anaplastic Lymphoma ◽  
Non Hodgkin Lymphoma ◽  
Raising Awareness ◽  
Large Cell Lymphoma

Abstract Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare, non-Hodgkin lymphoma which arises within the capsules of breast implants. These particular tumours have expression of CD30 and are negative for Anaplastic Lymphoma Kinase (ALK). Here, we report a case of BIA-ALCL in a 48-year-old woman post breast reconstruction. This case report is aimed at raising awareness and education on the significance of considering the development of BIA-ALCL in cases where cytology is negative and helping better understand this disease process.

Anaplastic Large Cell Lymphoma Arising in a Silicone Breast Implant Capsule: A Case Report and Review of the Literature

2003 ◽  
Vol 127 (3) ◽  
pp. e115-e118 ◽  
Author(s):  
Sunati Sahoo ◽  
Paul P. Rosen ◽  
Richard M. Feddersen ◽  
David S. Viswanatha ◽  
Douglas A. Clark ◽  
...  
Keyword(s):  
Anaplastic Large Cell Lymphoma ◽  
Cell Lymphoma ◽  
Breast Implant ◽  
Large Cell ◽  
Cell Phenotype ◽  
Augmentation Mammoplasty ◽  
Silicone Breast Implant ◽  
Rare Type ◽  
Breast Lymphoma ◽  
Large Cell Lymphoma

Abstract Anaplastic large cell lymphoma is a rare type of primary breast lymphoma. We report a case of anaplastic large cell lymphoma, T-cell phenotype, occurring in the periprosthetic capsule of a silicone breast prosthesis 9 years after implantation for augmentation mammoplasty. This case is unique for its unusual presentation.

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