scholarly journals Multidisciplinary approach in the clinical and laboratory investigation of a suspected case for anaplastic lymphoma associated with breast prosthesis

Mastology ◽  
2020 ◽  
Vol 30 ◽  
Author(s):  
René Aloisio da Costa Vieira ◽  
Idam de Oliveira-Junior ◽  
Luciana da Fonseca Santos ◽  
Ana Paula Uema Watanabe ◽  
Wilson Eduardo Furlan Matos Alves ◽  
...  
Keyword(s):  
Flow Cytometry ◽  
Cell Lymphoma ◽  
Breast Implant ◽  
False Negative ◽  
Fibrous Tissue ◽  
Breast Implants ◽  
Large Cell ◽  
Suspected Case ◽  
Anaplastic Lymphoma ◽  
Diagnostic Flowchart

Introduction: Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare subtype of CD30-positive and ALK- negative (anaplastic lymphoma kinase) T cell lymphoma, which can develop in the pericapsular fibrous tissue and the late seromas around breast implants. If BIA-ALCL is suspected, an adequate diagnostic flow is essential. Materials and methods: A flowchart of the procedures performed in the diagnostic investigation is discussed, associating a clinical case, and conducting a review on the topic. Results: In the assessment of late and recurrent periprosthetic seromas, prior communication from the surgeon and the pathologist is essential, aiming at the adequate collection and storage of the aspirated material. The material must be promptly fractionated for microbiological assessment by culture, immediate or transoperative cytologic assessment, immunophenotyping by flow cytometry (10 mL), direct cytopathological examination, and obtaining cell block material (50 mL). For flow cytometry, the material must be sent fresh, 70% alcohol or 10% buffered formalin can be added for the other procedures. If it is impossible to send the aspirated fluid to the laboratory in less than six hours, it can be temporarily stored in a refrigerator at 4°C. Immunophenotyping should be extensive, always assessing the expression of CD30 and ALK, regardless of cytological aspects. In cases of late and recurrent seromas in which BIA-ALCL is considered, even if initially discarded, it is suggested to perform capsulectomy with the removal of the prosthesis or careful clinical and laboratory monitoring. Conclusion: The diagnostic flowchart is essential, aiming at false-negative tests.

A Cautionary Tale and Update on Breast Implant–Associated Anaplastic Large Cell Lymphoma (BIA-ALCL)

2020 ◽  
Vol 40 (12) ◽  
pp. 1288-1300 ◽  
Author(s):  
Trina Ghosh ◽  
Eric Duncavage ◽  
Neha Mehta-Shah ◽  
Patricia A McGuire ◽  
Marissa Tenenbaum ◽  
...  
Keyword(s):  
Flow Cytometry ◽  
T Cells ◽  
T Cell ◽  
Cell Lymphoma ◽  
Breast Implant ◽  
Large Cell ◽  
World Health ◽  
Multidisciplinary Teams ◽  
Level Of Evidence ◽  
Anaplastic Lymphoma

Abstract Breast implant–associated anaplastic large T-cell lymphoma (BIA-ALCL) was first recognized by the World Health Organization in 2016. The total number of cases worldwide continues to increase, with >800 cases confirmed through a combination of Food and Drug Administration data, verified reports, and registries. To date, 33 deaths have been reported. Typical presentation includes a late seroma containing monoclonal T cells that are CD30 positive and anaplastic lymphoma kinase negative. We present a review of the current literature and report on 3 cases of BIA-ALCL at our institution, which serve to illustrate our approach to diagnosis and management of this disease. In 2 cases, the diagnosis of BIA-ALCL was not initially confirmed due to an incomplete workup but was recognized upon explantation. The seroma fluid was sent for flow cytometry. Initially, the cells were reported as morphologically suspicious for malignancy with phenotypically normal T cells based on standard CD3+ T-cell gating. Subsequent cytology specimens were reported as consistent with recurrent adenocarcinoma. However, upon regating of flow-cytometry data, a population of CD30+, CD3– T cells was noted and the diagnosis of BIA-ALCL was confirmed by immunohistochemical stains of the excised breast capsule specimen. Given the increasing incidence of this disease, as plastic surgeons we must stay informed to order the correct workup to avoid misdiagnosis and be prepared to appropriately refer affected patients to centers with multidisciplinary teams experienced in the management of BIA-ALCL. Level of Evidence: 4

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.

scholarly journals Breast Implant-Associated Anaplastic Large Cell Lymphoma

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
P. L. Moori ◽  
F. Ibison ◽  
D. Jacob ◽  
J. 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

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.

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 Breast Implant–Associated Anaplastic Large-Cell Lymphoma: Why Must We Learn About It?

2019 ◽  
pp. 1-5
Author(s):  
Letícia Morais Coelho de Oliveira Sermoud ◽  
Sérgio Romano ◽  
Maurício Chveid ◽  
Gilberto Luiz da Silva Amorim
Keyword(s):  
Anaplastic Large Cell Lymphoma ◽  
Health Care Professionals ◽  
Cell Lymphoma ◽  
Breast Implant ◽  
Breast Implants ◽  
Large Cell ◽  
Target Population ◽  
Medical Community ◽  
Anaplastic Lymphoma ◽  
Large Cell Lymphoma

Breast implant–associated anaplastic large-cell lymphoma (BIA-ALCL) is a rare, breast implant–associated T-cell lymphoma in which CD30 is expressed and anaplastic lymphoma kinase ( ALK) expression is absent. However, despite the low risk of developing the disease, more information on BIA-ALCL is necessary, because the number of women with breast implants has been increasing worldwide; Brazil is one of the main markets for this type of implant. The objectives of this review are to clarify the issue of BIA-ALCL occurrence after risk-reducing mastectomy, to show the importance of this disease, and to raise awareness among the medical community about this rare pathologic condition. In 2016, BIA-ALCL was included by WHO in the new classification of lymphomas, and this demonstrates the attention that medical entities should give to this disease. Thus, awareness about BIA-ALCL must be broadened among the medical societies and regulatory authorities, both to foster better approaches to this disease, which should be evaluated in a multidisciplinary manner, and to provide better knowledge among health care professionals and the target population about the use of implants.

scholarly journals Clinical and laboratory protocol in suspected cases of breast implant-associated anaplastic lymphoma

Mastology ◽  
2020 ◽  
Vol 30 (Suppl 1) ◽  
Author(s):  
Luciana da Fonseca Santos ◽  
Idam de Oliveira ◽  
Luciano Neder ◽  
Wilson Eduardo Furlan Matos Alves ◽  
Rene Aloisio da Costa Vieira
Keyword(s):  
Breast Implant ◽  
False Negative ◽  
Large Cell ◽  
Systematic Evaluation ◽  
Anaplastic Lymphoma ◽  
Negative Results ◽  
Positron Emission ◽  
Paraffin Block ◽  
The Subject ◽  
Diagnostic Flowchart

Introduction: Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare entity. As a result, care in the diagnostic flowchart is not systematized and known by all mastologists. Non-systematic evaluation can lead to false-negative assessments, making it crucial to have systematic knowledge about the subject. Methods: The Research Ethics Committee of the Hospital de Câncer de Barretos approved this study, under the number 23026719.5.0000.5437/2019. We sought to conduct an integrative review on the subject, aiming at identifying the diagnostic flowchart and therapeutic care to be adopted by mastologists. Results: BIA-ALCL diagnosis should be considered in patients with peri-implant seroma when the implant was placed for more than a year. Despite being more associated with textured implants, the disease was also identified in smooth implants. In clinical practice, breast ultrasound is the examination of choice. The main finding is peri-implant seroma, with puncture. Breast magnetic resonance imaging can help evaluate implant integrity. Positron emission tomography-computed tomography (PET-CT) can be used in high suspicion or confirmed cases, improving the staging. Some precautions are essential in the care of the collected fluid; otherwise, it can lead to false negatives. Cytology should be performed on the day of collection, in less than 6 hours. Centrifuging the fluid collected should be considered in order to obtain a smaller volume but with high cellularity. The centrifuged material can be processed to form a paraffin block (cell block), in which the Wright-Giemsa stain will be used. The material can be sent immediately or after adding 50% alcohol. Surgery should be indicated in cases of tumor mass, high clinical suspicion, or recurrent seroma. In these cases, drainage of the peri-implant content and capsulectomy with concomitant removal of the breast implant should be carried out. Bilateral implant removal is recommended if BIA-ALCL is confirmed; however, in case of suspected diagnosis, the indication becomes questionable, and the surgeon must discuss the situation with the patient. Conclusion: Diagnostic systematization reduces the possibility of false-negative results, improving the care described above.

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.

Breast implant – Associated Anaplastic large cell lymphoma

2021 ◽  
Vol 20 (3) ◽  
pp. 117-130
Author(s):  
Charilaos Ioannidis
Keyword(s):  
Anaplastic Large Cell Lymphoma ◽  
Soft Tissues ◽  
Cell Lymphoma ◽  
Breast Implant ◽  
Malignant Neoplasm ◽  
Large Cell ◽  
Surgical Removal ◽  
Treatment Change ◽  
Anaplastic Lymphoma ◽  
Large Cell Lymphoma

Breast Implant –Associated Anaplastic Large Cell Lymphoma is a newly recognized malignant neoplasm presenting in breasts of women who have had breast implants for cosmetic or reconstructive purposes. A review of the literature showed thatit is an uncommon, slow growing T-cell lymphoma with morphology and immunophenotype similar to anaplastic lymphoma kinase (ALK)-negative anaplastic large cell lymphoma. Its clinicopathologic features and treatment, however, are unique. It usually follows an indolent clinical course, but it has the potential to form a mass, to invade locally through the periimplant breast capsule into the breast parenchyma or soft tissues and/or to spread to regional lymph nodes. Surgical removal of the implant en bloc with the whole of the capsule (explantation plus complete capsulectomy) is the treatment of choice and confers an excellent disease free and overall survival. In the few cases with metastatic disease, chemotherapy is used as an adjuvant therapy. Early detection and management convey the best prognosis; therefore clinicians, gynecologists among others, ought to be aware of this new entity and refer suspicious cases for further evaluation and treatment. Change in attitudes towards implant based surgery does not seem necessary, as long as patients are properly informed about the risk of breast implant –associated anaplastic large cell lymphoma.

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

Sign in / Sign up

Export Citation Format

Share Document