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.

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 Etiology of Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL): Current Directions in Research

Cancers ◽  
2020 ◽  
Vol 12 (12) ◽  
pp. 3861
Author(s):  
Anand K. Deva ◽  
Suzanne D. Turner ◽  
Marshall E. Kadin ◽  
Mark R. Magnusson ◽  
H. Miles Prince ◽  
...  
Keyword(s):  
T Cell ◽  
Anaplastic Large Cell Lymphoma ◽  
Cell Lymphoma ◽  
Breast Implant ◽  
Bacterial Load ◽  
Locally Advanced ◽  
Large Cell ◽  
Future Research ◽  
Anaplastic Lymphoma ◽  
Large Cell Lymphoma

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a CD30-positive, anaplastic lymphoma kinase-negative T-cell lymphoma. Where implant history is known, all confirmed cases to date have occurred in patients with exposure to textured implants. There is a spectrum of disease presentation, with the most common occurring as a seroma with an indolent course. A less common presentation occurs as locally advanced or, rarely, as metastatic disease. Here we review the immunological characteristics of BIA-ALCL and potential triggers leading to its development. BIA-ALCL occurs in an inflammatory microenvironment with significant lymphocyte and plasma cell infiltration and a prominent Th1/Th17 phenotype in advanced disease. Genetic lesions affecting the JAK/STAT signaling pathway are commonly present. Proposed triggers for the development of malignancy include mechanical friction, silicone implant shell particulates, silicone leachables, and bacteria. Of these, the bacterial hypothesis has received significant attention, supported by a plausible biologic model. In this model, bacteria form an adherent biofilm in the favorable environment of the textured implant surface, producing a bacterial load that elicits a chronic inflammatory response. Bacterial antigens, primarily of Gram-negative origin, may trigger innate immunity and induce T-cell proliferation with subsequent malignant transformation in genetically susceptible individuals. Although much remains to be elucidated regarding the multifactorial origins of BIA-ALCL, future research should focus on prevention and treatment strategies, recognizing susceptible populations, and whether decreasing the risk of BIA-ALCL is possible.

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

2020 ◽  
Vol 28 (2) ◽  
pp. 117-126 ◽  
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.

scholarly journals Super-enhancer-based identification of a BATF3/IL-2R−module reveals vulnerabilities in anaplastic large cell lymphoma

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Huan-Chang Liang ◽  
Mariantonia Costanza ◽  
Nicole Prutsch ◽  
Mark W. Zimmerman ◽  
Elisabeth Gurnhofer ◽  
...  
Keyword(s):  
Anaplastic Large Cell Lymphoma ◽  
Cell Lymphoma ◽  
Breast Implant ◽  
Large Cell ◽  
Antibody Drug Conjugate ◽  
Anaplastic Lymphoma ◽  
Super Enhancer ◽  
Large Cell Lymphoma

AbstractAnaplastic large cell lymphoma (ALCL), an aggressive CD30-positive T-cell lymphoma, comprises systemic anaplastic lymphoma kinase (ALK)-positive, and ALK-negative, primary cutaneous and breast implant-associated ALCL. Prognosis of some ALCL subgroups is still unsatisfactory, and already in second line effective treatment options are lacking. To identify genes defining ALCL cell state and dependencies, we here characterize super-enhancer regions by genome-wide H3K27ac ChIP-seq. In addition to known ALCL key regulators, the AP-1-member BATF3 and IL-2 receptor (IL2R)-components are among the top hits. Specific and high-level IL2R expression in ALCL correlates with BATF3 expression. Confirming a regulatory link, IL-2R-expression decreases following BATF3 knockout, and BATF3 is recruited to IL2R regulatory regions. Functionally, IL-2, IL-15 and Neo-2/15, a hyper-stable IL-2/IL-15 mimic, accelerate ALCL growth and activate STAT1, STAT5 and ERK1/2. In line, strong IL-2Rα-expression in ALCL patients is linked to more aggressive clinical presentation. Finally, an IL-2Rα-targeting antibody-drug conjugate efficiently kills ALCL cells in vitro and in vivo. Our results highlight the importance of the BATF3/IL-2R-module for ALCL biology and identify IL-2Rα-targeting as a promising treatment strategy for ALCL.

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 Recurrent Systemic Anaplastic Lymphoma Kinase–Negative Anaplastic Large Cell Lymphoma Presenting as a Breast Implant–Associated Lesion

2015 ◽  
Vol 22 (3) ◽  
pp. 369-372 ◽  
Author(s):  
Amanda Zimmerman ◽  
Frederick L. Locke ◽  
Josephine Emole ◽  
Marilin Rosa ◽  
Pedro Horna ◽  
...  
Keyword(s):  
Anaplastic Large Cell Lymphoma ◽  
Anaplastic Lymphoma Kinase ◽  
Cell Lymphoma ◽  
Breast Implant ◽  
Large Cell ◽  
Anaplastic Lymphoma ◽  
Large Cell Lymphoma

Null-Type Anaplastic Lymphoma Kinase–Negative Anaplastic Large Cell Lymphoma Arising in a Silicone Breast Implant Capsule

2011 ◽  
Vol 127 (6) ◽  
pp. 159e-162e ◽  
Author(s):  
Davide Lazzeri ◽  
Tommaso Agostini ◽  
Giordano Giannotti ◽  
Giovanni Fanelli ◽  
Livio Colizzi ◽  
...  
Keyword(s):  
Anaplastic Large Cell Lymphoma ◽  
Anaplastic Lymphoma Kinase ◽  
Cell Lymphoma ◽  
Breast Implant ◽  
Large Cell ◽  
Silicone Breast Implant ◽  
Anaplastic Lymphoma ◽  
Large Cell Lymphoma

scholarly journals Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL): A Review and the Caribbean Perspective

2020 ◽  
Author(s):  
K Mitchell ◽  
K Lourenco ◽  
E Guelmo-Daisley ◽  
S Romany ◽  
P Gill ◽  
...  
Keyword(s):  
Anaplastic Large Cell Lymphoma ◽  
Cell Lymphoma ◽  
Breast Implant ◽  
Large Cell ◽  
Autologous Reconstruction ◽  
Early Presentation ◽  
Anaplastic Lymphoma ◽  
Pubmed Database ◽  
The Caribbean ◽  
Large Cell Lymphoma

ABSTRACT Objectives Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) is a rare CD-30 positive, Anaplastic Lymphoma Kinase Negative Non-Hodgkins lymphoma. The current estimated incidence is one to three cases per million implanted women. However, this is likely to rise with the increasing popularity of breast augmentation. This article contains a brief literature review and describes the Caribbean response to BIAALCL. Methods A literature search was done on the PUBMED Database. Keywords included ‘breast implant-associated anaplastic large cell lymphoma’, ‘brentuximab vedotin’, ‘breast implant’, ‘texturized implants’. The Caribbean Association of Plastic and Reconstructive Surgeons (CAPRS) formulated a regional response to BIA-ALCL during their meeting in August 2019. Results The Food and Drug Administration (FDA) has received 573 unique medical device reports of BIA-ALCL worldwide. The time from implantation to diagnosis, ranges from 7.5 to 10 years and the median age at diagnosis ranges from 47 to 58 years. The pathophysiology of BIA-ALCL is likely multifactorial and involves chronic inflammation in response to textured implants and chronic biofilm, in a genetically susceptible person. Early presentation has a good prognosis with treatment (5-year survival rate of 70-90%). Conclusion Recommendations included development of a regional breast implant registry, which will facilitate study on implant use and its complications. They also concluded that texturized devices should be avoided and utilization of smooth alternatives or autologous reconstruction be performed. Additionally, if requested by asymptomatic women, explant of textured implants and total capsulectomy is not unreasonable. However, these patients must be appropriately counselled.

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