Breast Implant-Associated Anaplastic Large Cell Lymphoma – from diagnosis to treatment

• Published in: European journal of surgical oncology Vol. 43; no. 8; pp. 1385 - 1392
• Main Authors: Kaartinen, Ilkka, MD, PhD, Sunela, Kaisa, MD, PhD, Alanko, Johanna, MD, Hukkinen, Katja, MD, PhD, Karjalainen-Lindsberg, Marja-Liisa, MD, PhD, Svarvar, Catarina, MD
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.08.2017
• Subjects: ALCL; ALK-negative lymphoma; BI-ALCL; Breast implants; Breast Implants - adverse effects; Breast Neoplasms - diagnosis; Breast Neoplasms - etiology; Breast Neoplasms - pathology; Breast Neoplasms - therapy; Carcinoma in Situ - diagnosis; Carcinoma in Situ - etiology; Carcinoma in Situ - pathology; Carcinoma in Situ - therapy; Combined Modality Therapy; Cytotoxic c-cell; Device Removal; Disease Progression; Female; Hematology, Oncology and Palliative Medicine; Humans; Lymphoma, Large-Cell, Anaplastic - diagnosis; Lymphoma, Large-Cell, Anaplastic - etiology; Lymphoma, Large-Cell, Anaplastic - pathology; Lymphoma, Large-Cell, Anaplastic - therapy; Neoplasm Staging; Prognosis; Seroma; Surgery; Survival Rate; seroma; breast implants; ALCL; cytotoxic c-cell; BI-ALCL; ALK-negative lymphoma; Cytotoxic c-cell; Seroma; Breast implants
• ISSN: 0748-7983; 1532-2157
• DOI: 10.1016/j.ejso.2017.05.021

Abstract Breast lymphomas comprise a rare group of malignant breast tumors. Among these, a new entity has emerged as a potentially under-diagnosed disease. Breast implant-associated anaplastic large cell lymphoma (BI-ALCL) most often manifests as a late periprosthetic effusion between 1 to 10 years after the implantation of silicone or saline-filled breast prostheses. BI-ALCL is an anaplastic lymphoma kinase-negative T-cell lymphoma that has a distinctively different clinical course than other breast lymphomas or ALCLs. Diagnosis is based on aspiration of the effusion around the implant and CD30 positivity of the sample. Every periprosthetic effusion after breast augmentation or reconstruction using implants should be considered as potential BI-ALCL until proven otherwise. The majority of cases at diagnosis are in the in situ stage, i.e., confined to the lumen around the prosthesis. Most patients have an excellent prognosis when complete removal of the capsule and prosthesis with negative margins is achieved surgically. Some patients, however, develop infiltrative disease with a potentially life-threatening clinical course. Treatment planning regarding the extent of surgery and role of adjuvant therapy, especially in advanced cases, requires further investigation.