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

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 impact of Allergan implant-related issues on patients with breast implants for reconstruction

“…Since the first BIA-ALCL case was reported in 1997, the U.S. FDA stated that 733 medical device reports of BIA-ALCL cases had been identified worldwide by 2020 [11,12]. In Korea, reconstruction and cosmetic surgery using breast implants is actively conducted, and in August 2019, the first BIA-ALCL case was reported in a patient with textured implants (Allergan, Inc.) [10]. After the first case report, the second and third patients in Korea were reported by October 2020 [13].…”

“…In August 2019, the first BIA-ALCL case was reported in Korea, and BIA-ALCL became an issue through the media [10]. Patients who underwent breast surgery with implants felt substantial anxiety about this issue; in particular, patients who underwent reconstruction after mastectomy were very worried that their risk of cancer could increase again.…”

Breast implant-associated anaplastic large cell lymphoma: a case report with a history of spontaneously resolved late seroma

“…Late-onset persistent seroma around breast implant represents the classic clinical presentation in up to 80% of women with BIA-ALCL, and the risk of BIA-ALCL in women who present with delayed seromas is up to 10% [9]. With increasing awareness of this disease, a few case reports have been published in Asia [10,11], including the current case from the pathologist's point of view [12]. This Korean female patient was presented with delayed swelling of her right breast 81 months after implantation and was diagnosed with late seroma on initial ultrasonography (USG).…”

Comment on “Breast implant-associated anaplastic large cell lymphoma: the first South Korean case”

“…Hence, the medical staff and the Korean Society of Plastic Surgeons requested the Health Insurance Review and Assessment Service to cover BIA-ALCL, and it was approved. As such, the first case of BIA-ALCL in Korea is a meaningful and memorable case for all plastic surgeons.The case report of the first case of BIA-ALCL in Korea was published online in December 2020 and published in print in April 2021 [4]. Molecular analysis and histopathologic analysis were performed, although these were time-consuming.…”

“…The case report of the first case of BIA-ALCL in Korea was published online in December 2020 and published in print in April 2021 [ 4 ]. Molecular analysis and histopathologic analysis were performed, although these were time-consuming.…”