Anaplastični velikocelični limfom, povezan z vsadki dojk

Abstract

IzvlečekPo svetu se vedno več žensk odloča za estetsko korekcijo dojk s silikonskimi vsadki in rekonstrukcijo dojk po zdravljenju karcinoma s tkivnim ekspandrom in silikonskim vsadkom. Ocene pravijo, da ima že več kot 10 milijonov žensk po svetu silikonske vsadke dojk. V literaturi je opisanih približno 200 posameznih primerov bolnic z anaplastičnim velikoceličnim limfomom (angl. anaplastic large cell lymphoma, ALCL), ki se povezuje s silikonskimi vsadki. Gre za redko bolezen, ki se po ocenah pojavlja pri 0,1-0,3/100.000 žensk s silikonskimi vsadki letno. Pri kliničnih znakih je potrebno pomisliti tudi na to, sicer zelo redko obliko ALCL. Bolnice so v povprečju stare 50 let. Pri njih se pozno po operaciji lahko pojavi povečanje dojke, bolečina in asimetrija. Pri diagnosticiranju sta pomembni ultrazvočna in citološka preiskava. Ultrazvočno lahko ugotovimo tekočinsko formacijo (serom) ali solidno tumorsko maso. Zdravljenje je individualno. Zaradi narave tumorja je v večini primerov potrebna odstranitev vsadka in popolna odstranitev tkivne ovojnice, katerima sta redko pridruženi kemo-in radioterapija. Petletno preživetje je odvisno od oblike tumorja in dobro korelira s prisotnostjo seroma ali tumorske mase. Pri seromu, ki je pogostejša oblika, je petletno preživetje 100-odstotno, medtem ko je pri solidni tumorski masi petletno preživetje 75-odstotno. Redkost bolezni predstavlja velik diagnostičen izziv, vendar je zgodnje odkrivanje in zdravljenje ključno za ozdravitev bolnic. AbstractAn increasing number of women worldwide decide for esthetic correction of breasts with silicone implants and post-cancer breast reconstruction with tissue expanders and silicone breast implants. It is estimated that more than 10 million women around the globe have them. There are approximately 200 known cases of patients with anaplastic large cell lymphoma (ALCL) linked with silicone breast implants reported in medical literature. ALCL is a rare disease with an annual incidence of 0.1-0.3/100 000 women with breast silicone implants. In the presence of clinical signs, physician should also consider this rare form of ALCL in differential diagnosis. Patients are on average 50 years old. Long after implantation surgery, the patient may experience breast swelling, pain and/or asymmetry. In diagnostics, ultrasound and cytological examination are required. During ultrasound examination fluid formation (seroma) or solid tumor mass can be detected. Treatment is individualized. Due to tumor nature, implant resection and total capsulectomy are usually indicated; also, chemo-and radiotherapy might rarely be required. Five-year survival rate depends on tumor form and correlates well with clinical findings of seroma or solid mass. In the more frequent form, seroma, five-year survival rate is 100 %, while in the case of solid tumor mass five-year survival rate is 75 %. The rarity of this disease makes it difficult to diagnose, but nevertheless, early detection and treatment are important for better recovery.