Breast Implant-associated Anaplastic Large Cell Lymphoma

Abstract

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is an uncommon lymphoproliferative disorder, mainly associated with textured implants. The average time from the breast implants to the development of BIA-ALCL is about 7 to 10 years, and the median age at the time of diagnosis is in the mid-50s. The exact incidence and prevalence of BIA-ALCL are not known. The pathogenesis of BIA-ALCL remains unclear. Different theories have been postulated, including immune response to textured implants, subclinical bacterial infection, and genetic predisposition. However, none of those theories have yet been proven to be causal in the pathogenesis of BIA-ALCL. BIA-ALCL is histologically similar to but clinically distinct from other CD30-positive T-cell lymphomas such as anaplastic lymphoma kinase-positive, anaplastic lymphoma kinase-negative, and primary cutaneous ALCL. The revised World Health Organization classification of lymphoid neoplasm in 2016 recognized BIA-ALCL as a provisional entity. Suspected cases need proper evaluation and workup to confirm the diagnosis. Surgical resection should be considered for all the cases. However, adjuvant radiotherapy and anthracycline-based chemotherapy are warranted for locally advanced and advanced cases.

Breast Implanted-Associated Anaplastic Large Cell Lymphoma: A Case of Advanced Disease with Flow Cytometric Findings

“…The tumor was designated pT4 and with three ipsilateral axillary nodes involved by breast implantassociated ALCL, the nodal involvement was pN2 (see Figure 1D), thus TNM stage III. 1,2 Morphological assessment and immunohistochemical analyses supported the diagnosis of breast implant-associated ALCL (see Figures 2 and 3). The neoplasm consisted mostly of large cells with atypical nuclei and vesicular chromatin, conspicuous nucleoli, prominent mitoses, and moderately abundant cytoplasm.…”

Current Understanding of Breast Implant-Associated Anaplastic Large Cell Lymphoma

“…In those people who have a genetic predisposition to the disease, the shell particle of the textured implants causes chronic T cell and phagocytic cellular aggregation, which results in chronic inflammation and immunological dysregulation. This collection of T cells might be in close proximity to the silicone substance, which may eventually cause them to become sensitive to particles composed of silicones or their subsequent proteins, triggering a response to the antigen and its presentation in T cells [ 26 ]. Monocytes and T lymphocytes are mainly infiltrated close to the surface of biomaterials, where they release IL-4, IL-13, and other substances as a result [ 6 , 27 ].…”

“…A research study of whole exome sequencing performed on DNA extracted from cytology fluid and germline DNA of two patients with effusion-limited BIA-ALCL revealed mutations in JAK1 and STAT3 as well as a germline JAK3 mutation, the latter of which suggested a potential genetic susceptibility for the development of this lymphoma [ 28 , 29 ]. Chronic inflammation brought on by the ongoing processing of antigens may result in immunological dysregulation, cell proliferation, formation of foreign body giant cells (FBGCs) with a higher chance of genetic mutation, and ultimately cancer (Figure 1 ) [ 26 ].…”

“…In some situations, CD15 and PAX-5 results may be positive, raising the possibility of a conventional Hodgkin's disease, particularly when infiltrative illness is present [ 17 ]. Large pleomorphic cells with lots of eosinophil granules embedded in the cytoplasm along with horse-shoe shaped nuclei (considered as hallmark cells) with noticeable nucleoli may be seen as the morphological and histological feature of malignant cells of BIA-ALCL [ 21 , 26 , 36 ].…”

Regional lymphomatoid papulosis arising after total mastectomy for breast cancer

“…Although the exact pathogenesis of BIA-ALCL is unclear, one hypothesis is that inflammatory cell aggregation induced by textured implants leads to immune dysregulation and cell proliferation. [ 3 ]…”