Breast Implant-Associated Lymphoma

Abstract

2011 the United States Food and Drug Administration (FDA) confirmed on its website that breast implants can cause the rare tumor entity known as anaplastic large-cell lymphoma (ALCL) (1). This sparked growing interest both in professional journals and in the daily press. The first case of ALCL in a woman with breast implants was published in 1997 (2). The most recent publication from the FDA lists 414 implant-associated events (medical device reports, MDR) relating to breast implants, and the PROFILE database of the Plastic Surgery Foundation contains 516 cases (3,4).Owing to the low prevalence and as yet unknown incidence of breast implant-associated (BIA) ALCL, the existing treatment evaluation data come from case reports.The published guidelines are on the level of expert consensus, therefore treatment recommen- SummaryBackground: There has been increasing evidence in recent years that breast implants can, in rare cases, be associated with the development of an anaplastic large-cell lymphoma (ALCL).Methods: This review is based on relevant publications retrieved by a selective search in PubMed for articles that appeared from the time of the initial description of breast-implant-associated ALCL onward (1997 to January 2018), and by a further search in German nationwide databases.Results: 516 pathologically confirmed cases of breast-implant-associated (BIA) ALCL were documented around the world until February 2018; seven of these arose in Germany and were reported to the Federal Institute for Drugs and Medical Devices (Bundesinstitut für Arzneimittel und Medizinprodukte, BfArM). In approximately 80% of the affected women, the BIA-ALCL manifested itself as a late-developing seroma at the implant site; in the rest, as a solid tumor with or without an accompanying seroma. The mean implant exposure time ranged from 7 to 13 years on average. 16 fatalities have been reported worldwide. Among the 7 cases reported in Germany, four women had undergone breast reconstruction with implants after breast cancer surgery, and two had undergone breast augmentation surgery. In all patients, the entire capsule-and-implant unit was resected. One patient underwent chemotherapy and one further patient underwent chemotherapy and adjuvant radiotherapy. Conclusion:The risk that a woman with breast implants will develop a primary anaplastic large-cell lymphoma is estimated at 0.35 to 1 case per million persons per year. The incidence of implant-associated ALCL is thus very low, yet nevertheless markedly higher than that of other primary lymphomas of the breast. Because of the low case numbers, recommendations for the diagnostic evaluation and treatment of this entity have not been adequately evaluated. Treatment with primary curative intent for BIA-ALCL confers a much better prognosis than when performed for a systemic ALCL. Whenever a patient with a breast implant presents with a late-developing seroma, BIA-ALCL should be included in the differential diagnosis. This diagnosis is reportable.

Microbial detection in seroma fluid preceding the diagnosis of breast implant-associated anaplastic large cell lymphoma: a case report and review of the literature

“…We report a case of a patient with late-onset seroma of the breast after implant reconstruction, who was initially diagnosed with an implant-related infection of the breast due to the detection of Staphylococcus epidermidis in the seroma fluid. After diagnosis of BIA-ALCL, almost seven months later, the complete capsule containing the implant was removed [14].…”

<p>Primary Pulmonary Diffuse Large B Cell Lymphoma Mimicking Metastasis: A Case Report and Literature Review</p>

“…There is increasing evidence that breast implants can induce the development of anaplastic large cell lymphoma (ALCL). 23 Up to February 2018, 516 pathologically identified breast-implant-associated (BIA) ALCL cases were described globally. 23,24 BIA-ALCL generally presents as a late-developing seroma after an average of 7-13 years after implant exposure.…”

Incidence of Anaplastic Large Cell Lymphoma and Breast-Implant-Associated Lymphoma—An Analysis of a Certified Tumor Registry over 17 Years

“…Breast-implant-associated anaplastic large cell lymphoma (BI-ALCL) is a rare type of non-Hodgkin lymphoma first described by Keech et al [3] Among several histologic subtypes, the expression of CD30 (CD30-positive) and an absent receptor tyrosine kinase, the anaplastic lymphoma kinase (ALK-negative), are important characteristics of BI-ALCL [4,5]. Since 1997, approximately 800 cases have been reported worldwide, only twenty-four of which were listed by the German Federal Institute for Drugs and Medical Devices (BfArM) [6][7][8][9][10][11][12]. As known from other malignancies and given the rarity of the disease along with unreleased implant sales data, calculating an exact incidence is challenging [13,14].…”