How I treat breast implant–associated anaplastic large cell lymphoma

Mehta‐Shah, Neha; Clemens, Mark W.; Horwitz, Steven M.

doi:10.1182/blood-2018-03-785972

Cited by 67 publications

(83 citation statements)

References 48 publications

(83 reference statements)

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“…A recent population‐based case‐control study based on the pathology registry in the Netherlands established that BI is associated with a markedly increased risk (400 times) of developing ALCL, but the absolute cumulative risk is estimated to one case for every 50 000 women with BI by the age of 50 years and one per 7000 by the age of 75 . In another study based on US cases, the lifetime risk of BIA‐ALCL in women with textured implants was estimated to be 1 in 30 000 …”

Section: Breast Implant‐associated Anaplastic Large Cell Lymphomamentioning

confidence: 99%

“…However, lymphoma involvement is not proven by biopsy in all instances so that the actual incidence of locoreginal nodal dissemination is likely lower. Uncommonly, cutanous lesions or B sympoms have been reported at presentation …”

Section: Breast Implant‐associated Anaplastic Large Cell Lymphomamentioning

confidence: 99%

“…Several studies have highlighted an association between the clinical pattern and disease aggressiveness, ie, most cases presenting as a seroma appear to be cured with surgery alone and infrequently experience recurrences, while the presence of a solid tumor mass is an adverse prognostic factor . Importantly, in patients with lymphoma confined to the fibrous periprosthetic capsule, complete surgical excision (total capsulectomy and BI removal) is an important determinant of a better overall survival and is the treatment of choice over partial excision, chemotherapy, or radiation therapy only . Lymph node involvement at initial presentation was found to correlate with an inferior overall survival .…”

Section: Breast Implant‐associated Anaplastic Large Cell Lymphomamentioning

confidence: 99%

“…A detailed longitudinal analysis of patients who died of BI‐ALCL showed locoregional dissemination of the disease to the breast, locoregional lymph nodes, chest, and mediastinum but no systemic dissemination typical of other lymphomas. Therefore and because of the importance of complete surgical resection in patients with localized disease, it was suggested to use a Tumor, Node, Metastases (TNM) staging system similar in its principles to those applied to solid tumors, for evaluating BIA‐ALCL . (Table ).…”

Section: Breast Implant‐associated Anaplastic Large Cell Lymphomamentioning

confidence: 99%

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Breast implant‐associated anaplastic large cell lymphoma and other rare T‐cell lymphomas

Leval

2019

Hematological Oncology

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Peripheral T-cell lymphomas (PTCLs) account for less than 15% of all non-Hodgkin lymphomas worldwide. In the current WHO classification, more than 25 types of T-cell neoplasms are listed (Table 1). 1 Considering the noncutaneous T-cell lymphomas, despite substantial geographic variations in the incidence and the subtype prevalence, a few entities-essentially those presenting as nodal diseases-are relatively common and account for the majority of the cases, while extranodal entities are far less common or distinctively rare. Here, we will review the clinico-pathological features of breast implant (BI)-associated anaplastic large cell lymphoma and intestinal T-cell neoplasms, with a focus on the recent advances in the understanding of their molecular biology and pathogenesis. 2 | BREAST IMPLANT-ASSOCIATED ANAPLASTIC LARGE CELL LYMPHOMA Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a very rare form of T-cell lymphoma that arises in association with BIs. BIA-ALCL was introduced as a new provisional disease entity in the recently revised WHO classification of lymphoid malignancies, distinct from the other types of ALCLs already recognized (anaplastic lymphoma kinase [ALK]-positive and ALK-negative ALCL and primary cutaneous ALCL). 1 2.1 | Epidemiology Since the first case was described in 1997, more than 500 cases of BIA-ALCL have been reported in the literature worldwide. An increasing number of dioagnoses were recorded over the recent years reflecting a substantial increase in recognition and awareness of the disease. Notwithstanding these trends, the incidence of BIA-ALCL remains very low. Primary breast lymphomas represent 1% to 2% of all non-Hodgkin lymphomas, with most cases diagnosed as diffuse large B-cell lymphomas, follicular or marginal zone B-cell lymphomas. Among more than 400 breast lymphomas accumulated between 2010 and 2018 in the French lymphoma network, BIA-ALCL represented 10% of the diagnoses. 2Taking into consideration the very large number of women with BIs over the world, the individual risk of BIA-ALCL is very small. A recent population-based case-control study based on the pathology registry in the Netherlands established that BI is associated with a markedly increased risk (400 times) of developing ALCL, but the absolute cumulative risk is estimated to one case for every 50 000 women with BI by the age of 50 years and one per 7000 by the age of 75. 2 In another study based on US cases, the lifetime risk of BIA-ALCL in women with textured implants was estimated to be 1 in 30 000. 3 | Clinical featuresThe mean age at diagnosis is in the 50s. Approximately 60% of women who develop BIA-ALCL had implants for cosmetic reasons, and 40% had implants for reconstructive purposes after surgery for breast cancer. BIA-ALCL has also been reported in three transgender male to female individuals. The median time interval between implant insertion and lymphoma diagnosis is 8 to 9 years in different studies, but wide variations are observed. There is no significant difference in risk o...

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Section: Breast Implant‐associated Anaplastic Large Cell Lymphomamentioning

confidence: 99%

Section: Breast Implant‐associated Anaplastic Large Cell Lymphomamentioning

confidence: 99%

Section: Breast Implant‐associated Anaplastic Large Cell Lymphomamentioning

confidence: 99%

Section: Breast Implant‐associated Anaplastic Large Cell Lymphomamentioning

confidence: 99%

See 2 more Smart Citations

Breast implant‐associated anaplastic large cell lymphoma and other rare T‐cell lymphomas

Leval

2019

Hematological Oncology

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show abstract

“…Doren et al 3 reported that lifetime prevalence of BIA-ALCL was approximately 1 in 30,000 for women with textured implants. Other series estimate lifetime risk range from 1:1000 to 1:10,000 in women with textured implants 4 . Up to date, more than 500 cases of BIA-ALCL have been confirmed worldwide 5 ; nevertheless, the exact incidence is difficult to define due to unfamiliarity with this new entity.…”

Section: Introductionmentioning

confidence: 99%

Breast implant-associated anaplastic large cell lymphoma in li-fraumeni syndrome: case-based literature review

Sonagli¹,

Formiga²,

Abdala³

et al. 2019

Mastology

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O linfoma anaplásico de células grandes associado ao implante mamário é uma doença rara relacionada ao seroma crônico em torno dos implantes mamários. O linfoma anaplásico de células grandes associado ao implante foi recentemente reconhecido pela Organização Mundial de Saúde como um tipo de linfoma não-Hodgkin de células T da mama. As principais características incluem o seroma crônico que se desenvolve um ano depois da cirurgia da mama, com sintomas como dor na mama, inchaço, hiperemia da pele e um nódulo ou massa da mama. A síndrome de Li-Fraumeni está associada à mutação da linha germinativa no TP53 e aumenta o risco de desenvolvimento de muitos tipos de câncer, incluindo neoplasias mamárias e hematológicas. Relatamos um caso de uma mulher de 56 anos de idade com Síndrome de Li-Fraumeni e um histórico de câncer de mama submetido a uma mastectomia para tratar câncer de mama e mastectomia profilática contralateral poupadora de mamilo seguida de reconstrução bilateral de implantes mamários com implantes de silicone texturizados. Esta paciente desenvolveu linfoma anaplásico de células grandes associado ao implante mamário sete anos depois. Foi realizada uma revisão da literatura sobre uma abordagem multidisciplinar para essa condição. ABSTRACTBreast implant-associated anaplastic large cell lymphoma is a rare disease related to chronic seroma around breast implants. Breast implant-associated anaplastic large cell lymphoma has been recently recognized by the World Health Organization as a type of T-cell non-Hodgkin lymphoma of the breast. The main features comprise chronic seroma which develops a year posterior to breast surgery, with symptoms such as breast pain, swelling, skin hyperemia and a nodule or mass of the breast. Li-Fraumeni Syndrome is associated with germline TP53 mutation and enhances the risks of developing many types of cancers, including breast and hematologic malignancies. We report a case of a 56-year-old female with Li-Fraumeni Syndrome and a history of breast cancer who underwent a mastectomy to treat breast cancer and prophylactic contralateral nipple-sparing mastectomy followed by bilateral breast implant reconstruction with textured silicone implants. This patient developed Breast implant-associated anaplastic large cell lymphoma seven years later. A literature review on multidisciplinary approach to this condition was performed.

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Breast Implant–Associated Anaplastic Large Cell Lymphoma

2020

Self Cite

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Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), first reported in 1997, is recognized in the 2016 edition of the World Health Organization as a subtype of the peripheral T-cell lymphomas. 1 Whether they are filled with saline or silicone gel, the shells of breast implants can have smooth or textured surfaces. A textured-surface breast implant is associated with every case of BIA-ALCL where the entire breast implant history of the patient is known. Estimates of the lifetime risk of BIA-ALCL vary, ranging from 1 in 1000 to 1 in 30 000 patients with textured breast implants. As of May 2019, the American Society of Plastic Surgeons reports 722 distinct cases worldwide. 2 On May 2, 2019, the US Food and Drug Administration (FDA),advocated for "strengthening the evidence generated to help inform future regulatory actions" but did not restrict access to any implants. By contrast, the National Agency for Medicine and Health Products of France banned textured breast implants from several manufacturers on April 2, 2019. Health Canada suspended the licenses of available macrotextured breast implants on May 28, 2019. Based on the available evidence, and the expectation that plastic surgeons will provide comprehensive information for patients to make an informed decision, we agree with the FDA's measured approach.Breast implant-associated ALCL most commonly develops 7 to 9 years after breast implant placement and presents with a delayed, spontaneous seroma in approximately 80% of cases or mass in approximately 20%. Shortly after placement, breast implants are encased in a specialized scar tissue or capsule. Fortunately, most BIA-ALCL cases are confined to the capsule and effectively treated by complete, confluent resection of the capsule and implant, often referred to as en bloc capsulectomy. 3 Those who have disease limited to the capsule have an excellent prognosis. Only 4% of those receiving en bloc capsulectomy for early-stage disease will recur by 5 years. However, 15% of cases have more advanced disease and can be treated with chemotherapy, antibody drug conjugates (such as brentuximab vedotin), or combination approaches for curative intent. 4 In patients with advanced disease, up to 70% of patients may have a recurrence; however, this is likely improved with more modern chemotherapeutic approaches. 5 Given the rare nature of this disease, which requires a specific surgical approach, we recommend treatment at a center with experience with this diagnosis.The etiology of BIA-ALCL is elusive because it occurs so rarely and typically develops many years after breast implantation. However, because it occurs exclusively in textured-surface devices, many investigators suggest that BIA-ALCL is initiated by an inflammatory

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How I treat breast implant–associated anaplastic large cell lymphoma

Cited by 67 publications

References 48 publications

Breast implant‐associated anaplastic large cell lymphoma and other rare T‐cell lymphomas

Breast implant‐associated anaplastic large cell lymphoma and other rare T‐cell lymphomas

Breast implant-associated anaplastic large cell lymphoma in li-fraumeni syndrome: case-based literature review

Breast Implant–Associated Anaplastic Large Cell Lymphoma

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