Seroma-associated primary anaplastic large-cell lymphoma adjacent to breast implants: an indolent T-cell lymphoproliferative disorder

Abstract

Non-Hodgkin lymphomas of the breast are rare, encompassing approximately 0.04-0.5% of all malignant breast tumors, and the vast majority are B-cell lymphomas. In contrast, lymphomas of T-cell phenotype have been rarely reported and some of these have been in close proximity to a breast implant. In our consultation practice, we have identified four patients with primary T-cell anaplastic large-cell lymphoma presenting adjacent to silicone or saline breast implants. All patients presented with seroma and neoplastic cells were identified in suspension in the serous fluid without solid tissue invasion. Three patients had no evidence of systemic disease (stage 1E), and one patient was not staged. The mean age of the patients was 46 years (range, 34-59 years). In all patients, the neoplastic cells had a T-cell phenotype, expressed CD30, cytotoxic granuleassociated proteins, EMA and clusterin, and were anaplastic lymphoma kinase-1-negative. Clonal T-cell receptor c-chain gene rearrangements were identified in three patients. All patients underwent capsulectomy with removal of the implant. One patient subsequently received chemotherapy and radiation therapy, and another was treated with radiation alone. The third patient received no further therapy and the fourth patient has been recently diagnosed. After a mean time of 13 months (range, 9-20 months), all three patients with follow-up were alive and well without any recurrence or systemic disease. Although the follow-up time was relatively short, our series and other reported cases suggest that primary anaplastic large-cell lymphoma adjacent to breast implants is an indolent T-cell lymphoproliferative disorder. Keywords: anaplastic large-cell lymphoma; primary lymphoma of breast; breast implant; silicone; saline Non-Hodgkin lymphomas of the breast are rare and comprise approximately 0.04-0.5% of all malignant breast tumors and 2.2% of extranodal lymphomas.

Mucosal CD30-positive T-cell lymphoproliferations of the head and neck show a clinicopathologic spectrum similar to cutaneous CD30-positive T-cell lymphoproliferative disorders

“…CD30-positive T-cell lymphoproliferations with similar features have been reported arising in association with breast implants. 37 These lesions typically have localized disease and an indolent clinical course, although breast implants also can be involved in the setting of either systemic anaplastic large cell lymphoma or primary cutaneous anaplastic large cell lymphoma. 38 Designating primary mucosal CD30-positive T-cell lymphoproliferations as ALK-negative anaplastic large cell lymphomas (or other peripheral T-cell lymphoma subtype) might lead to overtreatment as suggested previously.…”

Breast Implant–Associated Anaplastic Large-Cell Lymphoma: Long-Term Follow-Up of 60 Patients

“…Corresponding authors responded with additional clinical follow-up for 28 patients 2,3,6,[12][13][14][15][16][17][18][19][20][21] and 16 patients reported previously [9][10][11][12][22][23][24][25][26] had a definitive end point; however, no follow-up was obtained for six reported patients. Together with the 16 new patients seen in consultation either at MD Anderson Cancer Center or diagnosed at different institutions in Australia, a total of 60 patients represent our study group and their clinicopathologic features are listed in Table 1.…”

Implant-associated anaplastic large cell lymphoma of the breast: Insight into a poorly understood disease

“…It is well known that textured implants have been associated with late-onset seromas but their association with ALCL is less clear (12,33). Because ALCL is a result of T cell activation and expansion, some have argued that ALCL may be a result of an immunogenic response (27). However, direct antigenic stimulation is unlikely because ALCL cells have been found to lack a T cell receptor signalling system (34).…”

“…Another case of implant-associated ALCL that resulted in a more aggressive course presented with multiple subcutaneous nodules. This case had no associated seroma and ultimately resulted in systemic dissemination of disease (27,30). A patient that presents with a distinct periprosthetic mass instead of a seroma may indicate a more aggressive implant-associated ALCL, similar to that of ALK-1(−) systemic ALCL and, therefore, may necessitate aggressive treatment and close observation (29,31).…”

“…Breast implant-associated ALCL should be classified as its own distinct clinical entity (8,10,19,27,28). It shares features of both systemic and cutaneous ALCL, but does not truly fit into either disease category.…”