Use of flow cytometry and cytology to differentiate breast implant‐associated anaplastic large cell lymphoma from reactive seromas in Brazilian patients

Abstract

Introduction:The combination of cytology and multiparametric flow cytometry (MFC) may be useful in the diagnosis of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) and may be a practical way to differentiate lymphoma from benign and reactive seromas. Although the Brazilian breast implant market is the second largest in the world, with several manufacturers and the almost exclusive use of textured implants, the occurrence of BIA-ALCL in Brazil is underreported. Methods: One hundred seventeen sequential collections of suspicious periprosthetic fluid (PF) from 105 Brazilian patients registered between March/2018 and March/2021 were evaluated by routine cytomorphology and flow cytometry. The combination of CD30, HLA-DR, and CD25 was used together with T and B lymphocyte and monocyte evaluation. The PF samples were divided into positive, acute reactive (neutrophilic exudate), or chronic reactive (macrophage or lymphocyte rich), and unavailable samples. Results: Nine BIA-ALCL positive cases (7.7%) were identified, with typical morphology and increased FSC/SSC dispersion, bright expression of CD30, CD25 and HLA-DR, and absence or weakness of T-cell antigens (CD3, CD8, CD4, CD5, and CD7). Reactive samples were acute (n = 18, 15.4%) and chronic (n = 70, 59.8%). Twenty samples were excluded. The mean age of BIA-ALCL patients was 50 years (31-57 years) and 35 years in reactive patients (20-69 years). Conclusion: Use of MFC with a comprehensive antibody panel consisting of CD30 in conjunction with CD25 and HLA-DR can discriminate anaplastic cells of BIA-ALCL from lymphoid or neutrophilic reactive cells and should be considered in the initial evaluation of seroma.

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

“… 29 Our case showed similar findings, the malignant cells exhibiting strong CD30, CD45, CD4, and CD2 expression, negative for CD5 and low positive expression of CD3, CD7, and CD8. In other reported case series, the neoplastic CD30-positive cells were found to co-express CD25 and HLA-DR, 27 , 31 a finding also present in our case.…”

“… 16 More recently, various groups are assessing the role of flow cytometry analyses in the initial diagnosis and evaluation of breast implant-associated ALCL. 27 – 31 Romero et al 30 published a case series that identified four breast implant-associated ALCL cases out of a total of 39 periprosthetic fluid samples. 30 They identified a statistically significant difference in the percentage of CD30-positive cells between breast implant-associated ALCL and those samples without tumor (54.3% in breast implant-associated ALCL vs. 0.3% in non-tumor; P = .03).…”

“…Our flow cytometric findings showed a similar immunophenotype to cases reported in published series and supported the use of an “ungated” CD30/SSC plot in breast implant-associated ALCL diagnosis. 27 , 28 , 30 , 31 However, evaluation of flow cytometric data in a larger number of cases should be undertaken to better establish its role and utility in screening seromas around breast implants. Collection of these data may be facilitated by the preexisting breast implant-associated ALCL databases to encourage research in this still largely underdeveloped field.…”

Issue Highlights—July 2022

“…The submitting authors have hypothisized that the occurrence of BIA‐ALCL in Brazil is underreported, and therefore it is important to focus on this subject to better investigate this disease. In this report, the authors concluded that the application of FC with a comprehensive antibody panel consisting of CD30 in conjunction with CD25 and HLA‐DR can discriminate anaplastic cells of breast implant‐ associated anaplastic large cell lymphoma from lymphoid or neutrophilic reactive cells and should be considered in the initial evaluation of these lymphoma entities (De Azambuja et al, 2022; Debliquis et al, 2020; Wong‐Arteta et al, 2020).…”

“…The submitting authors have hypothisized that the occurrence of BIA-ALCL in Brazil is underreported, and therefore it is important to focus on this subject to better investigate this disease. In this report, the authors concluded that the application of FC with a comprehensive antibody panel consisting of CD30 in conjunction with CD25 and HLA-DR can discriminate anaplastic cells of breast implantassociated anaplastic large cell lymphoma from lymphoid or neutrophilic reactive cells and should be considered in the initial evaluation of these lymphoma entities(De Azambuja et al, 2022;Debliquis et al, 2020;Wong-Arteta et al, 2020).CAR-T-cell therapy has been recently approved in United Statesand Europe for the treatment of several hematological malignancies, since it achieved impressive results in patients with relapsed/ refractory B-acute lymphocytic leukemia (B-ALL) and diffuse large B-cell lymphoma (DLBCL)(Johansson et al, 2021;Maryamchik et al, 2020;Sarikonda et al, 2020;Yu et al, 2022). However, an increasing body of evidence suggests that a sizeable proportion of patients treated with CAR-T cells do not experience a long-term response.…”