Breast Implant–Associated Anaplastic Large Cell Lymphoma: What We Know

Abstract

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare peripheral T-cell lymphoma, first reported in 1997. It is pathologically confirmed as a CD30-positive, anaplastic lymphoma kinase (ALK)-negative ALCL by immunohistochemistry. Unlike systemic ALK-negative ALCL, breast implant-associated disease has a much more favorable prognosis overall. In most cases, BIA-ALCL will present with delayed seroma more than 1 year after breast implantation indicated for either cosmetic or reconstructive purposes. The average onset of seroma presentation is 8 to 9 years after implantation. Breast implant-associated anaplastic large cell lymphoma may arise in one of two distinct forms: either in situ or infiltrative disease. In situ disease is confined within a seroma, while infiltrative disease may present with lymph node involvement either with or without palpable breast mass or tumor. Infiltrative disease has an overall worse prognosis in regards to disease-related mortality, up to 40% within 2 years. Appropriate pathological consultation with an experienced hematopathologist and oncologist is imperative when making a diagnosis of BIA-ALCL. There are several theorized risk factors associated with the disease; however, the exact pathophysiology is not yet known. Our objective in writing this review article is to provide an overview of what we know about the epidemiology, disease characteristics, and current management strategies. In doing so, we aim to bring awareness and familiarity to the advanced practitioner population in recognizing and treating BIA-ALCL.

Breast Implant-Associated Tumors

“…The markers must be detected in cells that exhibit the typical cytological properties of an ALCL. Therefore, other markers must also be included, where appropriate 30 39 40 .…”

Paraneoplastic acquired ichthyosis as the first manifestation in breast implant-associated anaplastic large cell lymphoma

“…It can manifest with regional lymphadenopathy (predominantly axillary, supra-, or infra-clavicular) in 20% of cases, or concurrent with skin lesions (erythema, rash, erythematous nodules) or as de novo in 8% of cases. 3 , 4 , 5 , 6 , 7 …”

Surgical Management of Textured Breast Implants: Assessing Risk and Analyzing Patient-Reported Outcomes

“…[1][2][3][4][5] Despite their purported benefits, textured implants became controversial after studies linked them to breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL). [6][7][8][9][10][11] The discourse surrounding their use culminated in July of 2019, when the U.S. Food and Drug Administration recalled Allergan Biocell textured implants, 12 raising questions for the millions of patients with such implants in place. Currently, the U.S. Food and Drug Administration does not recommend removal of textured implants in patients without symptoms.…”