Breast implant‐associated anaplastic large cell lymphoma (BIA‐ALCL): an overview of presentation and pathogenesis and guidelines for pathological diagnosis and management

Abstract

Aims Breast implant‐associated anaplastic large cell lymphoma (BIA‐ALCL) is an uncommon complication associated largely with textured implants. It is important that the symptoms associated with BIA‐ALCL are recognised and that robust pathways are in place to establish the diagnosis. The aim of this paper is to review what is known of the incidence of the disease, current thoughts on pathogenesis, patterns of presentation and pathological features to provide standard guidelines for its diagnosis. Methods and results Systematic review of the literature via PubMed covering cases series, modes of presentation, cytological, histological and immunohistochemical features and disease outcome. Since 1997, 518 cases throughout 25 countries have been registered on the American Society of Plastic Surgeons PROFILE registry, with an estimated risk for women with an implant of one to three per million per year. It most frequently presents as a late‐onset accumulation of seroma fluid, sometimes as a mass lesion. The neoplastic cells are highly atypical, consistently strongly positive for CD30, with 43–90% also positive for EMA, and all are ALK‐negative. Behaviour is best predicted using a staging system for solid tumours. Conclusion BIA‐ALCL is a rare but important complication of breast implants. While characterised by CD30‐positive neoplastic cells this must be interpreted with care, and we provide pathological guidelines for the robust diagnosis of this lesion as well as the most appropriate staging system and management strategies. Finally, in order to generate more accurate data on incidence, we recommend mechanisms for the routine central reporting of all cases.

Multidisciplinary approach in the clinical and laboratory investigation of a suspected case for anaplastic lymphoma associated with breast prosthesis

“…In the presence of evidence or highly suspected BIA-ALCL, the standard surgical procedure consists of emptying the periprosthetic content, capsulectomy, and removal of the breast prosthesis 16 , as performed in the present case. Generally, BIA-ALCL is confined to the fibrous capsule.…”

“…Immunophenotypically, BIA-ALCLs are indistinguishable from other anaplastic lymphomas of CD30-positive and ALK-negative T cells, and their diagnosis requires adequate clinical and laboratory assessment, which can be problematic in some cases. Some special care must be taken in the preservation of the material, which will be subjected to cytopathological analysis, immunohistochemistry assessment, and flow cytometry with immunophenotyping, which must include CD30 and ALK [13][14][15][16] . Therefore, a multidisciplinary approach and observance of a protocol of procedures are necessary to avoid the occurrence of false-negative results, a fact that motivated the present study.…”

Interpositional Arthroplasty Using Mammary Capsule for Finger Joints: A Novel Technique

“…Properly discussing the breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) T-cell, it is a late disease (8–10 years) and appears with periprosthetic fluid or seroma, the most common presentation (90% of the cases), also pain and swelling in the breast and sometimes as a mass lesion. 13 …”

Aktueller Algorithmus zur Diagnostik und Therapie des Brustimplantat-assoziierten anaplastischen großzelligen Lymphoms

“…Das BIA-ALCL ist ein non-Hodgkin Lymphom der T-Zellreihe. Charakteristisch ist die monoklonale CD-30 positive anaplastische Zellpopulation, welche ALK (anaplastic lymphoma kinase) negativ ist und eine variable Expression T-Zell spezifischer Marker zeigt [26]. Die Pathogenese ist bis heute weitestgehend ungeklärt.…”