Breast Implant-Associated Anaplastic Large-Cell Lymphoma Can Be a Diagnostic Challenge for Pathologists

Talagas, Matthieu; Uguen, Arnaud; Charles-Petillon, Françoise; Conan‐Charlet, Virginie; Marion, Véronique; Hu, W.; Amice, Jean; Braekeleer, Marc De

doi:10.1159/000355861

Cited by 35 publications

(21 citation statements)

References 13 publications

(27 reference statements)

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“…We read with interest the recently published Novel Insights from Clinical Practice in Acta Cytologica describing the cytological features of breast implant-associated anaplastic large-cell lymphoma by Talagas et al [1]. The authors report that this is the first description of the cytological features of this relatively recently described entity.…”

Section: Figmentioning

confidence: 97%

Cytological Features of Breast Peri-Implant Synovial Metaplasia

Stone

Boost²

2014

Acta Cytologica

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Section: Figmentioning

confidence: 97%

Cytological Features of Breast Peri-Implant Synovial Metaplasia

Stone

Boost²

2014

Acta Cytologica

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“…Nevertheless, the identification of localized BI-ALCL cases, in which scant tumor cell clusters adhere to the luminal surface of the capsule, might be challenging, particularly when a wide sampling of the capsule is not performed [6], [7], [8]. Flow cytometry (FC) may be a valuable tool for the diagnosis of BI-ALCL [9], [10].…”

Section: Introductionmentioning

confidence: 99%

Cytological diagnostic features of late breast implant seromas: From reactive to anaplastic large cell lymphoma

et al. 2017

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Late breast implant seroma may be the presentation of a breast implant-associated anaplastic large cell lymphoma (BI-ALCL), which claims for a prompt recognition. However, BI-ALCL diagnosis on fine-needle aspiration (FNA) might be challenging for pathologists lacking experience with peri-implant breast effusions. Sixty-seven late breast implant seromas collected by FNA from 50 patients were evaluated by Papanicolaou smear stain and immunocytochemistry on cell blocks. A diagnostic algorithm based on the cellular composition, cell morphology and percentage of CD30+ cells was developed. Histological evaluation of the corresponding peri-prosthetic capsules was also performed. Most of the effusions (91% of the samples) were classified as reactive and 9% as BI-ALCL. In the BI-ALCL cases, medium-to-large atypical cells expressing CD30 represented more than 70% of the cellularity, whereas in in the reactive effusions CD30+ elements were extremely rare (<5%) and consisted of non-atypical elements. The reactive effusions were categorized into three patterns: i) acute infiltrate with prominent neutrophilic component (33% of the samples); ii) mixed infiltrate characterized by a variable number of neutrophils, lymphocytes and macrophages (30% of the samples); iii) chronic infiltrate composed predominantly of T lymphocytes or macrophages with only sporadic granulocytes (37% of the samples). The inflammatory cytological patterns were consistent with the histology of the corresponding capsules. Our results indicate that cytological analysis of late breast implant effusions, supported by the knowledge of the heterogeneous cytomorphological spectrum of late seromas, is a valuable approach for the early recognition of BI-ALCL.

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“…The most common clinical presentation of breast‐implant ALK‐negative anaplastic large cell lymphoma (BI‐ALCL) is a late peri‐implant effusion allowing preoperative cytological diagnosis by the presence of large atypical lymphoid cells . However, the clinical approach of these effusions, many times not submitted for cytological analysis, is not uniform.…”

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Cytological Diagnosis of Bilateral Breast Implant‐Associated Lymphoma of the ALK‐Negative Anaplastic Large‐Cell Type. Clinical Implications of Peri‐Implant Breast Seroma Cytological Reporting

Granados

Lumbreras

Delgado

et al. 2016

Diagnostic Cytopathology

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The cytological examination of peri-prosthetic breast effusions allowed the diagnosis of bilateral breast-implant ALK-negative anaplastic large cell lymphoma (BI-ALCL) in the case reported. Ten years after reconstructive surgery with bilateral breast implants, a large unilateral seroma developed and was cytologically analyzed. The presence of CD30 and CD4-positive large-sized atypical lymphoid cells exhibiting horseshoe-shaped nuclei and a brisk mitotic activity rendered the diagnosis of BI-ALCL. Similar cells were seen in the peri-prosthetic fluid intraoperatively collected from the contralateral breast. Although initial histological analysis of the capsulectomy specimens showed unilateral tumor, the cytological findings prompted a more thorough tissue sampling, resulting in the diagnosis of bilateral disease. BI-ALCL usually follows an indolent clinical course; however, there are reported cases with an aggressive behavior. While the presence of bilateral disease is a putative risk factor for a bad prognosis, the small number of cases reported precludes a definitive assessment of this risk. Since most BI-ALCL present with late seromas, cytologic analysis of these effusions in women with breast implants should be mandatory. Cytology is a safe tool for diagnosis and follow-up of patients with breast implant-related late seromas, sometimes proven more sensitive than histological analysis. Complete bilateral capsulectomy and a detailed histological analysis should follow a cytological diagnosis of BI-ALCL in a breast effusion in order to avoid false negative diagnoses. Our case constitutes the first published report of a bilateral BI-ALCL diagnosed by cytology. Diagn. Cytopathol. 2016;44:623-627. © 2016 Wiley Periodicals, Inc.

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Breast Implant-Associated Anaplastic Large-Cell Lymphoma Can Be a Diagnostic Challenge for Pathologists

Cited by 35 publications

References 13 publications

Cytological Features of Breast Peri-Implant Synovial Metaplasia

Cytological Features of Breast Peri-Implant Synovial Metaplasia

Cytological diagnostic features of late breast implant seromas: From reactive to anaplastic large cell lymphoma

Cytological Diagnosis of Bilateral Breast Implant‐Associated Lymphoma of the ALK‐Negative Anaplastic Large‐Cell Type. Clinical Implications of Peri‐Implant Breast Seroma Cytological Reporting

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