Breast implant‐associated anaplastic large cell lymphoma and other rare T‐cell lymphomas

Abstract

Peripheral T-cell lymphomas (PTCLs) account for less than 15% of all non-Hodgkin lymphomas worldwide. In the current WHO classification, more than 25 types of T-cell neoplasms are listed (Table 1). 1 Considering the noncutaneous T-cell lymphomas, despite substantial geographic variations in the incidence and the subtype prevalence, a few entities-essentially those presenting as nodal diseases-are relatively common and account for the majority of the cases, while extranodal entities are far less common or distinctively rare. Here, we will review the clinico-pathological features of breast implant (BI)-associated anaplastic large cell lymphoma and intestinal T-cell neoplasms, with a focus on the recent advances in the understanding of their molecular biology and pathogenesis. 2 | BREAST IMPLANT-ASSOCIATED ANAPLASTIC LARGE CELL LYMPHOMA Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a very rare form of T-cell lymphoma that arises in association with BIs. BIA-ALCL was introduced as a new provisional disease entity in the recently revised WHO classification of lymphoid malignancies, distinct from the other types of ALCLs already recognized (anaplastic lymphoma kinase [ALK]-positive and ALK-negative ALCL and primary cutaneous ALCL). 1 2.1 | Epidemiology Since the first case was described in 1997, more than 500 cases of BIA-ALCL have been reported in the literature worldwide. An increasing number of dioagnoses were recorded over the recent years reflecting a substantial increase in recognition and awareness of the disease. Notwithstanding these trends, the incidence of BIA-ALCL remains very low. Primary breast lymphomas represent 1% to 2% of all non-Hodgkin lymphomas, with most cases diagnosed as diffuse large B-cell lymphomas, follicular or marginal zone B-cell lymphomas. Among more than 400 breast lymphomas accumulated between 2010 and 2018 in the French lymphoma network, BIA-ALCL represented 10% of the diagnoses. 2Taking into consideration the very large number of women with BIs over the world, the individual risk of BIA-ALCL is very small. A recent population-based case-control study based on the pathology registry in the Netherlands established that BI is associated with a markedly increased risk (400 times) of developing ALCL, but the absolute cumulative risk is estimated to one case for every 50 000 women with BI by the age of 50 years and one per 7000 by the age of 75. 2 In another study based on US cases, the lifetime risk of BIA-ALCL in women with textured implants was estimated to be 1 in 30 000. 3 | Clinical featuresThe mean age at diagnosis is in the 50s. Approximately 60% of women who develop BIA-ALCL had implants for cosmetic reasons, and 40% had implants for reconstructive purposes after surgery for breast cancer. BIA-ALCL has also been reported in three transgender male to female individuals. The median time interval between implant insertion and lymphoma diagnosis is 8 to 9 years in different studies, but wide variations are observed. There is no significant difference in risk o...

Approach to nodal-based T-cell lymphomas

“…That possibility should be considered in axillary lymph nodes involved by translocation-negative ALCL in a woman with breast implant(s). 145,159 ALK-ALCL may be difficult to distinguish from PTCL-NOS. In fact, the definitional criteria remain subject to variations in interpretation, especially as the morphological criteria for 'anaplastic' morphology are not established and remain subjective.…”

A Novel JAK1 Mutant Breast Implant-Associated Anaplastic Large Cell Lymphoma Patient-Derived Xenograft Fostering Pre-Clinical Discoveries

“…To the best of our knowledge, only three continuous BIA-ALCL cell lines have been developed (namely TLBR1-2-3) [20,23]. These models have real advantages and have allowed important advances in the understanding of BIA-ALCL [12,16,24,25]; however, they display limitations, such as impaired cell-cell and cell-matrix interactions. Moreover, putative clonal selections may occur, along with the establishment of cell lines, determining a potentially incomplete representation of the natural lymphoma heterogeneity [26].…”

Controversies in the Treatment of Peripheral T‐cell Lymphoma

“…2 , panels D-E). 34 Most cases confined to the periprosthetic effusion and capsule (seroma or in situ lymphoma) have excellent outcomes; a minority of patients present with a tumor mass, which is an adverse prognostic factor. BIA-ALCL does not harbor recurrent translocations found in other ALK-negative ALCL; conversely, activation of STAT3 is common and recurrent mutations of STAT3 , JAK1, or SOCS1 have been reported.…”