Immunophenotypic characteristics of breast implant‐associated anaplastic large‐cell lymphoma by flow cytometry

Montgomery-Goecker, Crystal; Fuda, Franklin; Krueger, Jo Ellen; Chen, Weina

doi:10.1002/cyto.b.21222

Cited by 26 publications

(25 citation statements)

References 7 publications

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“…The neoplastic cells of BIA‐ALCL are consistently strongly positive for CD30, with 43–90% of cases also positive for EMA, and all are ALK‐negative . However, CD30 expression needs to be interpreted with care: CD30 has been detected on both activated T and B cells, in some cases shown to be induced by viral infection, as well as on natural killer (NK) cells, monocytes and lymphocytes . Thus, detection of CD30 expression alone is insufficient to make a diagnosis – expression must be in a cell population with the characteristic cytological features of ALCL, as described above.…”

Section: Immunophenotypementioning

confidence: 99%

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

et al. 2019

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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.

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Section: Immunophenotypementioning

confidence: 99%

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

et al. 2019

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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]. However, in the routine diagnostic testing of late peri-implant breast seromas flow cytometry is restricted to adequately equipped institutions and to effusions with sufficient viable events.…”

Section: Introductionmentioning

confidence: 99%

“…However, in the routine diagnostic testing of late peri-implant breast seromas flow cytometry is restricted to adequately equipped institutions and to effusions with sufficient viable events. Moreover, as for the diagnosis of other large-cell lymphomas [11], flow cytometry studies on BI-ALCL highlighted several issues related to lymphomatous cells falling outside the typical lymphocyte region, to the marked loss of T cell antigens, and to the variable expression of myeloid markers [9], [10]. These aspects, altogether, may pose a diagnostic challenge and may give false-negative results when not integrated with the morphologic evaluation of the cells and clinical data, particularly in cases containing a low percentage of neoplastic cells.…”

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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“…Other authors confirmed these findings and additionally identified frequent CD4 expression; marked loss of other T cell antigens, including CD3; expression of activation markers; and variable expression of myeloid markers. In isolation, these flow cytometry findings could represent a diagnostic challenge and warrant correlation with morphological and clinical characteristics …”

Section: Case Reports and Discussionmentioning

confidence: 99%

Diagnostic dilemmas and pitfalls in ThinPrep^®cytology of breast fine needle aspiration biopsy:

Carniello

Pareja

Santos-Zabala

et al. 2017

Diagnostic Cytopathology

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Fine needle aspirations (FNA) of the breast for primary diagnoses have become less popular in the USA and are usually performed for lesions with low or extremely high clinical suspicion. They are also performed for lesions in close proximity to a breast implant. Liquid-based cytological preparations, such as ThinPrep® (TP), provide a practical alternative to clinicians who are performing FNA. Using a selection of cases that represent challenging diagnoses, we describe common diagnostic pitfalls of breast FNA that are specifically associated with this preparation. Well known breast cytology pitfalls, such as fibroadenoma, when solely examined using a TP slide can be even more challenging since the usual stripped bipolar cells seen in the background of smeared slides, can appear singly dispersed with preserved cytoplasm, resembling carcinoma. We describe that large fragments of solid papillary carcinoma are represented by mostly singly dispersed cells with plasmacytoid features that mimic those of a lobular carcinoma. Since nuclear features are more pronounced in TP, prominent nucleoli and cytological atypia can potentially be overcalled. TP processing might also lead to clumping of epithelioid histiocytes that appear atypical, which increases the suspicion of malignancy. The presence of atypical cells in a TP slide of a peri implant seroma should always undergo additional testing, especially in patients with a prior history of breast carcinoma, to determine if it represents recurrent carcinoma or an implant associated anaplastic large cell lymphoma. Familiarity with the aforementioned artifacts associated with TP is essential to avoid diagnostic misinterpretations.

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Immunophenotypic characteristics of breast implant‐associated anaplastic large‐cell lymphoma by flow cytometry

Cited by 26 publications

References 7 publications

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

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

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

Diagnostic dilemmas and pitfalls in ThinPrep^®cytology of breast fine needle aspiration biopsy:

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Immunophenotypic characteristics of breast implant‐associated anaplastic large‐cell lymphoma by flow cytometry

Cited by 26 publications

References 7 publications

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

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

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

Diagnostic dilemmas and pitfalls in ThinPrep®cytology of breast fine needle aspiration biopsy:

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Diagnostic dilemmas and pitfalls in ThinPrep^®cytology of breast fine needle aspiration biopsy: