Implant-associated anaplastic large cell lymphoma of the breast: Insight into a poorly understood disease

Abstract

A naplastic large cell lymphoma (ALCL) is the subject of increasing scrutiny among plastic surgeons and the public. Accounting for only 3% of all non-Hodgkin's lymphoma and 0.5% of all breast cancers, ALCL is rare (1-4). Multiple reports have highlighted a possible relationship between ALCL in the breast and breast implants. In January 2011, the United States Food and Drug Administration (FDA) published an investigation of ALCL and breast implants, which concluded that there is a possible association between breast implants and ALCL; however, the low incidence of ALCL -0.1 to 0.3 per 100,000 -would make proving causality exceedingly difficult (5,6). A multidisciplinary panel of experts reached a similar conclusion (7,8), suggesting an association without a causal relationship between breast implants and ALCL. Other than asserting that an association between implants and ALCL likely exists, no clear consensus regarding ALCL and breast implants has emerged.In the literature, contributing factors for implant-associated ALCL have not been established. Of the known cases of ALCL associated with implants, both saline and silicone implants have been documented (5). It has been reported in patients both receiving implants for cosmetic purposes and for reconstruction secondary to cancer (9). Time to presentation after placement of breast implants has ranged from one to 23 years, and patients' age has ranged from 28 to 87 years (6). The most consistent association is that all cases of breast implantassociated ALCL in which cytology is known, demonstrate strong CD30 positivity and are anaplastic lymphoma kinase-1 (ALK-1) negative (5,7,10). Continued vigilance in reporting cases is needed to further elucidate possible contributing factors.The majority of what is known about ALCL is derived from case reports. The data from these reports are somewhat limited in that not all contain complete details. A standard work-up for suspected new cases has been recommended by the FDA to ensure that all pertinent information is obtained from each case in the future (5). This will ensure accurate and complete information, and further the study of ALCL and its relationship with breast implants. Using these new recommendations, we present one case of implant-associated ALCL that presented to our facility. Case presentationA 44-year-old female underwent bilateral subglandular breast augmentation in 2005 in Mexico with 410 mL CUI round-textured silicone implants (Allergan, USA) through an inframammary approach. The patient experienced no immediate postoperative complications and had an uneventful course until her presentation to the Ben Taub General Hospital (Texas, USA) seven years after surgery.In 2012, the patient presented to the Ben Taub General Hospital emergency department complaining of progressive left breast swelling and erythema for three months. The patient denied fever, chills or symptoms of systemic toxicity. The patient had no recent history of trauma or breastfeeding. On presentation, the patient was afebrile and hemodynamical...

Breast implant–associated anaplastic large cell lymphoma, a systematic review and in‐depth evaluation of the current understanding

“…The average age of patients documented was 53.6 years. The majority of cases presented with unilateral breast swelling (including enlargement and tenderness), lymphadenopathy, skin manifestations, and B symptoms (fever, chills, weight loss, night sweats, etc) . Imaging done showed a pericapsular fluid collection in the majority of patients, with masses and superficial lesions presenting much more rarely .…”

Recurrent Systemic Anaplastic Lymphoma Kinase–Negative Anaplastic Large Cell Lymphoma Presenting as a Breast Implant–Associated Lesion

“…Breast implant-associated anaplastic large cell lymphoma (ALCL) is a rare T-cell neoplasm typically presenting in women as a mass or late seroma in the breast implant capsule. 1,2 Textured silicone implants have been associated with an increased risk for the development of ALCL, which may occur as a reactive process involving the fibrous capsule. [3][4][5][6] Breast implant-ALCL is histologically and molecularly indistinguishable from anaplastic lymphoma kinase (ALK)-negative ALCL.…”