Skip to main content

Advertisement

SpringerLink
Log in

Breast Implant-Associated Anaplastic Large Cell Lymphoma: A Systematic Review of the Literature and Mini-Meta Analysis

  • Lymphomas (C Dearden, Section Editor)
  • Published:
Current Hematologic Malignancy Reports Aims and scope Submit manuscript

Abstract

Breast implant-associated ALCL (BIA-ALCL) is a rare, but likely under-reported entity, which most commonly presents with an effusion developing between the breast implant and the host fibrous capsule that surrounds it. It has been described in association with breast implants used for post-cancer reconstructive surgery and when implanted for purely cosmetic reasons. Two different presentations are seen; presentation with an effusion alone +/− co-existing capsular contracture, without an associated mass, and presentation with a mass lesion +/− an effusion. These two presentations are associated with very different outcomes, with women presenting with effusion alone having an excellent long-term survival, even in the absence of specific therapy other than implant removal. In these women, no further therapy other than implant removal is likely necessary. In contrast, women presenting with a mass lesion have a higher rate of relapse and may require more aggressive therapy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. FDA. FDA Medical Device Safety Communication: Reports of Anaplastic Large Cell Lymphoma (ALCL) in Women with Breast Implants. 2011 [16/2/2013]; Available from: http://www.fda.gov/medicaldevices/safety/alertsandnotices/ucm240000.htm.

  2. • de Jong D, Vasmel WL, de Boer JP, Verhave G, Barbe E, Casparie MK, et al. Anaplastic large cell lymphoma in women with breast implants. JAMA. 2008;300(17):2030–5. [Research Support, Non-U.S. Gov’t]. One of few available epidemiological studies suggesting an association between breast implants and ALCL.

    Article  PubMed  Google Scholar 

  3. Lipworth L, Tarone RE, McLaughlin JK. Breast implants and lymphoma risk: a review of the epidemiologic evidence through 2008. Plast Reconstr Surg. 2009;123(3):790–3 [Review].

    Article  PubMed  CAS  Google Scholar 

  4. Brisson J, Holowaty EJ, Villeneuve PJ, Xie L, Ugnat AM, Latulippe L, et al. Cancer incidence in a cohort of Ontario and Quebec women having bilateral breast augmentation. Int J Cancer. 2006;118(11):2854–62 [Research Support, Non-U.S. Gov’t].

    Article  PubMed  CAS  Google Scholar 

  5. Brinton LA, Lubin JH, Burich MC, Colton T, Brown SL, Hoover RN. Cancer risk at sites other than the breast following augmentation mammoplasty. Ann Epidemiol. 2001;11(4):248–56 [Multicenter Study].

    Article  PubMed  CAS  Google Scholar 

  6. Deapen DM, Hirsch EM, Brody GS. Cancer risk among Los Angeles women with cosmetic breast implants. Plast Reconstr Surg. 2007;119(7):1987–92 [Multicenter Study Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov’t Research Support, U.S. Gov’t, P.H.S.].

    Article  PubMed  CAS  Google Scholar 

  7. Lipworth L, Tarone RE, Friis S, Ye W, Olsen JH, Nyren O, et al. Cancer among Scandinavian women with cosmetic breast implants: a pooled long-term follow-up study. Int J Cancer. 2009;124(2):490–3 [Research Support, Non-U.S. Gov’t].

    Article  PubMed  CAS  Google Scholar 

  8. Pukkala E, Boice Jr JD, Hovi SL, Hemminki E, Asko-Seljavaara S, Keskimaki I, et al. Incidence of breast and other cancers among Finnish women with cosmetic breast implants, 1970–1999. J Long Term Eff Med Implants. 2002;12(4):271–9 [Research Support, Non-U.S. Gov’t].

    Article  PubMed  Google Scholar 

  9. Swerdlow SH, Campo E, Harris NL, Jaffe ES, Pileri S, Stein H, et al., editors. WHO classification of tumours of haematopoietic and lymphoid tissues. Lyon: IARC; 2008.

    Google Scholar 

  10. Falini B, Martelli MP. Anaplastic large cell lymphoma: changes in the World Health Organization classification and perspectives for targeted therapy. Haematologica. 2009;94(7):897–900 [Comment Editorial].

    Article  PubMed  Google Scholar 

  11. Gascoyne RD, Aoun P, Wu D, Chhanabhai M, Skinnider BF, Greiner TC, et al. Prognostic significance of anaplastic lymphoma kinase (ALK) protein expression in adults with anaplastic large cell lymphoma. Blood. 1999;93(11):3913–21 [Research Support, Non-U.S. Gov’t Research Support, U.S. Gov’t, P.H.S.].

    PubMed  CAS  Google Scholar 

  12. Savage KJ, Harris NL, Vose JM, Ullrich F, Jaffe ES, Connors JM, et al. ALK- anaplastic large cell lymphoma is clinically and immunophenotypically different from both ALK+ ALCL and peripheral T cell lymphoma, not otherwise specified: report from the International Peripheral T-Cell Lymphoma Project. Blood. 2008;111(12):5496–504 [Multicenter Study].

    Article  PubMed  CAS  Google Scholar 

  13. Willemze R, Jaffe ES, Burg G, Cerroni L, Berti E, Swerdlow SH, et al. WHO-EORTC classification for cutaneous lymphomas. Blood. 2005;105(10):3768–85 [Review].

    Article  PubMed  CAS  Google Scholar 

  14. Kempf W, Pfaltz K, Vermeer MH, Cozzio A, Ortiz-Romero PL, Bagot M, et al. EORTC, ISCL, and USCLC consensus recommendations for the treatment of primary cutaneous CD30-positive lymphoproliferative disorders: lymphomatoid papulosis and primary cutaneous anaplastic large cell lymphoma. Blood. 2011;118(15):4024–35 [Research Support, Non-U.S. Gov’t Review].

    Article  PubMed  CAS  Google Scholar 

  15. Barista I, Baltali E, Tekuzman G, Kars A, Ruacan S, Ozisik Y, et al. Primary breast lymphomas–a retrospective analysis of twelve cases. Acta Oncol. 2000;39(2):135–9.

    Article  PubMed  CAS  Google Scholar 

  16. • Roden AC, Macon WR, Keeney GL, Myers JL, Feldman AL, Dogan A. Seroma-associated primary anaplastic large cell lymphoma adjacent to breast implants: an indolent T cell lymphoproliferative disorder. Mod Pathol. 2008;21(4):455–63. [Case Reports]. Case series and one of the first papers to distinguish BIA-ALCL as a distinct pathological entity.

    Article  PubMed  CAS  Google Scholar 

  17. • Talwalkar SS, Miranda RN, Valbuena JR, Routbort MJ, Martin AW, Medeiros LJ. Lymphomas involving the breast: a study of 106 cases comparing localized and disseminated neoplasms. Am J Surg Pathol. 2008;32(9):1299–309. Large population-based study showing predominance of B cell lymphomas in patients with primary breast lymphoma without breast implants.

    Article  PubMed  Google Scholar 

  18. Domchek SM, Hecht JL, Fleming MD, Pinkus GS, Canellos GP. Lymphomas of the breast: primary and secondary involvement. Cancer. 2002;94(1):6–13.

    Article  PubMed  Google Scholar 

  19. Thompson PA, Lade S, Webster H, Ryan G, Prince HM. Effusion-associated anaplastic large cell lymphoma of the breast: time for it to be defined as a distinct clinico-pathological entity. Haematologica. 2010;95(11):1977–9 [Case Reports Letter Review].

    Article  PubMed  Google Scholar 

  20. Kraemer DM, Tony HP, Gattenlohner S, Muller JG. Lymphoplasmacytic lymphoma in a patient with leaking silicone implant. Haematologica. 2004;89(4):ELT01 [Case Reports Letter Research Support, Non-U.S. Gov’t].

    PubMed  Google Scholar 

  21. Nichter LS, Mueller MA, Burns RG, Stallman JM. First report of nodal marginal zone B cell lymphoma associated with breast implants. Plast Reconstr Surg. 2012;129(3):576e–8 [Case Reports Editorial].

    Article  PubMed  Google Scholar 

  22. Cook PD, Osborne BM, Connor RL, Strauss JF. Follicular lymphoma adjacent to foreign body granulomatous inflammation and fibrosis surrounding silicone breast prosthesis. Am J Surg Pathol. 1995;19(6):712–7 [Case Reports].

    Article  PubMed  CAS  Google Scholar 

  23. Said JW, Tasaka T, Takeuchi S, Asou H, de Vos S, Cesarman E, et al. Primary effusion lymphoma in women: report of two cases of Kaposi’s sarcoma herpes virus-associated effusion-based lymphoma in human immunodeficiency virus-negative women. Blood. 1996;88(8):3124–8 [Case Reports Research Support, Non-U.S. Gov’t Research Support, U.S. Gov’t, P.H.S.].

    PubMed  CAS  Google Scholar 

  24. Boulanger E, Gerard L, Gabarre J, Molina JM, Rapp C, Abino JF, et al. Prognostic factors and outcome of human herpesvirus 8-associated primary effusion lymphoma in patients with AIDS. J Clin Oncol. 2005;23(19):4372–80 [Research Support, Non-U.S. Gov’t].

    Article  PubMed  Google Scholar 

  25. Ferreri AJ, Govi S, Pileri SA, Savage KJ. ALK-negative. Anaplastic large cell lymphoma. Crit Rev Oncol Hematol. 2013;85(2):206–15.

    Article  PubMed  Google Scholar 

  26. Stein H, Foss HD, Durkop H, Marafioti T, Delsol G, Pulford K, et al. CD30(+) anaplastic large cell lymphoma: a review of its histopathologic, genetic, and clinical features. Blood. 2000;96(12):3681–95 [Research Support, Non-U.S. Gov’t Review].

    PubMed  CAS  Google Scholar 

  27. Brody G, Deapen D, Gill P, Epstein A, Martin S, Elatra W. T cell non Hodgkins anaplastic large cell lymphoma associated with one style of breast implants. Proceedings of the 89th annual American society of plastic surgeons meeting; Mar 20–23; San Antonio, Texas, USA: The Westin La Cantera 2010.

  28. Lechner MG, Megiel C, Church CH, Angell TE, Russell SM, Sevell RB, et al. Survival signals and targets for therapy in breast implant-associated ALK—anaplastic large cell lymphoma. Clin Cancer Res. 2012;18(17):4549–59 [Research Support, Non-U.S. Gov’t].

    Article  PubMed  CAS  Google Scholar 

  29. • Lechner MG, Lade S, Liebertz DJ, Prince HM, Brody GS, Webster HR, et al. Breast implant-associated, ALK-negative, T cell, anaplastic, large cell lymphoma: establishment and characterization of a model cell line (TLBR-1) for this newly emerging clinical entity. Cancer. 2011;117(7):1478–89. [Research Support, Non-U.S. Gov’t]. Outline of development of pre-clinical models based on a cell line taken from a case of BIA-ALCL with insights into the biology of the disease.

    Article  PubMed  CAS  Google Scholar 

  30. Maijers MC, Niessen FB. Prevalence of rupture in poly implant Prothese silicone breast implants, recalled from the European market in 2010. Plast Reconstr Surg. 2012;129(6):1372–8 [Comparative Study].

    Article  PubMed  CAS  Google Scholar 

  31. Keogh B. UK Department of Health; [updated 18/6/2012; cited 2013 1/2/2013]; NHS publication]. Available from: http://www.nhs.uk/conditions/breast-implants/documents/PIP expert group final report.pdf.

  32. Dieterich M, Stubert J, Stachs A, Radke A, Reimer T, Gerber B. Ruptured poly-implant protheses breast implant after aesthetic breast augmentation: diagnosis, case management, and histologic evaluation. Aesthet Plast Surg. 2013;37(1):91–4.

    Article  CAS  Google Scholar 

  33. UK Department of Health; 2011 [cited 2013 1/2/2013]; NHS Publication]. Available from: http://www.nhs.uk/news/2011/12December/Pages/pip-breast-implants-france-cancer-case.aspx.

  34. Alobeid B, Sevilla DW, El-Tamer MB, Murty VV, Savage DG, Bhagat G. Aggressive presentation of breast implant-associated ALK-1 negative anaplastic large cell lymphoma with bilateral axillary lymph node involvement. Leuk Lymphoma. 2009;50(5):831–3 [Case Reports Letter].

    Article  PubMed  CAS  Google Scholar 

  35. Aladily TN, Medeiros LJ, Alayed K, Miranda RN. Breast implant-associated anaplastic large cell lymphoma: a newly recognized entity that needs further refinement of its definition. Leuk Lymphoma. 2012;53(4):749–50 [Comment Letter].

    Article  PubMed  Google Scholar 

  36. Bishara MR, Ross C, Sur M. Primary anaplastic large cell lymphoma of the breast arising in reconstruction mammoplasty capsule of saline filled breast implant after radical mastectomy for breast cancer: an unusual case presentation. Diagn Pathol. 2009;4:11.

    Article  PubMed  Google Scholar 

  37. Do V, Shifrin DA, Oostendorp L. Lymphoma of the breast capsule in a silicone implant-reconstructed patient. Am Surg. 2010;76(9):1030–1 [Letter].

    PubMed  Google Scholar 

  38. Farkash EA, Ferry JA, Harris NL, Hochberg EP, Takvorian RW, Zuckerman DS, et al. Rare lymphoid malignancies of the breast: a report of two cases illustrating potential diagnostic pitfalls. J Hematop. 2009;2(4):237–44.

    Article  PubMed  Google Scholar 

  39. Fritzsche FR, Pahl S, Petersen I, Burkhardt M, Dankof A, Dietel M, et al. Anaplastic large cell non-Hodgkin’s lymphoma of the breast in periprosthetic localisation 32 years after treatment for primary breast cancer--a case report. Virchows Arch. 2006;449(5):561–4 [Case Reports].

    Article  PubMed  Google Scholar 

  40. Gaudet G, Friedberg JW, Weng A, Pinkus GS, Freedman AS. Breast lymphoma associated with breast implants: two case-reports and a review of the literature. Leuk Lymphoma. 2002;43(1):5.

    Article  Google Scholar 

  41. Hanson SE, Gutowski KA. Primary T cell lymphoma associated with breast implant capsule. Plast Reconstr Surg. 2010;126(1):39e–41 [Case Reports Letter].

    Article  PubMed  Google Scholar 

  42. Keech Jr JA, Creech BJ. Anaplastic T cell lymphoma in proximity to a saline-filled breast implant. Plast Reconstr Surg. 1997;100(2):554–5 [Case Reports Letter].

    Article  PubMed  Google Scholar 

  43. Shiyong Li AKL. Silicone implant and primary breast ALK1-negative anaplastic large cell lymphoma, fact or fiction? Int J Clin Exp Pathol. 2010;3(1):11.

    Google Scholar 

  44. Newman MK, Zemmel NJ, Bandak AZ, Kaplan BJ. Primary breast lymphoma in a patient with silicone breast implants: a case report and review of the literature. J Plast Reconstr Aesthet Surg. 2008;61(7):822–5 [Case Reports Review].

    Article  PubMed  Google Scholar 

  45. Olack B, Gupta R, Brooks GS. Anaplastic large cell lymphoma arising in a saline breast implant capsule after tissue expander breast reconstruction. Plast Reconstr Surg. 2006;118(s4):1.

    Google Scholar 

  46. Popplewell L, Thomas SH, Huang Q, Chang KL, Forman SJ. Primary anaplastic large cell lymphoma associated with breast implants. Leuk Lymphoma. 2011;52(8):1481–7 [Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov’t].

    Article  PubMed  Google Scholar 

  47. Smith TJ, Ramsaroop R. Breast implant related anaplastic large cell lymphoma presenting as late onset peri-implant effusion. Breast. 2012;21(1):102–4 [Case Reports].

    Article  PubMed  Google Scholar 

  48. Taylor KO, Webster HR, Prince HM. Anaplastic large cell lymphoma and breast implants: five Australian cases. Plast Reconstr Surg. 2012;129(4):610e–7 [Case Reports].

    Article  PubMed  CAS  Google Scholar 

  49. Sahoo S, Rosen PP, Feddersen RM, Viswanatha DS, Clark DA, Chadburn A. Anaplastic large cell lymphoma arising in a silicone breast implant capsule: a case report and review of the literature. Arch Pathol Lab Med. 2003;127(3):e115–8 [Case Reports Review].

    PubMed  Google Scholar 

  50. Wong AK, Lopategui J, Clancy S, Kulber D, Bose S. Anaplastic large cell lymphoma associated with a breast implant capsule: a case report and review of the literature. Am J Surg Pathol. 2008;32(8):1265–8 [Case Reports Review].

    Article  PubMed  Google Scholar 

  51. Carty MJ, Pribaz JJ, Antin JH, Volpicelli ER, Toomey CE, Farkash EA, et al. A patient death attributable to implant-related primary anaplastic large cell lymphoma of the breast. Plast Reconstr Surg. 2011;128(3):112e–8 [Case Reports].

    Article  PubMed  CAS  Google Scholar 

  52. • Aladily TN, Medeiros LJ, Amin MB, Haideri N, Ye D, Azevedo SJ, et al. Anaplastic large cell lymphoma associated with breast implants: a report of 13 cases. Am J Surg Pathol. 2012;36(7):1000–8. Largest published case series, with discussion of pathological features.

    Article  PubMed  Google Scholar 

  53. Kim B, Roth C, Young VL, Chung KC, van Busum K, Schnyer C, et al. Anaplastic large cell lymphoma and breast implants: results from a structured expert consultation process. Plast Reconstr Surg. 2011;128(3):629–39 [Research Support, Non-U.S. Gov’t Review].

    Article  PubMed  CAS  Google Scholar 

Download references

Conflict of Interest

Philip A. Thompson declares that he has no conflict of interest.

H. Miles Prince declares that he has no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Clinical Haematology and Bone Marrow Transplantation, Royal Melbourne Hospital, Parkville, Australia

    Philip A. Thompson

  2. DHMO, Peter MacCallum Cancer Centre, Locked Bag 1, A’Beckett St, Melbourne, Victoria, 8006, Australia

    H. Miles Prince

  3. University of Melbourne, Parkville, Australia

    H. Miles Prince

Authors
  1. Philip A. Thompson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. H. Miles Prince
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to H. Miles Prince.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Thompson, P.A., Prince, H.M. Breast Implant-Associated Anaplastic Large Cell Lymphoma: A Systematic Review of the Literature and Mini-Meta Analysis. Curr Hematol Malig Rep 8, 196–210 (2013). https://doi.org/10.1007/s11899-013-0164-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11899-013-0164-3

Keywords

Search

Navigation