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Breast Implant-Associated Anaplastic Large Cell Lymphoma: Origin and Outcome

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Managing Common and Uncommon Complications of Aesthetic Breast Surgery
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Abstract

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is an uncommon complication that can arise following insertion of a textured surface breast implant. This cancer presents as delayed fluid collection around a textured implant or surrounding scar capsule. BIA-ALCL can arise in either silicone or saline implants but only in textured implants to date and may be related to the shedding of surface particulate, which occurs in textured rather than smooth implants. Delayed seromas are not common, but upon their occurrence, there is a need to investigate for BIA-ALCL. Diagnosis of BIA-ALCL requires a monoclonal T-cell expansion of large anaplastic cells that express CD30. Treatment of BIA-ALCL involves surgical ablation with explantation of the implant and a capsulectomy, which can be curative if the disease is contained to the capsule. Testing, appropriate imaging, and oncology consultation are essential prior to any surgical intervention. The understanding of the etiology, disease progression, and treatment is important in the prevention, early diagnosis, and effective treatment of BIA-ALCL.

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References

  1. Food and Drug Administration website on breast implant associated ALCL. www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/BreastImplants/ucm239996.htm. Accessed March 2017.

  2. Clemens MW, Miranda RN. Coming of age: breast implant-associated anaplastic large cell lymphoma after 18 years of investigation. Clin Plast Surg. 2015;42(4):605–13.

    Article  PubMed  Google Scholar 

  3. Ramos-Gallardo G, Cuenca-Pardo J, Rodríguez-Olivares E, Iribarren-Moreno R, Contreras-Bulnes L, Vallarta-Rodríguez A, Kalixto-Sanchez M, Hernández C, Ceja-Martinez R, Torres-Rivero C. Breast implant and anaplastic large cell lymphoma meta-analysis. J Investig Surg. 2016;18:1–10.

    Google Scholar 

  4. Gidengil CA, Predmore Z, Mattke S, van Busum K, Kim B. Breast implant associated anaplastic large cell lymphoma: a systematic review. Plast Reconstr Surg. 2015;135(3):713–20.

    Article  CAS  PubMed  Google Scholar 

  5. Clemens MW, Nava MB, Rocco N, Miranda RN. Understanding rare adverse sequelae of breast implants: anaplastic large-cell lymphoma, late seromas, and double capsules. Gland Surg. 2017;6(2):169–84.

    Article  PubMed  PubMed Central  Google Scholar 

  6. U.S. Food and Drug Administration. Anaplastic large cell lymphoma (ALCL) in women with breast implants: preliminary FDA findings and analyses. Available at: http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/BreastImplants/ucm239996.htm. Accessed 20 Nov 2014.

  7. Swerdlow SH, Campo E, Pileri SA, et al. The 2016 revision of the World Health Organization (WHO) classification of lymphoid neoplasms. Blood. 2016;127(20):2375–90.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. World Health Organization International Agency for Research on Cancer. IARC monographs on the evaluation of carcinogenic risks to humans: Report of the advisory group to recommend priorities for IARC monographs during 2015–2019. Available at: http://monographs.iarc.fr/ENG/Publications/internrep/14-002.pdf. Accessed 1 Aug 2017.

  9. U.S. National Cancer Institute. Treatment for health professionals. Available at: http://www.cancer.gov/types/lymphoma/hp/adult-nhl-treatment-pdq#link/_100_toc. Accessed 1 Aug 2017.

  10. U.S. Food and Drug Administration. Anaplastic large cell lymphoma (ALCL) in women with breast implants: medical device reports of breast implants in women with ALCL; 2017. Retrieved from www.fda.gov on March 2017.

  11. Institut National du Cancer. Agence Nationale de Sécurité du Médicament. Breast implant associated anaplastic large cell lymphoma: Expert opinion. Available at: http://www.e-cancer.fr/content/download/119635/1429833/file/Breast%20implant-associated%20anaplastic%20large%20 cell%20lymphomas.pdf. Accessed 1 Feb 2017.

  12. Australian Therapeutic Goods Administration. Breast implants: update on TGA monitoring of anaplastic large cell lymphoma. Available at: https://www.tga.gov.au/alert/breast-implants. Accessed 20 Dec 2016.

  13. Medicines and Healthcare products Regulatory Agency. Breast implants and Anaplastic Large Cell Lymphoma (ALCL). Available at: https://www.gov.uk/guidance/breast-implants-and-anaplastic-large-cell-lymphoma-alcl. Accessed 26 July 2017.

  14. Grady, D. A shocking diagnosis: breast implants ‘Gave me cancer’. The New York Times. New York City, NY. May 14, 2017, p. 1–2.

    Google Scholar 

  15. Miranda RN, Aladily TN, Prince HM, et al. Breast implant-associated anaplastic large-cell lymphoma: long-term follow-up of 60 patients. J Clin Oncol. 2014;32(2):114–20.

    Article  PubMed  Google Scholar 

  16. 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.

    Article  CAS  PubMed  Google Scholar 

  17. Montgomery-Goecker C, Fuda F, Krueger JE, Chen W. Immunophenotypic characteristics of breast implant-associated anaplastic large-cell lymphoma by flow cytometry. Cytometry B Clin Cytom. 2015;88(5):291–3.

    Article  PubMed  Google Scholar 

  18. Kuehlmann B, Prantl L. Breast implants and possible association with ALCL: a retrospective study including a histological analysis of 296 explanted breast tissues and current literature. Clin Hemorheol Microcirc. 2016;63(4):439–49.

    Article  CAS  PubMed  Google Scholar 

  19. Taylor CR, Siddiqi IN, Brody GS. Anaplastic large cell lymphoma occurring in association with breast implants: review of pathologic and immunohistochemical features in 103 cases. Appl Immunohistochem Mol Morphol. 2013;21(1):13–20.

    Article  CAS  PubMed  Google Scholar 

  20. Xu J, Wei S. Breast implant-associated anaplastic large cell lymphoma: review of a distinct clinicopathologic entity. Arch Pathol Lab Med. 2014;138(6):842–6.

    Article  PubMed  Google Scholar 

  21. Miranda RN, Lin L, Talwalkar SS, Manning JT, Medeiros LJ. Anaplastic large cell lymphoma involving the breast: a clinicopathologic study of 6 cases and review of the literature. Arch Pathol Lab Med. 2009;133(9):1383–90.

    Article  PubMed  Google Scholar 

  22. 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.

    Article  PubMed  Google Scholar 

  23. 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.

    Article  PubMed  Google Scholar 

  24. de Jong D, Vasmel WL, de Boer JP, Verhave G, Barbé E, Casparie MK, van Leeuwen FE. Anaplastic large-cell lymphoma in women with breast implants. JAMA. 2008;300(17):2030–5.

    Article  PubMed  Google Scholar 

  25. Doren EL, Miranda RN, Selber JC, et al. U.S. epidemiology of breast implant-associated anaplastic large cell lymphoma. Plast Reconstr Surg. 2017;139(5):1042–50.

    Article  CAS  PubMed  Google Scholar 

  26. Srinivasa DR, Miranda RN, Kaura A, et al. Global adverse event reports of breast implant-associated ALCL: an international review of 40 government authority databases. Plast Reconstr Surg. 2017;139(5):1029–39.

    Article  CAS  PubMed  Google Scholar 

  27. Loch-Wilkinson A, Beath K, Knight RJW, et al. Breast implant associated anaplastic large cell lymphoma in Australia and New Zealand – high surface area textured implants are associated with increased risk. Plast Reconstr Surg. 2017;140(4):645–54.

    Google Scholar 

  28. Campanale A, Boldrini R, Marletta M. BIA-ALCL vigilance and surveillance by the Italian Ministry of Health. Plast Reconstr Surg. 2017;141(1):11e–9e.

    Article  CAS  Google Scholar 

  29. Adrada BE, Miranda RN, Rauch GM, Arribas E, Kanagal-Shamanna R, Clemens MW, et al. Breast implant-associated anaplastic large cell lymphoma: sensitivity, specificity, and findings of imaging studies in 44 patients. Breast Cancer Res Treat. 2014;147:1–14.

    Article  CAS  PubMed  Google Scholar 

  30. Acevedo-Báñez I, García-Gomez FJ, Jiménez-Granero P, Carrillo-Cruz E, Perez-Lopez O, Borrego-Dorado I. 18F-FDG-PET/CT in implant-associated anaplastic large cell lymphoma of the breast. Br J Haematol. 2015;169(1):1.

    Article  PubMed  CAS  Google Scholar 

  31. Clemens MW, Medeiros LJ, Butler CE, et al. Complete surgical excision is essential for the management of patients with breast implant-associated anaplastic large-cell lymphoma. J Clin Oncol. 2016;34(2):160–8.

    Article  CAS  PubMed  Google Scholar 

  32. Brody GS, Deapen D, Taylor CR, et al. Anaplastic large cell lymphoma occurring in women with breast implants: analysis of 173 cases. Plast Reconstr Surg. 2015;135(3):695–705.

    Article  CAS  PubMed  Google Scholar 

  33. Clemens MW, Miranda RN, Butler CE. Breast implant informed consent should include the risk of anaplastic large cell lymphoma. Plast Reconstr Surg. 2016;137(4):1117–22.

    Article  CAS  PubMed  Google Scholar 

  34. Jacombs A, Tahir S, Hu H, Deva AK, Almatroudi A, Wessels WL, Bradshaw DA, Vickery K. In vitro and in vivo investigation of the influence of implant surface on the formation of bacterial biofilm in mammary implants. Plast Reconstr Surg. 2014;133(4):471e–80e.

    Article  CAS  PubMed  Google Scholar 

  35. Hammond DC. Reply: chronic biofilm infection in breast implants is associated with an increased T-cell lymphocytic infiltrate: implications for breast implant–associated lymphoma. Plast Reconstr Surg. 2015;135(6):1057e–9e.

    Article  CAS  PubMed  Google Scholar 

  36. Prince HM, Johnstone R. Commentary on: biomarkers provide clues to early events in the pathogenesis of breast implant-associated anaplastic large cell lymphoma. Aesthet Surg J. 2016;36(7):782–3.

    Article  PubMed  Google Scholar 

  37. Kadin ME, Deva A, Xu H, et al. Biomarkers provide clues to early events in the pathogenesis of breast implant-associated anaplastic large cell lymphoma. Aesthet Surg J. 2016;36(7):773–81.

    Article  PubMed  Google Scholar 

  38. Brody GS. The case against biofilm as the primary initiator of breast implant-associated anaplastic large cell lymphoma. Plast Reconstr Surg. 2016;137(4):766e–7e.

    Article  CAS  PubMed  Google Scholar 

  39. Bizjak M, Selmi C, Praprotnik S, Bruck O, Perricone C, Ehrenfeld M, et al. Silicone implants and lymphoma: the role of inflammation. J Autoimmun. 2015;65:64–73.

    Article  CAS  PubMed  Google Scholar 

  40. Orciani M, Sorgentoni G, Torresetti M, Di Primio R, Di Benedetto G. MSCs and inflammation: new insights into the potential association between ALCL and breast implants. Breast Cancer Res Treat. 2016;156(1):65–72.

    Article  CAS  PubMed  Google Scholar 

  41. Lechner MG, Megiel C, Church CH, et al. Survival signals and targets for therapy in breast implant-associated ALK—anaplastic large cell lymphoma. Clin Cancer Res. 2012;18:4549–59.

    Article  CAS  PubMed  Google Scholar 

  42. Meza Britez ME, Caballero Llano C, Chaux A. Periprosthetic breast capsules and immunophenotypes of inflammatory cells. Eur J Plast Surg. 2012;35:647–51.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Hu H, Jacombs A, Vickery K, Merten SL, Pennington DG, Deva AK. Chronic biofilm infection in breast implants is associated with an increased T-cell lymphocytic infiltrate: implications for breast implant-associated lymphoma. Plast Reconstr Surg. 2015;135(2):319–29.

    Article  CAS  PubMed  Google Scholar 

  44. Walker JN, Hanson BM, Pinkner CL, Simar SR, Pinkner JS, Parikh R, Clemens MW, Hultgren SJ, Myckatyn TM. Insights into the microbiome of breast implants and periprosthetic tissue in breast implant-associated anaplastic large cell lymphoma. Sci Rep. 2019;9(1):10393.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  45. Hallab NJ, Samelko L, Hammond D. The inflammatory effects of breast implant particulate shedding: comparison with orthopedic implants. Aesthetic Surg J. 2019;39:S36–48. https://doi.org/10.1093/asj/sjy335.

    Article  Google Scholar 

  46. Kadin ME, Morgan J, Xu H, et al. IL-13 is produced by tumor cells in breast implant-associated anaplastic large cell lymphoma: implications for pathogenesis. Hum Pathol. 2018;78:54–62.

    Article  CAS  PubMed  Google Scholar 

  47. Kadin ME. What cytokines can tell us about the pathogenesis of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). Aesthet Surg J. 2019;39(1):S28–35. https://doi.org/10.1093/asj/sjy250.

    Article  PubMed  Google Scholar 

  48. Turner SD, Inghirami G, Miranda RN, Kadin ME. Cell of origin and immunologic events in the pathogenesis of breast implant-associated anaplastic large-cell lymphoma. Am J Pathol. 2020;190(1):2–10.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Clemens MW, Horwitz SM. NCCN consensus guidelines for the diagnosis and management of breast implant-associated anaplastic large cell lymphoma. Aesthet Surg J. 2017;37(3):285–9.

    Article  PubMed  Google Scholar 

  50. National Comprehensive Cancer Network. www.nccn.org/about. Accessed November 2016.

  51. Clemens MW, Jacobsen ED, Horwitz SM. 2019 NCCN consensus guidelines on the diagnosis and treatment of breast implant associated ALCL. Aesthet Surg J. 2019;39:S3–S13.

    Article  PubMed  Google Scholar 

  52. McGuire P, Reisman NR, Murphy DK. Risk factor analysis for capsular contracture, malposition, and late Seroma in subjects receiving Natrelle 410 form-stable silicone breast implants. Plast Reconstr Surg. 2017;139(1):1–9.

    Article  CAS  PubMed  Google Scholar 

  53. Di Napoli A, Pepe G, Giarnieri E, Cippitelli C, Bonifacino A, Mattei M, et al. Cytological diagnostic features of late breast implant seromas: from reactive to anaplastic large cell lymphoma. PLoS One. 2017;12(7):e0181097.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  54. Brody GS, Deapen D, Taylor CR, Pinter-Brown L, et al. Anaplastic large cell lymphoma occurring in women with breast implants: analysis of 173 cases. Plast Reconstr Surg. 2015;135(1):695–705.

    Article  CAS  PubMed  Google Scholar 

  55. Alcalá R, Llombart B, Lavernia J, Traves V, Guillén C, Sanmartín O. Skin involvement as the first manifestation of breast implant-associated anaplastic large cell lymphoma. J Cutan Pathol. 2016;43(7):602–8.

    Article  PubMed  Google Scholar 

  56. Lazzeri D, Zhang YX, Huemer GM. Capsular contracture as a further presenting symptom of implant-related anaplastic large cell lymphoma. Am J Surg Pathol. 2012;36(11):1735–6; author reply 1736–8.

    Article  PubMed  Google Scholar 

  57. de Boer M, van der Sluis WB, de Boer JP, et al. Breast implant-associated anaplastic large-cell lymphoma in a transgender woman. Aesthet Surg J. 2017;37(8):83–7.

    Article  Google Scholar 

  58. Clemens MW, Brody GS, Mahabir RC, Miranda RN. How to diagnose and treat breast implant associated anaplastic large cell lymphoma. Plast Reconstr Surg. 2018;141(4):586e–99e.

    Article  CAS  PubMed  Google Scholar 

  59. Jaffe ES, Ashar BS, Clemens MW, et al. Best practices guideline for the pathologic diagnosis of breast implant-associated anaplastic large-cell lymphoma. J Clin Oncol. 2020;38(10):1102–11. https://doi.org/10.1200/JCO.19.02778.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  60. Clemens MW, Miranda RN. Commentary: lymphomas associated with breast implants: a review of the literature. Aesthet Surg J. 2015;35(5):545–7.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Falini B, Pileri S, Pizzolo G, et al. CD30 (Ki-1) molecule: a new cytokine receptor of the tumor necrosis factor receptor superfamily as a tool for diagnosis and immunotherapy. Blood. 1995;85(1):1–14.

    Article  CAS  PubMed  Google Scholar 

  62. Cheson BD, Fisher RI, Barrington SF, et al. Recommendations for initial evaluation, staging, and response assessment of Hodgkin and non-Hodgkin lymphoma: the Lugano classification. J Clin Oncol. 2014;32:3059.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Paulli M, Berti E, Rosso R, et al. CD30/Ki-1-positive lymphoproliferative disorders of the skin--clinicopathologic correlation and statistical analysis of 86 cases: a multicentric study from the European Organization for Research and Treatment of Cancer Cutaneous Lymphoma Project Group. J Clin Oncol. 1995;13(6):1343–54.

    Article  CAS  PubMed  Google Scholar 

  64. Wieser I, Wohlmuth C, Nunez CA, et al. Lymphomatoid papulosis in children and adolescents: a systematic review. Am J Clin Dermatol. 2016;17:319.

    Article  PubMed  Google Scholar 

  65. Clemens MW, Collins MS, Butler CE, et al. Characteristics and treatment of patients with breast implant-associated anaplastic large cell lymphoma presenting with aggressive features. Plast Reconstr Surg. 2015;136(4 Suppl):119–20.

    Article  Google Scholar 

  66. Brody GS. Brief recommendations for dealing with a new case of anaplastic large T-cell lymphoma. Plast Reconstr Surg. 2012;129(5):871e–2e.

    Article  PubMed  CAS  Google Scholar 

  67. Horwitz SM, Zelenetz AD, Gordon LI, et al. NCCN guidelines insights: non-Hodgkin’s lymphomas, version 3.2016. J Natl Compr Cancer Netw. 2016;14(9):1067–79.

    Article  Google Scholar 

  68. Pro B, Advani R, Brice P, et al. Brentuximab vedotin (SGN-35) in patients with relapsed or refractory systemic anaplastic large-cell lymphoma: results of a phase II study. J Clin Oncol. 2012;30:2190–6.

    Article  CAS  PubMed  Google Scholar 

  69. Pro B, Advani R, Brice P, et al. Four-year survival data from an ongoing pivotal phase 2 study of brentuximab vedotin in patients with relapsed or refractory systemic anaplastic large cell lymphoma [abstract]. Blood. 2014;124:Abstract 3095.

    Article  Google Scholar 

  70. Zimmerman A, Locke FL, Emole J, et al. Recurrent systemic anaplastic lymphoma kinase–negative anaplastic large cell lymphoma presenting as a breast implant–associated lesion. Cancer Control. 2015;22(3):369–73.

    Article  PubMed  Google Scholar 

  71. Johnson L, O'Donoghue J, Stark H, Collis N, et al. Abstract P5-03-02: breast implant associated anaplastic large cell lymphoma (BIA-ALCL)– the UK experience and first reported case of neoadjuvant brentuximab. Cancer Res. 2017;77(4 Supplement):P5-03-02.

    Article  Google Scholar 

  72. Carty MJ, Pribaz JJ, Antin JH, et al. A patient death attributable to implant-related primary anaplastic large cell lymphoma of the breast. Plast Reconstr Surg. 2011;128(3):112–8.

    Article  CAS  Google Scholar 

  73. Ivaldi C, Perchenet AS, Jallut Y, et al. Two cases of lymphoma in an implant capsule: a difficult diagnosis, an unknown pathology [in French]. Ann Chir Plast Esthet. 2013;58:688–93.

    Article  CAS  PubMed  Google Scholar 

  74. US Food and Drug Administration. The FDA takes action to protect patients from risk of certain textured breast implants; requests Allergan voluntarily recall certain breast implants and tissue expanders from the market: FDA Safety Communication. http://www.fda.gov/medical-devices/safety-communications/fda-takes-action-protect-patients-risk-certain-textured-breast-implants-requests-allergan. Accessed 26 July 2019.

  75. Keech JA Jr, Creech BJ. Anaplastic T-cell lymphoma in proximity to a saline-filled breast implant. Plast Reconstr Surg. 1997;100:554–5.

    Article  PubMed  Google Scholar 

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Clemens, M.W. (2021). Breast Implant-Associated Anaplastic Large Cell Lymphoma: Origin and Outcome. In: Kim, J.Y. (eds) Managing Common and Uncommon Complications of Aesthetic Breast Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-57121-4_9

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