Skip to main content

Advertisement

SpringerLink
Log in

Spontaneous Regression and Resolution of Breast Implant-Associated Anaplastic Large Cell Lymphoma: Implications for Research, Diagnosis and Clinical Management

  • Original Article
  • Breast Surgery
  • Published:
Aesthetic Plastic Surgery Aims and scope Submit manuscript

Abstract

Background

First described in 1997, breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) was recognised by the World Health Organisation in 2016 as a specific disease. It typically presents as a late seromacontaining atypical, monoclonal T cells which are CD30+ and anaplastic lymphoma kinase negative. Until recently, it was thought that the disease was very rare. However, it is being diagnosed increasingly frequently with 56 cases confirmed in Australia by September 2017 and the estimated incidence revised from 1 in 300,000 to between 1 in 1000 and 1 in 10,000 patients with bilateral implants. There is debate about the spectrum of BIA-ALCL. According to the current WHO classification, BIA-ALCL is a cancer in all cases. Treatment guidelines require that it is treated urgently with a minimum of bilateral removal of implants and capsulectomies. Whilst acknowledging the disease has been under diagnosed in the past, with some notable exceptions the BIA-ALCL literature has given scant attention to the epidemiological evidence. Now that it is known that the disease may occur in up to 1 in 1000 patients with a median of 7.5 years from implantation to diagnosis, understanding it in its epidemiological context is imperative. The epidemiology of cancer and lymphoma in women with breast implants strongly suggests that most patients do not have a cancer that will inevitably progress without treatment but instead a self-limiting lympho-proliferative disorder. Although the possibility of spontaneous regression has been raised and the observation made that treatment delay did not seem to increase the risk of spread, the main objection to the lympho-proliferative hypothesis has been the lack of documented cases of spontaneous regression or resolution. Because all cases currently are considered malignant and treated urgently, only case report evidence, interpreted in the proper epidemiological context, is likely to be available to challenge this thinking.

Methods and Results

New observations and interpretation of the epidemiology of BIA-ALCL are made. These are supported by the presentation of two cases, which to the best of our knowledge comprise the first documented evidence of spontaneous regression and spontaneous resolution of confirmed BIA-ALCL.

Conclusions

The epidemiology of the disease strongly suggests that the vast majority of cases are not a cancer that will inevitably progress without treatment. The findings presented in the manuscript provide supportive clinical evidence. Consequently, an alternative view of BIA-ALCL with implications for research, diagnosis and clinical management needs to be considered.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

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

Similar content being viewed by others

References

  1. Keech Jr., J.A., Creech, B.J.: Anaplastic T-cell lymphoma in proximity to a saline-filled breast implant. Plast Reconstr Surg 100(2), 554–555 (1997)

    Article  Google Scholar 

  2. Swerdlow, S.H., Campo, E., Pileri, S.A., et al.: The 2016 revision of the World Health Organization classification of lymphoid neoplasms. Blood 127(20), 2375–2390 (2016)

    Article  CAS  Google Scholar 

  3. Anaplastic large cell lymphoma (ALCL) in women with breast implants: preliminary FDA findings and analyses. In: Services DoHaH (ed). US Food and Drug Administration, Washington, DC (2013)

  4. Breast implants and anaplastic large cell lymphoma. Update-additional confirmed cases of anaplastic large cell lymphoma (2017). https://www.tga.gov.au/alert/breast-implants-and-anaplastic-largecell-lymphoma. Accessed 4 Dec 2017

  5. Breast implants and anaplastic large cell lymphoma. Expert advisory panel advice on association with anaplastic large cell lymphoma (2016). https://www.tga.gov.au/alert/breast-implants. Accessed 26 Dec 2016

  6. Story, S.K., Schowalter, M.K., Geskin, L.J.: Breast implantassociated ALCL: a unique entity in the spectrum of CD30? lymphoproliferative disorders. Oncologist 18(3), 301–307 (2013)

    Article  Google Scholar 

  7. Miranda, R.N., Aladily, T.N., Prince, H.M., et al.: Breast implantassociated anaplastic large-cell lymphoma: long-term follow-up of 60 patients. J Clin Oncol 32(2), 114–120 (2014)

    Article  Google Scholar 

  8. Clemens, M.W., Medeiros, L.J., Butler, C.E., et al.: Complete surgical excision is essential for the management of patients with breast implant-associated anaplastic large-cell lymphoma. J Clin Oncol 34(2), 160–168 (2016)

    Article  CAS  Google Scholar 

  9. Brody, G.S., Deapen, D., Taylor, C.R., et al.: Anaplastic large cell lymphoma occurring in women with breast implants: analysis of 173 cases. Plast Reconstr Surg 135(3), 695–705 (2015)

    Article  CAS  Google Scholar 

  10. Rupani, A., Frame, J.D., Kamel, D.: Lymphomas associated with breast implants: a review of the literature. Aesthet Surg J 35(5), 533–544 (2015)

    Article  Google Scholar 

  11. Loch-Wilkinson, A., Beath, K.J., Knight, R.J.W., 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 140(4), 645–654 (2017)

    Article  CAS  Google Scholar 

  12. Brinton, L.A., Lubin, J.H., Burich, M.C., Colton, T., Brown, S.L., Hoover, R.N.: Cancer risk at sites other than the breast following augmentation mammoplasty. Ann Epidemiol 11(4), 248–256 (2001)

    Article  CAS  Google Scholar 

  13. Brisson, J., Holowaty, E.J., Villeneuve, P.J., et al.: Cancer incidence in a cohort of Ontario and Quebec women having bilateral breast augmentation. Int J Cancer 118(11), 2854–2862 (2006)

    Article  CAS  Google Scholar 

  14. Laurent, C., Delas, A., Gaulard, P., et al.: Breast implant-associated anaplastic large cell lymphoma: two distinct clinicopathological variants with different outcomes. Ann Oncol 27(2), 306–314 (2016)

    Article  CAS  Google Scholar 

  15. Lipworth, L., Tarone, R.E., Friis, S., et al.: Cancer among Scandinavian women with cosmetic breast implants: a pooled long-term follow-up study. Int J Cancer 124(2), 490–493 (2009)

    Article  CAS  Google Scholar 

  16. Lipworth, L., Tarone, R.E., McLaughlin, J.K.: Breast implants and lymphoma risk: a review of the epidemiologic evidence through 2008. Plast Reconstr Surg 123(3), 790–793 (2009)

    Article  CAS  Google Scholar 

  17. Vase, M.O., Friis, S., Bautz, A., Bendix, K., Sorensen, H.T., d'Amore, F.: Breast implants and anaplastic large-cell lymphoma: a Danish population-based cohort study. Cancer Epidemiol Biomark Prev 22(11), 2126–2129 (2013)

    Article  Google Scholar 

  18. Agrawal, B., Reddish, M., Longenecker, B.M.: CD30 expression on human CD8? T cells isolated from peripheral blood lymphocytes of normal donors. J Immunol 157(8), 3229–3234 (1996)

    CAS  PubMed  Google Scholar 

  19. Tarkowski, M.: Expression and function of CD30 on T lymphocytes. Arch Immunol Ther Exp (Warsz) 47(4), 217–221 (1999)

    CAS  Google Scholar 

  20. Kadin, M., Morgan, J., Xu, H., Glicksman, C.A.: CD30? T cells in late seroma may not be diagnostic of breast implant-associated anaplastic large cell lymphoma. Aesthet Surg J 37(7), 771–775 (2017)

    Article  Google Scholar 

  21. Deva AK (2017) Personal communication to corresponding author

  22. Hart, A.M., Lechowicz, M.J., Peters, K.K., Holden, J., Carlson, G.W.: Breast implant-associated anaplastic large cell lymphoma: report of 2 cases and review of the literature. Aesthet Surg J. 34(6), 884–894 (2014)

    Article  Google Scholar 

  23. Australian Institute of Health and Welfare 2017. Cancer in Australia 2017. Cancer series no.101.Cat. no. CAN 100. AIHW, Canberra

  24. Park, B.Y., Lee, D.H., Lim, S.Y., et al.: Is late seroma a phenomenon related to textured implants? A report of rare complications and a literature review. Aesthet Plast Surg 38(1), 139–145 (2014)

    Article  Google Scholar 

  25. Spear, S.L., Rottman, S.J., Glicksman, C., Brown, M., Al-Attar, A.: Late seromas after breast implants: theory and practice. Plast Reconstr Surg 130(2), 423–435 (2012)

    Article  CAS  Google Scholar 

  26. Park, S., Oh, C.M., Cho, H., et al.: Association between screening and the thyroid cancer "epidemic" in South Korea: evidence from a nationwide study. BMJ 355, i5745 (2016)

    Article  Google Scholar 

  27. Macaulay WL (1968) Lymphomatoid papulosis. A continuing self-healing eruption, clinically benign–histologically malignant. Arch Dermatol 97(1):23–30

  28. Kadin, M.E., Xu, H., Pavlov, I.: Breast implant associated ALCL closely resembles primary cutaneous ALCL. Lab Invest 92(Suppl 1), 346A (2012)

    Google Scholar 

  29. Kempf, W., Pfaltz, K., Vermeer, M.H., et al.: EORTC, ISCL, and USCLC consensus recommendations for the treatment of primary cutaneous CD30-positive lymphoproliferative disorders: lymphomatoid papulosis and primary cutaneous anaplastic largecell lymphoma. Blood 118(15), 4024–4035 (2011)

    Article  CAS  Google Scholar 

  30. Sieber, D.A., Adams Jr., W.P.: What's your micromort? A patient-oriented analysis of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). Aesthet Surg J 37(8), 887–891 (2017)

    Article  Google Scholar 

  31. Esserman, L.J., Thompson, I.M., Reid, B., et al.: Addressing overdiagnosis and overtreatment in cancer: a prescription for change. Lancet Oncol 15(6), e234–e242 (2014)

    Article  Google Scholar 

  32. Woods, W.G., Gao, R.N., Shuster, J.J., et al.: Screening of infants and mortality due to neuroblastoma. N Engl J Med 346(14), 1041–1046 (2002)

    Article  Google Scholar 

Download references

Acknowledgements

The authors wish to thank Dr. Roberto Miranda at the MD Anderson Cancer Centre, for his review of the slides of both cases, and Dr. Linda Shen at Pathology Queensland, for her assistance with the case of spontaneous resolution.

Author information

Authors and Affiliations

  1. Cosmetic Surgery Institute of Australia, PO Box 213, Fortitude Valley, Brisbane, QLD, 4006, Australia

    Daniel Fleming

  2. QML Pathology, 1 Riverview Place, Metroplex on Gateway, Murarrie, QLD, 4172, Australia

    Jason Stone

  3. NorthEast Plastic Surgery, Wickham House, Level 1 155 Wickham Terrace, Spring Hill, Brisbane, QLD, 4000, Australia

    Patrick Tansley

Authors
  1. Daniel Fleming
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jason Stone
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Patrick Tansley
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Daniel Fleming.

Ethics declarations

Conflict of interest

The first author has previously acted as a consultant to the Silimed Corporation. All other authors have no conflicts of interest to disclose.

Additional information

This article is being reprinted for ISAPS 50th Anniversary Special Issue.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Fleming, D., Stone, J. & Tansley, P. Spontaneous Regression and Resolution of Breast Implant-Associated Anaplastic Large Cell Lymphoma: Implications for Research, Diagnosis and Clinical Management. Aesth Plast Surg 44, 1109–1115 (2020). https://doi.org/10.1007/s00266-020-01810-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00266-020-01810-2

Keywords

Search

Navigation