Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL): Breast Imaging Perspective

Breast Imaging ◽

Cell Lymphoma ◽

Breast Implant ◽

Fluid Collection ◽

Clinical History ◽

Large Cell ◽

Skin Lesions ◽

Large Cell Lymphoma ◽

One Year

Breast implant-associated anaplastic large cell lymphoma is a rare disease first described in 1997. Since then, its incidence has continued to increase. Current estimated lifetime risk in women with textured breast implants range from 1:1000 to 1:30,000. Most cases present with rapid and dramatic breast swelling resulting from peri-implant fluid collection. Palpable mass, pain, and skin lesions also occur. A high index of suspicion in patients who develop a seroma around the breast implant more than one year after implant placement is required. The combination of clinical history, physical exam findings, and appropriate imaging workup can lead to a timely and accurate diagnosis. The disease has excellent prognosis when it is diagnosed earlier, and complete surgery is performed. Radiologists, particularly those involved in breast imaging, can play an essential role in early diagnosis. This chapter presents an overview of the disease, including relevant imaging findings.

Breast Implant-Associated Anaplastic Large Cell Lymphoma: A Case Report

Journal of Hematology and Oncology Research ◽

10.14302/issn.2372-6601.jhor-21-3733 ◽

2021 ◽

Vol 4 (1) ◽

pp. 28-34

Author(s):

Kumkum Vadehra ◽

Jennifer Cai ◽

Rashmi Rekha Bhuyan ◽

Ping Ji ◽

Rose Venegas ◽

...

Keyword(s):

Tumor Cells ◽

Cell Lymphoma ◽

Breast Implant ◽

Fluid Collection ◽

Breast Implants ◽

Large Cell ◽

Silicone Implants ◽

Axillary Lymph ◽

Breast implant-associated anaplastic large cell lymphoma (ALCL) is a recently recognized type of T-cell lymphoma that can develop following breast implants, with morphologic and immunophenotypic features indistinguishable from those of ALK-negative ALCL. Here we report a case of a 58-year-old woman with a history of subglandular silicone implants placed for bilateral breast augmentation 25 years ago, who presented with bilateral breast pain and was found to have bilateral Baker Grade III capsular contracture, and heterogenous fluid collection centered near the left third costochondral articulation, a suspicious left chest wall lesion, and left axillary lymphadenopathy on imaging. A left axillary lymph node core biopsy and an aspiration of the fluid were performed, and no malignant cells were identified. The patient underwent bilateral removal of breast implants and total capsulectomies. Microscopic examination of the capsule surrounding the left breast implant revealed large pleomorphic tumor cells in a fibrinous exudate. By immunohistochemistry, the tumor cells were found to be positive for CD3 (subset), CD4, CD7, CD30 (strong and uniform), and CD43, and negative for CD2, CD5, CD8, and ALK1, supporting the diagnosis of breast implant-associated ALCL. No lymphoma cells were identified in the right breast capsule, confirmed by CD30 stain. Breast implant-associated ALCL is a very rare disease that can develop many years after breast implant placement. Proper evaluation with breast imaging and pathologic workup is essential to confirm the diagnosis in suspected cases. Our case highlights that adequate sampling is important in the investigation of patients with suspected breast implant-associated ALCL.

MRI features of breast implant-associated anaplastic large cell lymphoma: a pictorial review

British Journal of Radiology ◽

10.1259/bjr.20210093 ◽

2021 ◽

pp. 20210093

Author(s):

Anna Rotili ◽

Federica Ferrari ◽

Luca Nicosia ◽

Filippo Pesapane ◽

Valentina Tabanelli ◽

...

Keyword(s):

Breast Imaging ◽

Cell Lymphoma ◽

Case Reports ◽

Breast Implant ◽

Case Series ◽

Large Cell ◽

Pictorial Review ◽

Mri Features ◽

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare and newly recognized subtype of T cell Non-Hodgkin Lymphoma (NHLs) associated with breast implants. The mechanism involved in the development of this kind of lymphoma is still uncertain. BIA-ALCL is generally an indolent disease localized to the breast implant and its capsule and effectively treated with capsulectomy alone without chemotherapy. Clinically, BIA-ALCL may typically present a sudden-onset breast-swelling secondary to peri-implant effusion. The minority of BIA-ALCL patients present a more aggressive mass-forming subtype, for which systemic therapy is mandatory. Despite the number of cases has recently increased, BIA-ALCL remains a rare disease described mainly in several case reports and small case series. Breast imaging, including mammography, ultrasound (US) and breast magnetic resonance imaging (MRI) are routinely used in the screening of breast cancer; however, guidelines for the imaging and pathological diagnosis of this disease have only recently been proposed and included in the 2019 National Comprehensive Cancer Network (NCCN) consensus guidelines for BIA-ALCL (REFERENCE). The main purpose of this pictorial is to illustrate the MRI signs of BIA-ALCL and correlate them with the corresponding pathology features in order to improve the knowledge of the principals MRI features of this type of lymphoma.

Description of Two Cases of Anaplastic Large Cell Lymphoma Associated with a Breast Implant

Case Reports in Radiology ◽

10.1155/2019/6137198 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6

Author(s):

Julie Crèvecoeur ◽

Véronique Jossa ◽

Joan Somja ◽

Jean-Claude Parmentier ◽

Jean-Luc Nizet ◽

...

Keyword(s):

Cell Lymphoma ◽

Breast Implant ◽

Fluid Collection ◽

Breast Implants ◽

Large Cell ◽

World Health ◽

Breast Volume ◽

Volume Increase ◽

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a recently recognized provisional entity in the 2017 revision of the World Health Organization classification of lymphoid neoplasms. Although the majority of the cases described in the literature demonstrate an effusion confined to the capsule of the breast implant, this rare pathology can also invade the capsule and adjacent tissues and/or involve lymph nodes. We hereby report two new cases of BIA-ALCL in a 58-year-old and a 47-year-old Caucasian female who received a silicone breast implant. The first patient showed a sudden and rapid right breast volume increase 6 years after the implantation surgery. As for the second patient, a left breast volume increase was observed also suddenly and quickly 11 years after surgery. In both cases, an uncompressed mammography was performed allowing a new approach to highlight periprosthetic fluid reaction. Pathologic examination of the fluid collection revealed atypical cells positive for CD30 and CD45 and negative for ALK and CK7. This allowed pathologists to diagnose a breast implant-associated anaplastic large cell lymphoma. Patients were treated with bilateral capsulectomy with no additional local or systemic therapy. The development of breast augmentation may come with an increase in the frequency of this pathology. Radiologists and senologists must therefore be careful when women with breast implants show an increase of breast volume and all cases of BIA-ALCL must be recorded and reported.

Breast Implant–Associated Anaplastic Large-Cell Lymphoma: Current Understanding and Recommendations for Management

Plastic Surgery ◽

10.1177/2292550320925906 ◽

2020 ◽

Vol 28 (2) ◽

pp. 117-126 ◽

Cited By ~ 1

Author(s):

Tessa L. St. Cyr ◽

Barbara A. Pockaj ◽

Donald W. Northfelt ◽

Fiona E. Craig ◽

Mark W. Clemens ◽

...

Keyword(s):

Cell Lymphoma ◽

Breast Implant ◽

Fluid Collection ◽

Breast Implants ◽

Large Cell ◽

Surgical Removal ◽

Stage Disease ◽

Large Cell Lymphoma ◽

Disease Stages

Worldwide, millions of women live with breast implants. Therefore, it is important that physicians be aware of an uncommon but possibly serious complication arising from breast implants: breast implant–associated anaplastic large cell lymphoma (BIA-ALCL). Breast implant–associated anaplastic large-cell lymphoma most commonly presents as a delayed fluid collection around a textured breast implant or as a mass in the capsule surrounding the implant. The exact pathogenesis of the disease remains unclear. The neoplastic cells of BIA-ALCL show strong uniform staining for CD30 and are consistently negative for activin receptor-like kinase 1. Patients with confirmed cases should be referred to a lymphoma specialist or breast medical oncologist for a complete oncologic evaluation before any surgical intervention. For disease confined to the fluid accumulation or capsule, or both, surgical removal of the implant and complete capsulectomy is the preferred treatment. Postoperative chemotherapy or radiation, or both, are not considered necessary for patients with limited-stage disease and are reserved for advanced disease stages. Generally, BIA-ALCL is a local disease that follows an indolent course and has an excellent prognosis. Although complete remission of disease has occurred in patients with BIA-ALCL, median overall survival is reduced. As of March 2018, approximately 529 unique, confirmed BIA-ALCL cases had been reported in 23 countries. To date, 16 patients have died from BIA-ALCL, and all had extracapsular involvement. The aim of this article is to summarize the diagnosis, evaluation, and management of BIA-ALCL, based on established guidelines, for all practitioners who may care for patients with breast implants.

Breast implant–associated anaplastic large cell lymphoma: Brief overview of current data and imaging findings

Breast Disease ◽

10.3233/bd-201017 ◽

2021 ◽

pp. 1-7

Author(s):

Fernando Collado-Mesa ◽

Monica M. Yepes ◽

Jose M. Net ◽

Merce Jorda

Keyword(s):

Cell Lymphoma ◽

Imaging Modality ◽

Breast Implant ◽

Fluid Collection ◽

Large Cell ◽

World Health ◽

Imaging Features ◽

Implant Placement ◽

In 2016, the World Health Organization added Breast Implant-Associated Anaplastic Large Cell lymphoma as a provisionally recognized lymphoma to the family of existing Anaplastic Large Cell lymphomas. Current estimates of the lifetime risk of the disease in women with textured breast implants range from 1:1,000 to 1:30,000. The mean interval from implant placement to diagnosis is 10.7 ± 4.6 years and the most common clinical symptom at presentation is breast swelling. A high level of clinical suspicion is recommended in patients presenting with breast symptoms and/or peri-implant fluid collection occurring more than 1 year after breast implant placement. Ultrasound is the imaging modality of choice, with a high sensitivity for peri-implant fluid and a high specificity for peri-implant mass. When ultrasound is inconclusive, breast MRI is indicated. As of today, all confirmed cases have tested positive for CD30 immunohistochemistry and the disease has shown to have an excellent prognosis when it is diagnosed earlier (localized disease), and when complete surgery, consisting of explantation, capsulectomy, and removal of any associated capsule mass, is performed. This overview summarizes the available epidemiological and clinical data of Breast Implant-Associated Anaplastic Large Cell lymphoma, with an emphasis on imaging features.

96 A Rare Case of Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL)?

British Journal of Surgery ◽

10.1093/bjs/znab259.267 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

P R Chew ◽

F Hogg

Keyword(s):

Cell Lymphoma ◽

Breast Implant ◽

Fluid Collection ◽

Large Cell ◽

Disease Diagnosis ◽

Anaplastic Lymphoma ◽

Select Group ◽

Large Cell Lymphoma ◽

Alk Positive

Abstract Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare subtype of T-cell lymphoma that develops around breast implants and was first described in 1997. To date, the estimated risk of BIA-ALCL in UK is reported to be 1 in 24000, but as yet appears to have a substantial variation of incidence around the world. The aetiology of this recognised clinical entity remained widely unknown. A 72-year-old woman in remission for systemic anaplastic lymphoma kinase (ALK)-positive ALCL of right axilla, presented with a discoloured lump at the medial mastectomy scar following a progressive enlargement of right breast, 20 years after silicone breast implant reconstruction. Imaging studies showed fluid collection and herniation of the affected breast implant. Subsequently, the discoloured lump burst and patient then had tissue biopsy and removal of her right breast implant in together with intravenous antibiotic. Histocytopathological examination confirmed the presence of BIA-ALCL without capsular invasion and the growth of Gram-negative bacteria were noted in fluid culture. Total capsulectomy was performed and patient continues to be in remission with no local or systemic therapy. We reported a rare yet interesting case of the coexistence of BIA-ALCL and systemic ALK-positive ALCL in an elderly patient. This case has further strengthened the causal relationship of composition and/or textured implant, and the presence of a theoretical association of a select group of pathogens maybe a trigger and contributes to the pathogenesis of BIA-ALCL. Due to the rarity of this disease, diagnosis can be challenging and requires a multidisciplinary approach.