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Curr Hematol Malig Rep. 2018 Dec;13(6):516-524. doi: 10.1007/s11899-018-0478-2.

Breast Implant-Associated Anaplastic Large Cell Lymphoma.

Author information

1
Department of Plastic, Reconstructive & Maxillofacial Surgery - Macquarie University, Sydney, New South Wales, Australia.
2
Medical Oncology and Cancer Immunology, Epworth Healthcare, 140 Clarendon Street, East Melbourne, Victoria, 3002, Australia. miles.prince@petermac.org.
3
Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia. miles.prince@petermac.org.

Abstract

PURPOSE OF REVIEW:

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a recently recognised malignancy of T lymphocytes exclusively associated with textured breast implants. This review aims to evaluate existing theories regarding the epidemiology, pathogenesis, clinical evaluation and management of the disease.

RECENT FINDINGS:

The true incidence of BIA-ALCL is difficult to define. Prevailing pathogenic theories recognise the interplay between textured implants, Gram-negative bacteria, host genetics (e.g. JAK/STAT, p53) and time. Patients typically present with a delayed seroma and less commonly with a capsular mass or systemic disease at an average of 8-10 years after implantation. BIA-ALCL staging has evolved from a "liquid tumour" model to a "solid tumour" classification. For localised disease, surgery involving complete capsulectomy and implant removal is the cornerstone of treatment. For more advanced disease, treatment includes surgery followed by chemotherapy (combination anthracycline-based), radiotherapy and the antibody drug conjugate (brentuximab vedotin). The interplay between the Gram-negative biofilm, implant texturing, genetic mutations and time has been implicated in pathogenesis of BIA-ALCL. The identification of a putative infectious cause is not unique to lymphomagenesis. Future research, investigating BIA-ALCL genetic mutations and immunological modulation with Gram-negative biofilm in BIA-ALCL models is warranted.

KEYWORDS:

Anaplastic large cell lymphoma; Bacteria; Biofilm; Breast implant; Capsulectomy; T cell

PMID:
30345474
DOI:
10.1007/s11899-018-0478-2
[Indexed for MEDLINE]

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