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Aesthet Surg J. 2020 Jan 2. pii: sjz377. doi: 10.1093/asj/sjz377. [Epub ahead of print]

A Cautionary Tale and Update on Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL).

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Division of Plastic and Reconstructive Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO.
Department of Pathology and Immunology, Washington University in St. Louis School of Medicine, St. Louis, MO.
Division of Hematology and Oncology, Washington University in St. Louis School of Medicine, St. Louis, MO.
Private practice in St. Louis, MO.


Breast implant-associated anaplastic large T-cell lymphoma (BIA-ALCL) was first recognized by the World Health Organization in 2016. The total number of cases worldwide continues to increase, with >800 cases confirmed through a combination of the FDA, verified reports, and registries. There are 33 deaths currently reported. Typical presentation includes a late seroma containing monoclonal T cells that are CD30+ and anaplastic lymphoma kinase (ALK) negative. We present a review of the current literature and report on three cases of BIA-ALCL at our institution, which serve to illustrate our approach to diagnosis and management of this disease. In two cases, the diagnosis of BIA-ALCL was not initially confirmed due to an incomplete workup but was recognized upon explantation. The seroma fluid was sent for flow cytometry. Initially, the cells were reported as morphologically suspicious for malignancy with phenotypically normal T-cells based on standard CD3+ T-cell gating. Subsequent cytology specimens were reported as consistent with recurrent adenocarcinoma. However, upon re-gating of flow cytometry data, a population of CD30+, CD3- T-cells was noted and the diagnosis of BIA-ALCL was confirmed by immunohistochemical stains of the excised breast capsule specimen. Given the increasing incidence of this disease, as plastic surgeons we must stay informed to order the correct workup to avoid misdiagnosis and be prepared to appropriately refer affected patients to centers with multidisciplinary teams experienced in the management of BIA-ALCL.


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