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J Clin Oncol. 2014 Jan 10;32(2):114-20. doi: 10.1200/JCO.2013.52.7911. Epub 2013 Dec 9.

Breast implant-associated anaplastic large-cell lymphoma: long-term follow-up of 60 patients.

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Roberto N. Miranda, Rashmi Kanagal-Shamanna, Luis E. Fayad, Summer E. Hanson, John T. Manning Jr, Zijun Y. Xu-Monette, Patricia Fox, Roland L. Bassett, Ken H. Young, L. Jeffrey Medeiros, The University of Texas MD Anderson Cancer Center; Alonso R. Miranda, University of Houston, Houston; Eid Mustafa, Plastic and Reconstructive Surgery, Wichita Falls; Steven Sanchez, Pathology Associates of Tyler, Tyler, TX; Mitual B. Amin, Oakland University William Beaumont School of Medicine, Royal Oak, MI; Nisreen Haideri, Saint Lukes Cancer Institute, Kansas City, MO; Govind Bhagat, Columbia University Medical Center, New York Presbyterian Hospital and Herbert Irving Comprehensive Cancer Center, New York, NY; Glen S. Brooks, Tufts University, Longmeadow; Ephram P. Hochberg, Massachusetts General Hospital; Matthew J. Carty, Brigham & Women's Hospital, Boston, MA; David A. Shifrin, Advocate Medical Group Plastic Surgery, Oak Lawn, IL; Dennis P. O'Malley, Clarient Laboratories/GE Healthcare, Aliso Viejo, CA; Shiyong Li, Emory University Hospital, Atlanta, GA; John A. Keech Jr, MultiCare Regional Cancer Center, MultiCare Health Systems, Tacoma, WA; Jorge J. Castillo, The Warren Alpert Medical School of Brown University, The Miriam Hospital, Providence, RI; Dongjiu Ye, Bioreference Laboratories, Elmwood Park, NJ; Douglas Clark, New Mexico Cancer Center, Albuquerque, NM; Tariq N. Aladily, The University of Jordan, Amman, Jordan; H. Miles Prince, Chan Y. Cheah, Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, Australia; Daphne de Jong, Vrije Universiteit Medical Center; Jan Paul de Boer, the Netherlands Cancer Institute, Amsterdam, the Netherlands; Carlos E. Bacchi, Gabriela Gualco, Consultoria em Patologia, Botucatu, São Paulo, Brazil; Brady E. Beltran, Edgardo Rebagliati Martins Hospital, Lima, Peru; Zaher Chakhachiro, American University of Beirut Medical Center, Beirut, Lebanon.



Breast implant-associated anaplastic large-cell lymphoma (ALCL) is a recently described clinicopathologic entity that usually presents as an effusion-associated fibrous capsule surrounding an implant. Less frequently, it presents as a mass. The natural history of this disease and long-term outcomes are unknown.


We reviewed the literature for all published cases of breast implant-associated ALCL from 1997 to December 2012 and contacted corresponding authors to update clinical follow-up.


The median overall survival (OS) for 60 patients was 12 years (median follow-up, 2 years; range, 0-14 years). Capsulectomy and implant removal was performed on 56 of 60 patients (93%). Therapeutic data were available for 55 patients: 39 patients (78%) received systemic chemotherapy, and of the 16 patients (28%) who did not receive chemotherapy, 12 patients opted for watchful waiting and four patients received radiation therapy alone. Thirty-nine (93%) of 42 patients with disease confined by the fibrous capsule achieved complete remission, compared with complete remission in 13 (72%) of 18 patients with a tumor mass. Patients with a breast mass had worse OS and progression-free survival (PFS; P = .052 and P = .03, respectively). The OS or PFS were similar between patients who received and did not receive chemotherapy (P = .44 and P = .28, respectively).


Most patients with breast implant-associated ALCL who had disease confined within the fibrous capsule achieved complete remission. Proper management for these patients may be limited to capsulectomy and implant removal. Patients who present with a mass have a more aggressive clinical course that may be fatal, justifying cytotoxic chemotherapy in addition to removal of implants.

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