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Am J Surg Pathol. 2018 Mar;42(3):293-305. doi: 10.1097/PAS.0000000000000985.

Clinicopathologic Features and Prognostic Impact of Lymph Node Involvement in Patients With Breast Implant-associated Anaplastic Large Cell Lymphoma.

Author information

1
Departments of Hematopathology.
2
Cayetano Heredia University, Lima, Peru.
3
Department of Pathology, Xuzhou Medical University, Jiangsu Province, P.R. China.
4
Plastic Surgery.
5
Surgical Breast Oncology, The University of Texas MD Anderson Cancer Center.
6
D├ępartement de Pathologie, CHU Purpan, University Institute of Cancer Oncopole, Toulouse, France.
7
Plastic Surgery, Auckland, New Zealand.
8
Department of Pathology and Laboratory Medicine, Oakland University William Beaumont School of Medicine, Royal Oak, MI.
9
Department of Anatomical Pathology, PathWest Laboratory Medicine, QEII Medical Centre, Perth, WA, Australia.
10
Middlemore Hospital.
11
Department of Clinical and Molecular Medicine, Pathology Unit, Sant'Andrea Hospital, School of Medicine and Psychology, Sapienza University of Rome, Rome, Italy.
12
Department of Pathology, Memorial Sloan-Kettering Cancer Center Weill Cornell Medical College.
13
Department of Pathology, Yale School of Medicine and Bridgeport Hospital, New Haven, CT.
14
Department of Pathology and Cell Biology, Columbia University Medical Center and New York Presbyterian Hospital, New York, NY.
15
SSM Health St. Mary's Hospital-Jefferson City, Jefferson City, MO.
16
Department of Pathology and Laboratory Services, The University of Arkansas for Medical Sciences, Little Rock, AR.
17
Tucson Pathology Associates, PC Carondelet St. Joseph Hospital, Tucson, AZ.
18
Department of Nuclear Medicine, Virgen Macarena University Hospital.
19
Department of Anatomic Pathology, Virgen del Rocio University Hospital, Sevilla.
20
Department of Laboratory Medicine and Pathology, Division of Hematopathology, Mayo Clinic, Rochester, MN.
21
Department of Pathology, Instituto de Investigaciones Hematologicas Academia de Medicina and FUNDALEU, Buenos Aires, Argentina.
22
Diagnostic Tissue/Cytology Group, Meridian, MS.
23
Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainsville, FL.
24
Department of Laboratory Medicine, University of Washington, Seattle, WA.
25
Department of Pathology and Laboratory Medicine, The University of Kansas Medical Center.
26
Department of Pathology, Massachusetts General Hospital and Harvard Medical School.
27
Department of Pathology, Baystate Health, Springfield, MA.
28
St. Joseph Medical Center, Kansas City, MO.
29
Department of Pathology, Brigham and Women's Hospital.
30
Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX.
31
Department of Pathology, University Hospital of Fuenlabrada.
32
University Hospital of Getafe, Madrid, Spain.
33
Department of Pathology, Academic Teaching Hospital Feldkirch, Feldkirch.
34
Department of Hematology and Oncology, Medical University Innsbruck, Innsbruck, Austria.
35
Department of Infectious diseases, University of Texas Health Science Center at Houston.

Abstract

Breast implant-associated anaplastic large cell lymphoma (BI-ALCL) is a rare T-cell lymphoma that arises around breast implants. Most patients manifest with periprosthetic effusion, whereas a subset of patients develops a tumor mass or lymph node involvement (LNI). The aim of this study is to describe the pathologic features of lymph nodes from patients with BI-ALCL and assess the prognostic impact of LNI. Clinical findings and histopathologic features of lymph nodes were assessed in 70 patients with BI-ALCL. LNI was defined by the histologic demonstration of ALCL in lymph nodes. Fourteen (20%) patients with BI-ALCL had LNI, all lymph nodes involved were regional, the most frequent were axillary (93%). The pattern of involvement was sinusoidal in 13 (92.9%) cases, often associated with perifollicular, interfollicular, and diffuse patterns. Two cases had Hodgkin-like patterns. The 5-year overall survival was 75% for patients with LNI and 97.9% for patients without LNI at presentation (P=0.003). Six of 49 (12.2%) of patients with tumor confined by the capsule had LNI, compared with LNI in 8/21 (38%) patients with tumor beyond the capsule. Most patients with LNI achieved complete remission after various therapeutic approaches. Two of 14 (14.3%) patients with LNI died of disease compared with 0/56 (0%) patients without LNI. Twenty percent of patients with BI-ALCL had LNI by lymphoma, most often in a sinusoidal pattern. We conclude that BI-ALCL beyond capsule is associated with a higher risk of LNI. Involvement of lymph nodes was associated with decreased overall survival. Misdiagnosis as Hodgkin lymphoma is a pitfall.

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