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Review
. 2014 Winter;22(4):267-9.
doi: 10.4172/plastic-surgery.1000894.

Update on anaplastic large cell lymphoma in women with breast implants

Walter Peters  1
Affiliations
Review

Update on anaplastic large cell lymphoma in women with breast implants

Walter Peters. Plast Surg (Oakv). 2014 Winter.

Abstract
in English, French

Since 1997, reports from the scientific community have suggested a possible association, without causation, between breast implants and anaplastic large cell lymphoma (ALCL). Analysis of these patients has been challenging. Many studies have been under-reported while others have been duplicated. In 2011, a United States Food & Drug Administration (FDA) 'white paper' analyzed 34 of the 60 cases reported worldwide. All 34 patients had undergone secondary surgery for breast swelling, firmness or pain. ALCL was an incidental finding. Diagnosis of ALCL is made by hematoxylin and eosin histology and immunochemistry for the CD30 marker. ALCL occurred with all types of implants. Subsequent studies have suggested that textured implants may have a greater risk. In all cases, ALCL cells were found in the capsule, in the seroma or within a mass adjacent to the implant. There was no invasion of cells beyond the capsule into the breast parenchyma. From the FDA study, the risk of developing ALCL after receiving implants appears to be approximately one in one million per year. All cases appear to be negative for the anaplastic lymphoma kinase marker. ALCL in most of these patients may represent a new entity with less aggressive behaviour. In most patients with capsule-confined disease, proper management may prove to be implant removal and capsulectomy. Patients with a distinct mass adjacent to their implant may have a more aggressive clinical course that may become systemic. They may require chemotherapy in addition to implant removal and capsulectomy. All cases of ALCL should be referred to an appropriate specialist and reported to the FDA.

Depuis 1997, des comptes rendus de la communauté scientifique laissent croire à des associations non causales entre les implants mammaires et les lymphomes anaplasiques à grandes cellules (LAGC). L’analyse de ces patientes est difficile. De nombreuses études sont sous-déclarées, tandis que d’autres sont dédoublées. En 2011, un « livre blanc » de la Food & Drug Administration (FDA) des États-Unis contenait l’analyse de 34 des 60 cas déclarés dans le monde. Les 34 patientes avaient toutes subi une chirurgie secondaire en raison d’une enflure, d’une fermeté ou d’une douleur de la poitrine. Les LAGC étaient des découvertes fortuites. Le diagnostic de LAGC est posé par une histologie de l’hématoxyline et de l’éosine et par l’immunochimie du marqueur CD30. Les LAGC se produisaient dans tous les types d’implants. Selon des études subséquentes, les implants texturés posent peut-être un risque plus élevé. Dans tous les cas, les cellules des LAGC ont été décelées dans la capsule fibreuse, le sérome ou une masse adjacente à l’implant. L’invasion des cellules ne dépassait pas la capsule fibreuse dans le parenchyme mammaire. D’après l’étude de la FDA, le risque de LAGC après des implants semble s’élever à environ un cas sur un million par année. Tous les cas semblent négatifs au marqueur de la kinase du lymphome anaplasique. Chez la plupart de ces patientes, les LAGC peuvent représenter une nouvelle entité moins agressive. Chez la plupart des patientes pour qui la maladie est confinée à la capsule fibreuse, l’extraction de l’implant et la capsulectomie peuvent représenter une bonne prise en charge. Les patientes présentant une masse distincte adjacente à l’implant peuvent présenter une évolution clinique plus agressive qui peut devenir systémique. Elles peuvent avoir besoin d’une chimiothérapie en plus de l’extraction de l’implant et de la capsulectomie. Tous les cas de LAGC devraient être orientés vers un spécialiste pertinent et déclarés à la FDA.

Keywords: ALCL; Anaplastic large cell lymphoma; Breast implant.

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Figures

Figure 1)
Figure 1)
Hematoxylin and eosin stain of a Hodgkin lymphoma showing homogeneous lymphocytes with a diagnostic Reed-Sternberg ‘popcorn cell’ with a ‘motheaten’ appearance in the lower left corner of the field (original magnification ×200). Adapted from reference 1
Figure 2)
Figure 2)
Hematoxylin and eosin stain of an anaplastic large cell lymphoma showing large cells with pleomorphic nuclei, abundant cytoplasm, kidney-shaped nuclei and a paranuclear eosinophilic region (original magnification ×200). Adapted from reference 2
Figure 3)
Figure 3)
Diagrammatic representation of anaplastic large cell lymphoma cells in the seroma and within the fibrous capsule surrounding a breast implant. Invasion of lymphoma beyond the fibrous capsule into breast parenchyma has not been observed. Adapted from reference 7
Figure 4)
Figure 4)
Hematoxylin and eosin stain showing anaplastic large cell lymphoma cells within the capsule around a breast implant (original magnification ×200) Adapted from reference 2
See this image and copyright information in PMC

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