Breast implant-associated anaplastic large cell lymphoma
Updates to Article Attributes
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare form of T-cell lymphoma which has primarily been associated with textured breast implants.
Epidemiology
Cases have been reported as early as 1 year after surgery and as late as 37 years postaugmentation mammoplasty ref. The average time to clinical presentation is reported to be approximately 10 years post breast augmentation ref.
Clinical presentation
Patients typically present with development of a late onset fluid collection surrounding the implant or less commonly after identification of a breast or axillary mass. Cases have been reported as early as 1 year after surgery and as late as 37 years post augmentation mammoplasty. The average time to clinical presentation is reported to be approximately 10 years post breast augmentation.
Pathology
Aetiology
The exact causative aetiology has not been confirmedremains unclear, however it is widely postulated that it is likelythought to be multifactorial in nature and, due to a combination of factors including chronic inflammation, implant texturingtexture and a subclinical infective pathology related to formation of a biofilm. The end result of the multiple insults is thought to causebe the malignant transformation of T-cells which arebecome anaplastic lymphoma kinase negative and CD30 positive.
Radiographic features
Ultrasound
Sonography typically demonstrates a fluid collection between the breast implant and the capsule. Septa; septa are often appreciated during the studyseen. Ultrasound is reported to have a sensitivity of 84% and specificity of 75% for detecting effusions and a sensitivity of 46% and specificity of 100% for detecting a BIA-ALCL mass3.
MRI
BIA-ALCL related effusions and masses may be appreciated on MRI. Capsular enhancement has also been reported in a small number of cases as has evidence of implant ruptureref.
One documented protocol for MR imaging in BIA-ALCL utilised the following sequences3ref:
- T1-weighted spin echo
- T2-weighted fat suppressed fast spin echo
-
Dynamicdynamic contrast enhanced T1-weighted 3D fat surpassed fast spoiled gradient echo at 2 minute intervals pre and post administration of intravenous gadopentetate dimeglumine. -
Delayeddelayed contrasted enhanced T1-weighted 3D fat-suppressed fast spoiled gradient echo
PET/CT
Lesions typically demonstrate fludeoxyglucosefluorodeoxyglucose (18F) avidity on positron emission tomography and the modality may be utilisedused to assess for systemic disease.
Treatment and prognosis
In the initial setting, ultrasound guided fine needle aspiration of the effusion surrounding the breast implant is undertaken. Cytology is subsequently used to assist with confirming the diagnosis. A finding of atypical cells with ≥10% expressing CD30 is said to favour a diagnosis of BIA-ALCL.
Multidisciplinary management including radiology, haematology, oncology, plastic surgery and or surgical oncology input forms the basis of management.
Management typically involves a complete en-bloc capsulectomy and explantation foexploration of the prosthesis with patients subsequently receiving some form of chemotherapy and or/or radiotherapy depending on the extent of disease.
Differential diagnosis
History
The first case of BIA-ALCL was reported in 1997 by Keech and Creech 6.
-<p><strong>Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL)</strong> is a rare form of T-cell <a href="/articles/lymphoma">lymphoma</a> which has primarily been associated with textured breast implants. </p><h4>Clinical presentation</h4><p>Patients typically present with development of a late onset fluid collection surrounding the implant or less commonly after identification of a breast or axillary mass. Cases have been reported as early as 1 year after surgery and as late as 37 years post augmentation mammoplasty. The average time to clinical presentation is reported to be approximately 10 years post breast augmentation. </p><h4>Pathology</h4><p>The exact causative aetiology has not been confirmed, however it is widely postulated that it is likely multifactorial in nature and due to a combination of factors including chronic inflammation, implant texturing and a subclinical infective pathology related to biofilm. The end result of the multiple insults is thought to cause malignant transformation of T-cells which are anaplastic lymphoma kinase negative and CD30 positive. </p><h4>Radiographic features</h4><h5>Ultrasound</h5><p>Sonography typically demonstrates a fluid collection between the breast implant and the capsule. Septa are often appreciated during the study. Ultrasound is reported to have a sensitivity of 84% and specificity of 75% for detecting effusions and a sensitivity of 46% and specificity of 100% for detecting a BIA-ALCL mass<a title="3" href="https://www.ncbi.nlm.nih.gov/pubmed/25073777"><sup>3</sup></a>. </p><h5>MRI</h5><p>BIA-ALCL related effusions and masses may be appreciated on MRI. Capsular enhancement has also been reported in a small number of cases as has evidence of implant rupture.</p><p>One documented protocol for MR imaging in BIA-ALCL utilised the following sequences<a href="https://www.ncbi.nlm.nih.gov/pubmed/25073777"><sup>3</sup></a>: </p><ul>- +<p><strong>Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL)</strong> is a rare form of T-cell <a href="/articles/lymphoma">lymphoma</a> which has primarily been associated with textured breast implants. </p><h4>Epidemiology</h4><p>Cases have been reported as early as 1 year after surgery and as late as 37 years postaugmentation mammoplasty <sup>ref</sup>. The average time to clinical presentation is reported to be approximately 10 years post breast augmentation <sup>ref</sup>.</p><h4>Clinical presentation</h4><p>Patients typically present with development of a late onset fluid collection surrounding the implant or less commonly after identification of a breast or axillary mass. </p><h4>Pathology</h4><h5>Aetiology</h5><p>The exact aetiology remains unclear, however it is widely thought to be multifactorial in nature, due to a combination of chronic inflammation, implant texture and a subclinical infective pathology related to formation of a biofilm. The end result is thought to be the malignant transformation of T-cells which become anaplastic lymphoma kinase negative and CD30 positive. </p><h4>Radiographic features</h4><h5>Ultrasound</h5><p>Sonography typically demonstrates a fluid collection between the breast implant and the capsule; septa are often seen. Ultrasound is reported to have a sensitivity of 84% and specificity of 75% for detecting effusions and a sensitivity of 46% and specificity of 100% for detecting a BIA-ALCL mass <sup>3</sup>. </p><h5>MRI</h5><p>BIA-ALCL related effusions and masses may be appreciated on MRI. Capsular enhancement has also been reported in a small number of cases as has evidence of implant rupture <sup>ref</sup>.</p><p>One documented protocol for MR imaging in BIA-ALCL utilised the following sequences <sup>ref</sup>: </p><ul>
-<li>Dynamic contrast enhanced T1-weighted 3D fat surpassed fast spoiled gradient echo at 2 minute intervals pre and post administration of intravenous gadopentetate dimeglumine. </li>-<li>Delayed contrasted enhanced T1-weighted 3D fat-suppressed fast spoiled gradient echo</li>-</ul><h5>PET/CT </h5><p>Lesions typically demonstrate fludeoxyglucose (<sup>18</sup>F) avidity on positron emission tomography and the modality may be utilised to assess for systemic disease. </p><h4>Treatment</h4><p>In the initial setting, ultrasound guided fine needle aspiration of the effusion surrounding the breast implant is undertaken. Cytology is subsequently used to assist with confirming the diagnosis. A finding of atypical cells with ≥10% expressing CD30 is said to favour a diagnosis of BIA-ALCL.</p><p>Multidisciplinary management including radiology, haematology, oncology, plastic surgery and or surgical oncology input forms the basis of management. </p><p>Management typically involves a complete en-bloc capsulectomy and explantation fo the prosthesis with patients subsequently receiving some form of chemotherapy and or radiotherapy depending on the extent of disease. </p><h4>Differential diagnosis</h4><ul>- +<li>dynamic contrast enhanced T1-weighted 3D fat surpassed fast spoiled gradient echo at 2 minute intervals pre and post administration of intravenous gadopentetate dimeglumine. </li>
- +<li>delayed contrasted enhanced T1-weighted 3D fat-suppressed fast spoiled gradient echo</li>
- +</ul><h5>PET/CT </h5><p>Lesions typically demonstrate fluorodeoxyglucose (<sup>18</sup>F) avidity on positron emission tomography and the modality may be used to assess for systemic disease. </p><h4>Treatment and prognosis</h4><p>In the initial setting, ultrasound guided fine needle aspiration of the effusion surrounding the breast implant is undertaken. Cytology is subsequently used to assist with confirming the diagnosis. A finding of atypical cells with ≥10% expressing CD30 is said to favour a diagnosis of BIA-ALCL.</p><p>Multidisciplinary management including radiology, haematology, oncology, plastic surgery and or surgical oncology input forms the basis of management. </p><p>Management typically involves a complete en-bloc capsulectomy and exploration of the prosthesis with patients subsequently receiving some form of chemotherapy and/or radiotherapy depending on the extent of disease. </p><h4>Differential diagnosis</h4><ul>
-<li><a href="/articles/breast-haematoma">liquified haematoma </a></li>- +<li><a href="/articles/breast-haematoma">liquefied haematoma </a></li>
-</ul><h4>History</h4><p>The first case of BIA-ALCL was reported in 1997 by Keech and Creech <sup>6</sup>.</p>- +</ul><h4>History</h4><p>The first case of BIA-ALCL was reported in 1997 by <strong>Keech </strong>and <strong>Creech </strong><sup>6</sup>.</p>
Systems changed:
- Breast
- Oncology