Revision 6 for 'Breast implant associated - anaplastic large cell lymphoma'

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Breast Implant Associated - Anaplastic Large Cell Lymphoma (BIA-ALCL)

Breast Implant Associated - Anaplastic Large Cell Lymphoma (BIA-ALCL) is a rare from of T-cell lymphoma which has primarily been associated with textured breast implants.  

Clinical presentation

Patients typically present with development of a late onset seroma 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

The exact causative etiology 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. The end result of the multiple insults malignant transformation of T-cells which are anaplastic lymphoma kinase negative and CD30 positive. 

Radiographic features

Ultrasound

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Mammography

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MRI

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Treatment and prognosis

Principles of management:

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Complications
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Differential diagnosis

  • Seroma 
  • Hematoma 

History

The first case of BIA-ALCL was reported by Keech and Creech in the Journal of Plastic & Reconstructive Surgery in 1997. No reports of BIA-ALCL have been identified in the medical literature prior to the arrival of textured breast implants in the 1990s. 

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