LITERATURE UPDATE
Anaplastic large cell lymphoma: an association with breast implants
Although rare in occurrence, breast implant-associated anaplastic large-cell lymphoma recently found its way into the national news. Here, Pathology in Practice Science Editor Brian Nation compiles a selection of current research interest in this iatrogenic disease.
Breast Implant-Associated Anaplastic Large Cell Lymphoma: Where Hematology and Plastic Surgery Meet Joks MM, Czernikiewicz K, Mazurkiewicz Ł et al. Clin Lymphoma Myeloma Leuk. 2024 Sep; 24 (9): e293–e300. doi: 10.1016/
j.clml.2024.05.008.
Breast implant insertion for breast reconstruction or breast augmentation is a developing procedure, with high demand worldwide-being the second most common plastic surgery in the US as of 2022. Breast-implant-associated anaplastic large cell lymphoma (BIA- ALCL) is T-cell, non-Hodgkin lymphoma, typically CD30+, ALK–, presenting with fluid collection in the inner aspect of the peri-implant capsule in most patients, with the onset exceeding one-year after implantation. The mean time between breast implant insertion and BIA-ALCL development is seven to 10 years. The main risk factor is the use of
textured implants because of their susceptibility to triggering local inflammation and immune stimulation, finally leading to lymphoproliferation. Genetic predispositions to hereditary breast cancer increase the risk of disease development as well. BIA-ALCL seems to be underestimated in many countries and the initial symptom-seroma might be overlooked and misdiagnosed. Despite its rarity, the awareness of the disease should be improved among patients and medical professionals. This paper summarises epidemiology, aetiopathogenesis, differential diagnosis, and treatment – both surgical and haematological approaches.
Role of flow cytometric
immunophenotyping in the diagnosis of breast implant-associated anaplastic large cell lymphoma: A 6-year, single- institution experience Chan A, Auclair R, Gao Q et al. Cytometry
Histopathology of anaplastic large-cell lymphoma (haematoxylin and eosin [H&E] staining).
B Clin Cytom. 2024 Mar; 106 (2): 117–25. doi: 10.1002/cyto.b.22162.
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is an uncommon mature T-cell neoplasm occurring in patients with textured breast implants, typically after seven to 10 years of exposure. Although cytopathologic or histopathologic assessment is considered the gold standard diagnostic method for BIA-ALCL, flow cytometry (FC)-based munophenotyping is recommended as an adjunct test. However, the diagnostic efficacy of FC is not well reported. In this study, the authors reviewed 290 FC tests from breast implant pericapsular fluid and capsule tissue from 182 patients, including 16 patients with BIA-ALCL over a six-year period, calculating diagnostic rates and test efficacy. FC showed an overall sensitivity of 75.9%, specificity
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of 100%, and negative and positive predictive values of 95.4% and 100%, respectively. Blinded expert review of false-negative cases identified diagnostic pitfalls, improving sensitivity to 96.6%. Fluid samples had better rates of adequate samples for FC testing compared with tissue samples. Paired with FC testing of operating room (OR)- acquired fluid samples, capsulectomy FC specimens added no diagnostic value in patients with concurrent fluid samples; no cases had positive capsule FC with negative fluid FC. Fluid samples are adequate for FC testing more often than tissue. Capsule tissue FC specimens do not improve FC efficacy when paired with OR-acquired fluid FC samples and are often inadequate samples.
Flow cytometry is 100% specific for BIA-ALCL and can serve as a confirmatory test but should not be the sole diagnostic
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