LITERATURE UPDATE
method. Awareness of sample-specific diagnostic pitfalls greatly improves the sensitivity of BIA-ALCL testing by FC.
Breast Implant-Associated Anaplastic Large Cell Lymphoma: A Case Report about a Male Patient with Pectoral Implants
Riecke K, Steinhilper L, von Bülow C et al. Breast Care (Basel). 2024 Feb; 19 (1): 73–6. doi: 10.1159/000534367.
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is still a rare extralymphatic lymphoma. As of 1 March 2023, approximately 1355 cases of BIA-ALCL have been reported worldwide. However, no such case has yet been described with pectoral implants in male patients. Most patients with BIA- ALCL present with nonspecific implant- associated symptoms such as late-onset seroma, swollen breasts, and deformation of implants.
In this case study, the authors describe BIA-ALCL in a 76-year-old male patient who presented with a late-onset seroma in order to raise awareness for BIA-ALCL also in men after aesthetic chest surgery with silicone pectoral implants. The patient had undergone augmentation of the pectoralis muscle with implants for aesthetic reasons nine years before. First cytological specimens showed no malignancy. A repeated cytological assessment after six weeks from recurring seroma showed characteristic CD30+ T-cell clones. Surgery with complete bilateral capsulectomy and implant removal was performed. Due to the early-stage ALCL being limited only to the capsule and no evidence of systemic disease, adjuvant systemic treatment was not considered necessary. Any persisting late-onset seroma also in male patients with pectoral implants should raise suspicion of ALCL as A differential diagnosis and should be assessed with cytological examination.
Our Experience in Diagnosing and Treating Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA- ALCL)
Shoham G, Haran O, Singolda R et al. J Clin Med. 2024 Jan 9; 13 (2): 366. doi: 10.3390/jcm13020366.
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is an uncommon T-cell lymphoma detected in association with textured implants. It presents as a fluid accumulation around the implant, usually years after the implantation. In this study, the authors present their experience in diagnosing and treating
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four patients with BIA-ALCL, each widely differing from the other. Data on patients’ surgical history, relevant medical information, and findings on pathological slides were retrieved from their medical charts and retrospectively reviewed. Each of the four patients was diagnosed with BIA-ALCL, one after breast augmentation, one after breast reconstruction with an implant, one after breast reconstruction with a latissimus dorsi flap and implant, and the fourth after the removal of breast implants. The cases were presented to a multidisciplinary team and subsequently underwent surgery. All four are currently free of tumours, as established by a negative follow-up via positron emission tomography-computed tomography. Although the incidence of BIA-
ALCL is rare, these cases emphasise the need to rule out the diagnosis of BIA- ALCL in patients with textured implants or a history of implanted textured devices who present with symptoms such as late seroma or peri-implant mass. This pathology is typically indolent and slow- growing, and heightened awareness for an early diagnosis could lead to quicker intervention and enhanced patient management.
Flow Cytometry Analysis in Breast Implant-Associated Anaplastic Large Cell Lymphoma: Three Case Reports Davanzo V, Falda A, Fogar P et al. Int J Mol Sci. 2024 Mar 20; 25 (6): 3518. doi: 10.3390/ijms25063518.
Breast implant-associated-anaplastic large cell lymphoma (BIA-ALCL) is a rare T-cell non-Hodgkin lymphoma associated with breast prosthetic implants and represents a diagnostic challenge. The National Comprehensive Cancer Network (NCCN) guidelines, updated in 2024, recommend for diagnosis an integrated work-up that should include cell morphology, CD30 immunohistochemistry (IHC), and flow cytometry (FCM). CD30 IHC, although the test of choice for BIA-ALCL diagnosis, is not pathognomonic, and this supports the recommendation to apply a multidisciplinary approach. A close collaboration between pathologists and laboratory professionals allowed the diagnosis of three BIA- ALCLs, presented as case reports, within a series of 35 patients subjected to periprosthetic effusions aspiration from 2018 to 2023. In one case, rare neoplastic cells were identified by FCM, and this result was essential in leading the anatomopathological picture as indicative of this neoplasm.
In fact, the distinction between a
lymphomatous infiltrate from reactive cells may be very complex in the cytopathology and IHC setting when neoplastic cells are rare. On the other hand, one limitation of FCM analysis is the need for fresh samples. In this study, the authors provide evidence that a dedicated fixative allows the maintenance of an unaltered CD30 expression on the cell surface for up to 72 hours.
Systematic under-ascertainment of anaplastic large cell lymphoma cases in cancer registries: report from a comprehensive cancer center Kinslow CJ, Kim A, Rohde CH et al. Plast Reconstr Aesthet Surg. 2024 Aug; 95: 49–51. doi: 10.1016/
j.bjps.2024.05.058.
Breast implant-associated anaplastic large cell lymphoma (ALCL) has been rapidly rising in the US and around the world, leading to a mandated “black-box” label on all silicone- and saline-filled implants by the Food and Drug Administration (FDA). Because regulatory decisions in the US and around the world have been influenced primarily by risk estimates derived from cancer registries, it is important to determine their validity in identifying cases of ALCL. The authors reviewed all cases of ALCL submitted to the New York State Cancer Registry from a large comprehensive cancer center in New York City from 2007 to 2019. To determine the possibility of misdiagnosis or under-diagnosis of ALCL cases reported to cancer registries, we accessed the sensitivity and specificity of the ICD-O-3 codes 9714 (ALCL) and 9702 (Mature T-cell lymphoma, not otherwise specified [T-NOS]) to identify pathologically-proven ALCL. A total of 286,164 pathology reports
were reviewed from 47,466 unique patients with primary cancers. Twenty- eight cases of histologically-proven ALCL were identified. The sensitivity and specificity of the ICD-O-3 code 9714 (ALCL) were 82% and 100%, respectively. The sensitivity of the combined codes 9714/9702 (ALCL/T-NOS) was 96% and the specificity was 44%. Previous epidemiological studies that influenced regulatory decisions by the FDA may have systematically underestimated the risk of ALCL by at least 20%. The authors encourage updated global risk estimates of breast ALCL using methods that ensure adequate case ascertainment.
The Spectrum of Non-neoplastic Changes Associated With Breast Implants: Histopathology, Imaging, and Clinical Significance
OCTOBER 2024
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