HAEM4:Breast Implant-Associated Anaplastic Large Cell Lymphoma

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Primary Author(s)*

Derick Okwan-Duodu, MD, PhD; Sumire Kitahara, MD

Cedars-Sinai Medical Center

Cancer Category/Type

Cancer Sub-Classification / Subtype

Definition / Description of Disease

  • Provisional entity in WHO 2016 classification
  • Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare T-cell lymphoproliferative disorder that occurs in patients with breast implants.
  • Belongs to the so-called triple negative category of systemic anaplastic large cell lymphomas (sALCL)[1]

Synonyms / Terminology

  • Seroma-associated anaplastic large cell lymphoma

Epidemiology / Prevalence

  • Rare (fewer than 1 in 100,000 with implants)[2]
  • No association with type of implant (silicone vs. saline, textured vs. smooth)[2]
  • Median time to lymphoma diagnosis after implant is 8-9 years[2]
  • Mean age 50[2]

Clinical Features

  • Pain, swelling around implant[3]
  • Peri-implant effusion most common (approximately 80% cases)[3]
  • Axillary lymphadenopathy[3]
  • Extracapsular extension to form a solid mass of tumor cells possible[3]

Sites of Involvement

  • Peri-implant (Stage I)
  • Extracapsular dissemination not uncommon

Morphologic Features

Immunophenotype

Finding[1][6] Marker
Positive (universal) CD30
Positive (frequent) Varying pan T-cell antigen expression (CD3, CD2, CD5, CD7, CD4, CD8), MUM1
Negative (universal) ALK

Chromosomal Rearrangements (Gene Fusions)

  • Not described

Characteristic Chromosomal Aberrations / Patterns

  • N/A

Genomic Gain/Loss/LOH

  • N/A

Gene Mutations (SNV/INDEL)

  • JAK1 and STAT3 mutation (variable pattern leads to activation)[7][8]


PUT IN THE TABLE FROM THE TEMPLATE, SO THE FREQUENCY OF THESE MUTATIONS AND THEIR SIGNIFICANCE CAN BE ENTERED.

Epigenomics (Methylation)

  • Not described

Genes and Main Pathways Involved

Diagnostic Testing Methods

  • Morphologic and immunohistochemical evaluation of aspirated seroma/effusion fluid and/or capsulectomy specimen
  • Exclude secondary involvement by systemic ALK(-) ALCL

Clinical Significance (Diagnosis, Prognosis and Therapeutic Implications)[10][11][4]

THIS SECTION IS REALLY FOR THE DIAGNOSTIC, PROGNOSTIC, AND THERAPEUTIC SIGNIFICANCE OF THE MOLECULAR CHANGES FOUND IN THIS ENTITY. YOU CAN KEEP THE WORK YOU HAVE DONE BUT PERHAPS MOVE IT TO "OTHER INFORMATION" SECTION?

  • Diagnosis
    • Clinical history (skin rash, ulcer or skin mass > 1 year after breast implant),
    • Ultrasound or MRI
    • Fine needle aspiration or tissue biopsy for morphologic and immunophenotypic analysis
    • For disseminated disease, clinical history of breast implants and negative DUSP22 and TP63 FISH studies strongly supports diagnosis and makes other sALCL's unlikely
  • Prognosis
    • Excellent prognosis (median survival over 12 years)
    • If extracapsular extension present, systemic therapy may be indicated
  • Therapeutic Implications
    • Focal disease: capsulectomy and implant removal followed by radiotherapy or watchful waiting
    • Disseminated disease: systemic therapy
    • Anthracyclin-based chemotherapy with brentuximab-vedotin superior to chemotherapy alone[12]

Familial Forms

  • None

Other Information

  • None

Links

References

(use "Cite" icon at top of page)

  1. ↑ 1.0 1.1 1.2 1.3 N, Oishi; et al. (2018). "Genetic subtyping of breast implant-associated anaplastic large cell lymphoma". doi:10.1182/blood-2017-12-821868. PMC 6073323. PMID 29921615.CS1 maint: PMC format (link)
  2. ↑ 2.0 2.1 2.2 2.3 Gs, Brody; et al. (2015). "Anaplastic large cell lymphoma occurring in women with breast implants: analysis of 173 cases". PMID 25490535.
  3. ↑ 3.0 3.1 3.2 3.3 D, Lazzeri; et al. (2011). "ALK-1-negative anaplastic large cell lymphoma associated with breast implants: a new clinical entity". PMID 21729665.
  4. ↑ 4.0 4.1 4.2 Rn, Miranda; et al. (2014). "Breast implant-associated anaplastic large-cell lymphoma: long-term follow-up of 60 patients". doi:10.1200/JCO.2013.52.7911. PMC 4062709. PMID 24323027.CS1 maint: PMC format (link)
  5. ↑ 5.0 5.1 Sh, Swerdlow; et al. (2016). "The 2016 revision of the World Health Organization classification of lymphoid neoplasms". doi:10.1182/blood-2016-01-643569. PMC 4874220. PMID 26980727.CS1 maint: PMC format (link)
  6. ↑ Ae, Quesada; et al. (2019). "Breast implant-associated anaplastic large cell lymphoma: a review". PMID 30206414.
  7. ↑ P, Blombery; et al. (2016). "Whole exome sequencing reveals activating JAK1 and STAT3 mutations in breast implant-associated anaplastic large cell lymphoma anaplastic large cell lymphoma". doi:10.3324/haematol.2016.146118. PMC 5060038. PMID 27198716.CS1 maint: PMC format (link)
  8. ↑ A, Di Napoli; et al. (2018). "Targeted next generation sequencing of breast implant-associated anaplastic large cell lymphoma reveals mutations in JAK/STAT signalling pathway genes, TP53 and DNMT3A". PMID 27859003.
  9. ↑ 9.0 9.1 Kim, Won Seog (2017-11-30). "Faculty Opinions recommendation of Breast implant-associated anaplastic large cell lymphoma: two distinct clinicopathological variants with different outcomes".
  10. ↑ Mw, Clemens; et al. (2019). "2019 NCCN Consensus Guidelines on the Diagnosis and Treatment of Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL)". PMID 30715173.
  11. ↑ Mc, Ferrufino-Schmidt; et al. (2018). "Clinicopathologic Features and Prognostic Impact of Lymph Node Involvement in Patients With Breast Implant-associated Anaplastic Large Cell Lymphoma". PMID 29194092.
  12. ↑ L, Johnson; et al. (2017). "Breast implant associated anaplastic large cell lymphoma: The UK experience. Recommendations on its management and implications for informed consent". PMID 28596034.

Notes

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