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Anaplastic Large Cell Lymphoma and Breast Implants? A Review of the Literature

Anaplastic Large Cell Lymphoma and Breast Implants? A Review of the Literature. G. Patrick Maxwell 1 , Joan Largent 2 , Michael G. Oefelein 2 1 Maxwell Aesthetics, Nashville, TN; 2 Allergan Inc., Irvine, CA Disclosures G. Patrick Maxwell is a Consultant for Allergan, Inc.

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Anaplastic Large Cell Lymphoma and Breast Implants? A Review of the Literature

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  1. Anaplastic Large Cell Lymphoma and Breast Implants? A Review of the Literature G. Patrick Maxwell1, Joan Largent2, Michael G. Oefelein2 1Maxwell Aesthetics, Nashville, TN; 2Allergan Inc., Irvine, CA Disclosures G. Patrick Maxwell is a Consultant for Allergan, Inc. Joan Largent and Michael G. Oefelein are Employees of Allergan, Inc.

  2. ABSTRACT Purpose:. We aimed to review the available evidence on Anaplastic Large Cell Lymphoma (ALCL) and breast implants (BI) including case reports and epidemiologic studies, and provide a critical evaluation. Methods: Search methods: i) Database=PubMed; ii) Search terms=”breast implant” and “lymphoma”, or “primary breast lymphoma” or “primary T-cell breast lymphoma” or “breast implant and ALCL”; iii) Inclusion criteria: language=English; human studies; iv) Expand search based on review of references. Results:ALCL is a rare, aggressive T-cell lymphoma characterized by the uniform expression of the CD30 antigen, with the majority of cases also positive for aplastic lymphoma kinase (ALK). ALCL can be either cutaneous or systemic. A review of the literature for reports of ALCL in breast implant recipients revealed a total of 15 published reports describing a total of 25 patients with ALCL in patients with silicone gel-filled or saline-filled breast implants (1 July 2010). Additional findings were: 1) Breast-ALCL has been reported in women with and without BI [5,6] and, 2) with and without a prior cancer history [18]. The only case-control study examining an association between ALCL and BI to date [6] included 6/11 ALK-negative ALCL cases with no history of BI . Nine of 25 (36%) ALCL cases reported among patients with BI had a personal history of breast cancer (N=8) or lymphoma (N=1) [18]. 3) Authors concluded ALCL in the anecdotal case reports behaves indolently, and spontaneous resolutions have been reported; however, most patients with ALCL received chemotherapy and/or radiotherapy [24]. 4) Device type in case reports is often unknown [18]; reports have included saline- and silicone-filled devices [18]. 5) Interval between implantation and ALCL diagnosis varies widely in the reports, between 1-23 years [6]. 6) Primary breast lymphomas may be difficult to definitively diagnose and distinguish from secondary involvement of disease originating elsewhere [8]. Five of 11 ALCL cases in the case-control study had disseminated disease with involvement of other sites providing uncertainty about the breast as the primary site [6]. 7) BI patients have been reported to have demographic and lifestyle characteristics which may influence their risk of certain cancers [3]; the relevance of these characteristics to ALCL risk is unknown. 8) While no prospective epidemiologic studies have examined ALCL risk among BI patients to date, several have reported no significantly increased NHL risk [19]. Conclusions: Overall, the evidence regarding a BI- ALCL association is inconclusive.

  3. OBJECTIVE We aimed to review the available evidence on Anaplastic Large Cell Lymphoma (ALCL) and breast implants (BI) including case reports and epidemiologic studies, and provide a critical evaluation.

  4. METHODS To identify cases of breast-associated ALCL, a PubMed search limited to English language, human studies was conducted using search terms ”breast implant” and “lymphoma”, “primary breast lymphoma” or “primary T-cell breast lymphoma” or “breast implant and ALCL”. Additional references of relevance were identified from the reference lists of retrieved publications.

  5. RESULTS Table 1: Summary of cases in the literature of anaplastic large T-cell lymphoma in patients with breast implants ALK, anaplastic lymphoma kinase; LN, lymph node; NA, not available

  6. Table 1 (Continued) ALK, anaplastic lymphoma kinase; LN, lymph node; NA, not available

  7. RESULTS Table 2: Summary of literature cases of anaplastic large T-cell lymphoma in patients with breast implants ALCL, anaplastic large T-cell lymphoma; NA, not available

  8. CONCLUSIONS The evidence to date regarding a causal association between breast implants and ALCL is inconclusive and deserves further rigorous scientific study to elucidate: 1) potential cause and effect; 2) proper disease classification; 3) Heterogeneous clinical course, 4) relevance of prior cancer and/or cancer treatment; 5) relevance of late seroma 6) extremely rare occurrence.

  9. REFERENCES • Alobeid, B, Sevilla, DW, El-Tamer, MB, et al. Aggressive presentation of breast implant-associated ALK-1 negative anaplastic large cell lymphoma with bilateral axillary lymph node involvement. Leuk Lymphoma 2009;50(5):831-833. • Bishara, MR, Ross, C, & Sur, M. Primary anaplastic large cell lymphoma of the breast arising in reconstruction mammoplasty capsule of saline filled breast implant after radical mastectomy for breast cancer: an unusual case presentation. Diagn Pathol 2009;4:11. • Brinton, L. A., J. H. Lubin, et al. (2000). "Breast cancer following augmentation mammoplasty (United States)." Cancer Causes Control11(9): 819-27. • Brisson, J, Holowaty, EJ, Villeneuve, PJ, et al. Cancer incidence in a cohort of Ontario and Quebec women having bilateral breast augmentation. Int J Cancer 6-1-2006;118(11):2854-2862. • Daneshbod, Y, Oryan, A, Khojasteh, HN, et al. Primary ALK-positive anaplastic large cell lymphoma of the breast: a case report and review of the literature. J Pediatr Hematol Oncol 2010;32(2):e75-e78. • de Jong, D, Vasmel, WL, de Boer, JP, et al. Anaplastic large-cell lymphoma in women with breast implants. JAMA 11-5-2008;300(17):2030-2035. • Deapen, DM, Hirsch, EM, & Brody, GS. Cancer risk among Los Angeles women with cosmetic breast implants. Plast Reconstr Surg 2007;119(7):1987-1992. • Domchek, S. M., J. L. Hecht, et al. (2002). "Lymphomas of the breast: primary and secondary involvement." Cancer94(1): 6-13. • Evens, AM & Chiu, BC. The challenges of epidemiologic research in non-Hodgkin lymphoma. JAMA 11-5-2008;300(17):2059-2061. • Farkash, EA, Ferry, JA, Harris, NL, et al. Rare lymphoid malignancies of the breast: a report of two cases illustrating potential diagnostic pitfalls. J Hematop 2009;2(4):237-244. • Fritzsche, FR, Pahl, S, Petersen, I, et al. Anaplastic large-cell non-Hodgkin's lymphoma of the breast in periprosthetic localisation 32 years after treatment for primary breast cancer--a case report. Virchows Arch 2006;449(5):561-564. • Gaudet, G, Friedberg, JW, Weng, A, et al. Breast lymphoma associated with breast implants: two case-reports and a review of the literature. Leuk Lymphoma 2002;43(1):115-119. • Gualco, G, Chioato, L, Harrington, WJ, Jr., et al. Primary and secondary T-cell lymphomas of the breast: clinico-pathologic features of 11 cases. Appl Immunohistochem Mol Morphol 2009;17(4):301-306. • Hanson, SE & Gutowski, KA. Primary T-cell lymphoma associated with breast implant capsule. Plast Reconstr Surg 2010;126(1):39e-41e.

  10. REFERENCES (cont.) • Keech, JA, Jr. & Creech, BJ. Anaplastic T-cell lymphoma in proximity to a saline-filled breast implant. PlastReconstrSurg 1997;100(2):554-555. • Kelten, C, Kabukcu, S, Sen, N, et al. Secondary involvement of the breast in T-cell non-Hodgkin lymphoma, an unusual example mimicking inflammatory breast carcinoma. Arch GynecolObstet 2009;280(1):149-152. • Kern, KA, Flannery, JT, & Kuehn, PG. Carcinogenic potential of silicone breast implants: a Connecticut statewide study. PlastReconstrSurg 1997;100(3):737-747. • Li, S & Lee, AK. Silicone implant and primary breast ALK1-negative anaplastic large cell lymphoma, fact or fiction? Int J Clin Exp Pathol 2010;3(1):117-127. • Lipworth, L, Tarone, RE, Friis, S, et al. Cancer among Scandinavian women with cosmetic breast implants: a pooled long-term follow-up study. Int J Cancer 1-15-2009;124(2):490-493. • Miranda, RN, Lin, L, Talwalkar, SS, et al. Anaplastic large cell lymphoma involving the breast: a clinicopathologic study of 6 cases and review of the literature. Arch Pathol Lab Med 2009;133(9):1383-1390. • Mora, P., A. C. Melo, et al. (2009). Primary T-Cell Anaplastic Lymphoma Associated To A Breast Implant. 14th Congress of the European Hematology Association, Berlin, Germany. • Newman, MK, Zemmel, NJ, Bandak, AZ, et al. Primary breast lymphoma in a patient with silicone breast implants: a case report and review of the literature. J PlastReconstrAesthetSurg 2008;61(7):822-825. • Olack, B, Gupta, R, & Brooks, GS. Anaplastic large cell lymphoma arising in a saline breast implant capsule after tissue expander breast reconstruction. Ann PlastSurg 2007;59(1):56-57. • Roden, AC, Macon, WR, Keeney, GL, et al. Seroma-associated primary anaplastic large-cell lymphoma adjacent to breast implants: an indolent T-cell lymphoproliferative disorder. Mod Pathol 2008;21(4):455-463. • Sahoo, S, Rosen, PP, Feddersen, RM, et al. Anaplastic large cell lymphoma arising in a silicone breast implant capsule: a case report and review of the literature. Arch Pathol Lab Med 2003;127(3):e115-e118. • Thompson, PA, Lade, S, Webster, H, et al. Effusion-associated anaplastic large cell lymphoma of the breast: time for it to be defined as a distinct clinico-pathological entity. Haematologica 8-26-2010. • van der Veldt, AA, Kleijn, SA, & Nanayakkara, PW. Silicone breast implants and anaplastic large T-cell lymphoma. JAMA 3-25-2009;301(12):1227-. • Wong, AK, Lopategui, J, Clancy, S, et al. Anaplastic large cell lymphoma associated with a breast implant capsule: a case report and review of the literature. Am J SurgPathol 2008;32(8):1265-1268

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