Learning objectives
- To provide an overview of the clinical presentation,
imaging appearances of breast-implant associated anaplastic large T-cell lymphoma (BI-ALCL) at diagnosis;
- To illustrate a case-based review of this disease with pathology correlation;
- To give tips in terms of imaging for a prompt diagnosis and an adequate follow-up.
Background
Breast implant-associated anaplastic large cell lymphoma (BI-ALCL) is an extremely rare and distinct oncological entity arising within or around the prosthesis previously inserted post-mastectomy,
either to treat a carcinoma or after glandular augmentation.
It is a T-cell lymphoma composed of large and pleomorphic cells which uniformly express CD30 and are negative for anaplastic lymphoma kinase (ALK) or lack genetic abnormalities involving this enzyme at chromosome 2q23.
Aetiology remains unclear.
The neoplasm begins on the luminal surface of the fibrous capsule surrounding the prosthesis and exhibiting...
Findings and procedure details
At our oncological hospital,
7 women,
between 29 and 55 years old,
were referred with BI-ALCLbetween 2015 and 2017.
We retrospectively reviewed imaging and pathology of these cases to highlight pathognomonic features.
Furthermore,
type and texture ofimplant along with the onset of the lymphoproliferative disease after surgery were also assessed (table 2).
Hereafter our most explicative and/or challenging cases (1-7) are illustrated.
Conclusion
Breast implant-associated anaplastic large T-cell lymphoma is a rare disease,
relatively recently increasingly recognised,
not well known or understood by clinicians,
radiologists or most lymphoma specialists not having experience of this condition.
Establishing its diagnosis is often challenging.
It is crucial to identify the potential for this condition when a patient with breast implant presents with late onset seroma,
and for a breast radiologist to perform a diagnostic aspirate which is cytologically analysed for lymphoma cells.
BI-ALCL presenting with seroma only has a good prognosis,...
Personal information
Dr Erika Pace1
Dr Andrew Wotherspoon2
Dr Ayoma Attingalle2
Dr Sunil Iyenar3
DrBhupinder Sharma1
1: Department of Radiology
2: Department of Histopathology
3: Department of Haemato-Oncology
The Royal Marsden NHS Foundation Trust,
Fulham Rd,
SW3 6JJ London,
The United Kingdom
References
[1]NICE Haemato-oncology Quality Standards Guideline 2017
https://www.nice.org.uk/guidance/qs150/chapter/Quality-statements
[2] Miranda RN.
et al.
2014 Breast implant-associated anaplastic large cell lymphoma: long-term follow-up of 60 patients.J Clin Oncol. 32(2): 114-120
[3] Clemens MW.
et al.
2016 Complete surgical excision is essential for the management of patients with breast implant-associated associated anaplastic large cell lymphoma.J Clin Oncol 34: 160-168
[4] Clemens MW.
2017Discussion: breast implant-associated anaplastic large cell lymphoma in Australia and New Zeeland: high-surface-area textured implants are associated with increased risk.Plast Reconstr Surg. 140(4): 660-662
[5]Campanale A....