Aesthetic Surgery Journal http://aes.sagepub.com/
Breast Implant−Associated Anaplastic Large Cell Lymphoma: Report of 2 Cases and Review of the Literature Alexandra M. Hart, Mary Jo Lechowicz, Kendall K. Peters, Jeannine Holden and Grant W. Carlson Aesthetic Surgery Journal 2014 34: 884 originally published online 17 June 2014 DOI: 10.1177/1090820X14539503 The online version of this article can be found at: http://aes.sagepub.com/content/34/6/884
Published by: http://www.sagepublications.com
On behalf of:
American Society for Aesthetic Plastic Surgery
Additional services and information for Aesthetic Surgery Journal can be found at: Email Alerts: http://aes.sagepub.com/cgi/alerts Subscriptions: http://aes.sagepub.com/subscriptions Reprints: http://www.sagepub.com/journalsReprints.nav Permissions: http://www.sagepub.com/journalsPermissions.nav
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539503 research-article2014
AESXXX10.1177/1090820X14539503Aesthetic Surgery JournalHart et al
Breast Surgery Case Report
Breast Implant–Associated Anaplastic Large Cell Lymphoma: Report of 2 Cases and Review of the Literature
Aesthetic Surgery Journal 2014, Vol. 34(6) 884–894 © 2014 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: http://www. sagepub.com/ journalsPermissions.nav DOI: 10.1177/1090820X14539503 www.aestheticsurgeryjournal.com
Alexandra M. Hart, MD; Mary Jo Lechowicz, MD; Kendall K. Peters, MD, FACS; Jeannine Holden, MD; and Grant W. Carlson, MD, FACS
Abstract Although primary breast lymphomas are exceedingly rare, cases of breast implant–associated anaplastic large cell lymphoma (iALCL) continue to be reported. The authors describe their experience with 2 patients and review the literature. Both patients presented with periprosthetic fluid collection. Neither had evidence of systemic disease nor received systemic therapy. Both were disease free after bilateral capsulectomies and implant removal without implant replacement, and disease did not recur. During the literature review, 63 cases of iALCL (including our 2 patients) were identified. The median time from implant placement to diagnosis was 9 years. Both saline and silicone implants were associated with iALCL. Of the 26 cases for which implant surface was reported, the surface was textured in 24. Of the 58 patients with an identifiable presentation, 39 had periprosthetic fluid collection, including 7 with an associated mass; 13 had an isolated mass at presentation, including 1 with axillary adenopathy. Forty patients had capsulectomy, 7 of whom underwent implant replacement. Of the 44 patients with known treatment, 33 received chemotherapy and 23 received radiation. Of the 49 patients with known anaplastic large cell lymphoma, 15 had disease recurrence, and 4 patient deaths were reported. Of the 18 patients presenting with a mass, 11 had disease recurrence, including all 4 patients who died. This study represents the largest review of patients with iALCL described to date. Although most cases have an indolent clinical course, the variety of presentations defined as “seroma” vs “capsular involvement” emphasizes the importance of investigating a definitive method of diagnosis, management, and treatment of this disease. Level of Evidence: 5 Keywords breast augmentation, breast reconstruction, breast lymphoma, breast cancer, breast implant, anaplastic lymphoma Accepted for publication February 3, 2014. Breast implant–associated anaplastic large cell lymphoma (iALCL) was first described by Keech and Creech in 1997.1 Primary breast lymphoma is extremely rare, constituting only 0.04% to 0.5% of breast malignancies.2 The majority of nonimplant-associated primary breast lymphomas are of B-cell origin. Anaplastic large cell lymphoma (ALCL) is a type of T-cell lymphoma that composes
Breast Implant−Associated Anaplastic Large Cell Lymphoma: Report of 2 Cases and Review of the Literature Alexandra M. Hart, Mary Jo Lechowicz, Kendall K. Peters, Jeannine Holden and Grant W. Carlson Aesthetic Surgery Journal 2014 34: 884 originally published online 17 June 2014 DOI: 10.1177/1090820X14539503 The online version of this article can be found at: http://aes.sagepub.com/content/34/6/884
Published by: http://www.sagepublications.com
On behalf of:
American Society for Aesthetic Plastic Surgery
Additional services and information for Aesthetic Surgery Journal can be found at: Email Alerts: http://aes.sagepub.com/cgi/alerts Subscriptions: http://aes.sagepub.com/subscriptions Reprints: http://www.sagepub.com/journalsReprints.nav Permissions: http://www.sagepub.com/journalsPermissions.nav
>> Version of Record - Aug 1, 2014 OnlineFirst Version of Record - Jun 17, 2014 What is This?
Downloaded from aes.sagepub.com at MEMORIAL UNIV OF NEWFOUNDLAND on August 1, 2014
539503 research-article2014
AESXXX10.1177/1090820X14539503Aesthetic Surgery JournalHart et al
Breast Surgery Case Report
Breast Implant–Associated Anaplastic Large Cell Lymphoma: Report of 2 Cases and Review of the Literature
Aesthetic Surgery Journal 2014, Vol. 34(6) 884–894 © 2014 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: http://www. sagepub.com/ journalsPermissions.nav DOI: 10.1177/1090820X14539503 www.aestheticsurgeryjournal.com
Alexandra M. Hart, MD; Mary Jo Lechowicz, MD; Kendall K. Peters, MD, FACS; Jeannine Holden, MD; and Grant W. Carlson, MD, FACS
Abstract Although primary breast lymphomas are exceedingly rare, cases of breast implant–associated anaplastic large cell lymphoma (iALCL) continue to be reported. The authors describe their experience with 2 patients and review the literature. Both patients presented with periprosthetic fluid collection. Neither had evidence of systemic disease nor received systemic therapy. Both were disease free after bilateral capsulectomies and implant removal without implant replacement, and disease did not recur. During the literature review, 63 cases of iALCL (including our 2 patients) were identified. The median time from implant placement to diagnosis was 9 years. Both saline and silicone implants were associated with iALCL. Of the 26 cases for which implant surface was reported, the surface was textured in 24. Of the 58 patients with an identifiable presentation, 39 had periprosthetic fluid collection, including 7 with an associated mass; 13 had an isolated mass at presentation, including 1 with axillary adenopathy. Forty patients had capsulectomy, 7 of whom underwent implant replacement. Of the 44 patients with known treatment, 33 received chemotherapy and 23 received radiation. Of the 49 patients with known anaplastic large cell lymphoma, 15 had disease recurrence, and 4 patient deaths were reported. Of the 18 patients presenting with a mass, 11 had disease recurrence, including all 4 patients who died. This study represents the largest review of patients with iALCL described to date. Although most cases have an indolent clinical course, the variety of presentations defined as “seroma” vs “capsular involvement” emphasizes the importance of investigating a definitive method of diagnosis, management, and treatment of this disease. Level of Evidence: 5 Keywords breast augmentation, breast reconstruction, breast lymphoma, breast cancer, breast implant, anaplastic lymphoma Accepted for publication February 3, 2014. Breast implant–associated anaplastic large cell lymphoma (iALCL) was first described by Keech and Creech in 1997.1 Primary breast lymphoma is extremely rare, constituting only 0.04% to 0.5% of breast malignancies.2 The majority of nonimplant-associated primary breast lymphomas are of B-cell origin. Anaplastic large cell lymphoma (ALCL) is a type of T-cell lymphoma that composes
