Breast Implant Capsule-Associated Anaplastic Large Cell Lymphoma (BIC-ALCL)
Carolyn Mies, Abha Goyal, Adam Bagg, Dale M Frank, Frederic G Barr, Aisner L Dara, Darshan B Roy, Shabnam Jaffer. Hospital of the University of Pennsylvania, Philadelphia, PA; Mount Sinai Medical Center, New York, NY
Background: The US-FDA recently issued preliminary findings of an analysis to assess a possible association between anaplastic large cell lymphoma (ALCL) and breast implants. The analysis was prompted by a small (∼30), but growing, number of cases of a rare form of lymphoma in women with breast implants, typically arising within the capsule and causing a clinically-evident peri-implant fluid accumulation. We describe 3 new cases of breast implant-associated anaplastic large cell lymphoma (BIC-ALCL) that highlight its characteristic clinical and pathologic features.
Design: We studied the histopathologic characteristics, molecular pathology and clinical course of 3 cases of BIC-ALCL.
Results: The patients were 46, 67 and 67 years old, respectively, and all had breast implant reconstruction following mastectomy for cancer. All 3 presented with peri-implant fluid accumulation occurring 5 to 13 years after reconstruction. Gross exam showed the affected peri-implant capsules were thickened. Microscopy showed non-cohesive, enlarged, atypical-appearing cells, some with reniform or horseshoe-shaped nuclei, in eosinophilic material adherent to the inner capsule surface; the atypical cells also infiltrated the inner capsule layers. In all 3 cases, the ALCL cells were ALK-negative and positive for CD30 and EMA; CD3 and CD4 were positive in 1 case each and both of these showed a monoclonally rearranged T-cell receptor γ-chain gene (TRG@). Flow cytometry analysis of peri-implant fluid from the third case detected a predominance of T cells, but molecular studies on the fluid did not detect a TRG@ gene rearrangement. All 3 had stage I lymphoma, confined to the breast. Two patients were treated with chemotherapy; one also had a stem cell transplant. All 3 are alive with neither breast cancer- nor lymphoma recurrence 36, 12 and 7 months after diagnosis of BIC-ALCL.
Conclusions: Breast implant exchange with capsule resection prompted by peri-implant fluid accumulation should be carefully examined for BIC-ALCL. Clues to diagnosis are the unusual clinical presentation, a thickened scar capsule and histologic sections showing an atypical cellular infiltrate. These findings should prompt appropriate immunohistochemical stains and molecular analysis, where feasible.
Monday, March 19, 2012 1:00 PM
Poster Session II # 51, Monday Afternoon