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Anaplastic Large Cell Lymphoma Occurring in Women with Breast Implants: Analysis of 173 Cases

Brody, Garry S. M.D., M.Sc.; Deapen, Dennis Dr.Ph.; Taylor, Clive R. M.D., D.Phil.; Pinter-Brown, Lauren M.D.; House-Lightner, Sarah Rose B.A.; Andersen, James S. M.D.; Carlson, Grant M.D.; Lechner, Melissa G. Ph.D.; Epstein, Alan L. M.D., Ph.D.

Plastic & Reconstructive Surgery: March 2015 - Volume 135 - Issue 3 - p 695–705
doi: 10.1097/PRS.0000000000001033
Breast: Special Topics
Discussion
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Background: The first silicone breast implant was inserted in 1962. In 1997, the first case of anaplastic large cell lymphoma (ALCL) in association with a silicone breast implant was reported. The authors reviewed 37 articles in the world literature reporting on 79 patients and collected another 94 unreported cases as of the date of submission.

Methods: The world literature was reviewed. Missing clinical and laboratory information was solicited from the authors and treating physicians. As several different specialties were involved, information was not in one place. Many (but not all) authors and treating physicians were responsive, resulting in incomplete data.

Results: ALCL lesions first presented as late peri-implant seromas, a mass attached to the capsule, tumor erosion through the skin, in a regional node, or discovered during revision surgery. The clinical course varied widely from a single positive cytology result followed by apparent spontaneous resolution, to disseminated treatment-resistant tumor and death. There was no preference for saline or silicone fill or for cosmetic or reconstructive indications. Where implant history was known, the patient had received at least one textured-surface device. Extracapsular dissemination occurred in 18 cases; nine of those were fatal. Histochemical markers were primarily CD-30+ and Alk-1. Other markers occurred at a lower frequency. Risk estimates ranged from one in 500,000 to one in 3 million women with implants.

Conclusion: Breast implant–associated ALCL is a novel manifestation of site- and material-specific lymphoma originating in a specific scar location, presenting a wide array of diverse characteristics and suggesting a multifactorial cause.

Los Angeles and Duarte, Calif.; Atlanta, Ga.; and Boston, Mass.

From the Division of Plastic Surgery, Departments of Epidemiology and Pathology, Keck School of Medicine at the University of Southern California; the Division of Oncology and Hematology, David Geffen School of Medicine at the University of California, Los Angeles; the Division of Plastic Surgery, Emory University School of Medicine; City of Hope Cancer Hospital.

Received for publication July 16, 2014; accepted August 28, 2014.

Disclosure: There was no personal funding for any of the authors other than to contract the services of Ms. House-Lightner from the Department of Preventive Medicine. Dr. Brody received no personal remuneration and was compensated only for travel expenses to meetings where he presented this work, including a five-city tour of Australia and New Zealand to inform the local plastic surgeons about ALCL at Allergan’s invitation. The tissue culture work by Dr. Epstein was supported by Mentor Corp. (Santa Barbara, Calif.), Allergan, Inc. (San Diego, Calif.), and Cancer Therapeutics Laboratories, Inc. (Los Angeles, Calif.), of which Dr. Epstein and Dr. Taylor are cofounders. None of the other authors has received any personal remuneration or has any conflict of interest.

This work was supported by THE PLASTIC SURGERY FOUNDATION.

Garry S. Brody, M.D., M.Sc., Division of Plastic Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo St., #415, Los Angeles, Calif. 90033, gsbmd@aol.com

©2015American Society of Plastic Surgeons