Seroma-associated primary anaplastic large-cell lymphoma adjacent to breast implants: An indolent T-cell lymphoproliferative disorder
Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA. Modern Pathology
(Impact Factor: 6.19).
05/2008; 21(4):455-63. DOI: 10.1038/modpathol.3801024
Non-Hodgkin lymphomas of the breast are rare, encompassing approximately 0.04-0.5% of all malignant breast tumors, and the vast majority are B-cell lymphomas. In contrast, lymphomas of T-cell phenotype have been rarely reported and some of these have been in close proximity to a breast implant. In our consultation practice, we have identified four patients with primary T-cell anaplastic large-cell lymphoma presenting adjacent to silicone or saline breast implants. All patients presented with seroma and neoplastic cells were identified in suspension in the serous fluid without solid tissue invasion. Three patients had no evidence of systemic disease (stage 1E), and one patient was not staged. The mean age of the patients was 46 years (range, 34-59 years). In all patients, the neoplastic cells had a T-cell phenotype, expressed CD30, cytotoxic granule-associated proteins, EMA and clusterin, and were anaplastic lymphoma kinase-1-negative. Clonal T-cell receptor gamma-chain gene rearrangements were identified in three patients. All patients underwent capsulectomy with removal of the implant. One patient subsequently received chemotherapy and radiation therapy, and another was treated with radiation alone. The third patient received no further therapy and the fourth patient has been recently diagnosed. After a mean time of 13 months (range, 9-20 months), all three patients with follow-up were alive and well without any recurrence or systemic disease. Although the follow-up time was relatively short, our series and other reported cases suggest that primary anaplastic large-cell lymphoma adjacent to breast implants is an indolent T-cell lymphoproliferative disorder.
Available from: Raphael Sinna
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ABSTRACT: There is a new concern about a possible association between anaplastic large cell lymphoma (ALCL) and breast implants. The purpose of this review was to identify and analyze all reported cases of ALCL occurring in patients with breast implants. Therefore, we reviewed all articles published concerning this subject between 1991 and 2011. We found 41 cases of ALCL. The mean age of the patients was 51 years old with an average of 108 months between the implantation and the diagnosis. Over 60 % of the reported cases were aesthetic augmentations. However, none of the published study managed to highlight a correlation between the prosthesis and this lymphoma. Therefore, we believe that for the moment, we can reassure our patients, but we must be aware of this association if a late seroma or a tumefaction occur on prosthesis. The surgical management seems to be essential for the diagnosis and the treatment, especially by the negative ALK and CD 30 expression of this lymphoma.
Available from: Judith A Ferry
- "As summarized by two recent studies, there have been 12 reported cases of ALCL arising as a primary breast neoplasm in association with prosthetic silicone or saline implants, ten of which were confirmed to be ALK-negative [16, 17]. In the majority of these cases (8/12, 67%) the presenting symptom was the formation of a peri-implant seroma; the remaining patients presented with a mass or ulceration [16–22]. "
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ABSTRACT: Breast involvement by lymphoma is uncommon and poses challenges in diagnosis. Lymphomas may clinically, radiologically, and morphologically mimic both benign and neoplastic conditions. We describe two cases of lymphoid malignancies predominantly involving the breast, both presenting diagnostic dilemmas. The first case, ALK-negative anaplastic large-cell lymphoma involving a seroma associated with a breast implant, is an emerging clinicopathologic entity. Anaplastic large-cell lymphoma has been identified in association with breast implants and seroma formation relatively recently. The second case, hairy cell leukemia involving the breast and ipsilateral axillary sentinel lymph node, is, to our knowledge, the first reported case of hairy cell leukemia involving the breast at the time of diagnosis. While a localized bone lesion was present at time of diagnosis, bone marrow involvement was relatively mild in comparison to that seen in the breast and lymph node. In the first case, lymphoma occurred in a clinical setting where malignancy was unsuspected, highlighting the importance of careful morphologic evaluation of paucicellular samples, as well as awareness of rare clinicopathologic entities, in avoiding a misdiagnosis of a benign inflammatory infiltrate. In the second case, the lymphoid neoplasm exhibited classic morphologic and immunophenotypic features, but presented at an unusual site of involvement. Knowledge of the patient's concurrent diagnosis of hairy cell leukemia involving the bone marrow and bone helped avoid a misdiagnosis of carcinoma rather than lymphoma.
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ABSTRACT: Der zunehmende Einsatz immunhistochemischer und molekularpathologischer Untersuchungen an lymphatischem Gewebe führt zu einer häufigeren Identifikation von „frühen“ Lymphoproliferationen. Diese weisen einige Merkmale maligner Lymphome auf, erfüllen jedoch klinisch und pathologisch nicht die für eine Lymphomdiagnose erforderlichen Kriterien. Neben den bereits länger bekannten prämalignen B-Zell-Neoplasien, wie der monoklonalen Gammopathie unklarer Signifikanz (MGUS) oder der monoklonalen B-Zell-Lymphozytose (MBL), wurden in den letzten Jahren In-situ-Lymphome, z. B. das follikuläre Lymphom in situ, beschrieben. Bei diesen lassen sich in morphologisch reaktivem lymphatischem Gewebe minimale, oft in typischer Lokalisation situierte Infiltrate klonaler B-Zellen darstellen, die immunphänotypisch und molekulargenetisch lymphomtypische Merkmale zeigen. Über die Frühformen von B-Zell-Neoplasien hinaus behandelt diese Übersicht einzelne Entitäten indolenter klonaler Lymphoproliferationen, wie das follikuläre Lymphom vom pädriatischen Typ und das pädiatrische nodale Marginalzonenlymphom. Dargestellt werden die diagnostischen Kriterien für „frühe“ prämaligne Lymphoproliferationen und ihre Abgrenzung gegenüber partiellen Lymphominfiltraten. Nicht berücksichtigt werden in dieser Arbeit virusinduzierte Lymphoproliferationen, die eine Grauzone zwischen rein reaktiven und neoplastischen Prozessen darstellen.
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