by Kadin, Marshall E.; Adams, William P. Jr.; Inghirami,
Giorgio; Di Napoli, Arianna
Plastic and
Reconstructive Surgery: January 2020
- Volume 145 - Issue 1 - p 30e-38e
Summary: Breast
implant-associated anaplastic large cell lymphoma (BIA-ALCL) has been included
as a provisional entity in the revised version of the World Health Organization
Classification of Tumors of Haematopoietic and Lymphoid Tissue. To increase
opportunities to intervene with early diagnosis, treatment, and possible
prevention, it is important to consider that BIA-ALCL may evolve from a
preexisting lymphoproliferative disorder characterized by (1) an indolent
localized (in situ) disease in approximately 80 percent of reported cases; (2)
a requirement for external cytokine stimulation for cell survival; (3) CD30+
cells in some clinically benign seromas/capsules; (4) undetected T-cell
clonality in some cases; (5) JAK/STAT mutations in only a minority of cases;
and (6) cure by capsulectomy and implant removal in most cases. BIA-ALCL
resembles CD30+ cutaneous lymphoproliferative disorder: ALK−, CD30+ anaplastic
cells with an aberrant T-cell phenotype; overexpression of oncogenes (JUNB,
SATB1, pSTAT3, SOCS3) in lymphomatoid papulosis; frequent apoptosis; complete
spontaneous regression in lymphomatoid papulosis; and partial spontaneous
regression in cutaneous ALCL. Unlike CD30+ cutaneous lymphoproliferative
disorder, BIA-ALCL cannot be readily observed over time to study the different
steps in progression to ALCL. BIA-ALCL also shares features of lymphomas of
mucosa-associated lymphoid tissue, which are clinically indolent, initially
localized, antigen driven, and caused by Gram-negative bacteria. Further studies
of cytokines, clonality, mutations, and other biomarkers are needed to identify
possible premalignant steps in the evolution of benign late seromas to
BIA-ALCL.
