Dr. Jie Xu
The Unviersity of Texas MD Anderson Cancer Center Houston, TX 77030, USA
Title: Breast implant-associated anaplastic large cell lymphoma
Biography
Biography: Dr. Jie Xu
Abstract
Breast implant–associated ALCL is a new provisional entity in the WHO Classification of Tumor of Hematopoietic and Lymphoid Tissues (Revised 4th edition, 2017). It is not a disease of the breast parenchyma, but instead is a disease of the fibrous capsule surrounding the implant. The patients usually present with an effusion around the implant and, rarely, with a solid mass. Morphologically, the neoplastic cells are large, epithelioid, and pleomorphic, with abundant cytoplasm, vesicular irregular nuclei, and frequent mitoses. The lesional cells typically show strong and diffuse immunoreactivity for CD30 and often express T-cell markers, cytotoxic-associated antigens, and epithelial membrane antigen. Almost all reported cases are negative for anaplastic lymphoma kinase. Molecular genetic analyses have demonstrated T-cell receptor gene rearrangements. The differential diagnosis essentially includes poorly differentiated carcinoma, other lymphomas, and chronic inflammation. Once a diagnosis of lymphoma is established, it is important to exclude systemic anaplastic lymphoma kinase–negative ALCL involving the breast, primary cutaneous ALCL, and other CD30+ lymphoproliferative disorders. The patients with effusion-associated ALCL often have an indolent course and excellent prognosis, responding well to excision of the fibrous capsule around the implant (capsulectomy) and implant removal; the addition of chemotherapy does not appear to affect outcomes. In contrast, patients who present with a distinct mass may have a more aggressive course and poor prognosis, requiring chemotherapy and/or radiation therapy.
Reference:
- Xu J and Wei S. Arch Pathol Lab Med. 2014 Jun;138(6):842-6.
- Feldman AL, Harris NL, Stein H, et al. WHO classification of Tumors of Hematopoietic and Lymphoid Tissues. IARC: Lyon 2017; p421-422.