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Anaplastic large-cell lymphoma associated with breast implants: a unique entity within the spectrum of peri-implant
Siaw Ming Chai1, Simon Kavangh, Sin Sin Ooi
1Department of Anatomical Pathology, PathWest Laboratory Medicine, QEII Medical Centre, Nedlands Western Australia, Australia.
Insights
Breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) is a rare complication. Diagnosis requires careful evaluation of peri-implant effusions using cytology and ancillary studies for early detection.
Area of Science:
- Oncology
- Pathology
- Immunology
Background:
- Anaplastic large-cell lymphoma (ALCL) is a rare complication associated with breast implants.
- Patients typically present with peri-implant effusions, which can be diagnosed via fine-needle aspiration.
- Proper laboratory handling and analysis of these effusions are critical for accurate diagnosis.
Purpose of the Study:
- To evaluate the cytological and ancillary study findings in breast implant-associated ALCL.
- To compare these findings with benign peri-implant effusions.
- To assess the diagnostic yield of effusion analysis for BIA-ALCL.
Main Methods:
- Retrospective review of peri-implant effusions from January 2003 to May 2013.
- Cytological evaluation of atypical lymphoid cells and 'hallmark' cells.
- Ancillary studies including immunohistochemistry (CD30, ALK1), flow cytometry, and T-cell receptor clonality.
- Correlation with clinical data, follow-up histology, and staging.
Main Results:
- Four cases of BIA-ALCL and six benign effusions were identified.
- ALCL cases showed highly atypical lymphoid cells with a CD30+, ALK1- immunophenotype.
- Benign effusions contained inflammatory cells (neutrophils or lymphocytes).
- T-cell receptor clonality confirmed aberrant T-cell immunophenotype in ALCL cases.
- ALCL was confirmed in subsequent capsulectomies in three of four cases.
- No lymphoma developed in patients with benign effusions during follow-up.
Conclusions:
- BIA-ALCL is a rare but significant finding in peri-implant effusions, accounting for 40% of such samples over a decade.
- Cytology and ancillary studies on effusion specimens are crucial for definitive diagnosis.
- Awareness of BIA-ALCL facilitates appropriate specimen triage and diagnosis, improving patient outcomes.
Abstract:
Anaplastic large-cell lymphoma (ALCL) is a rare and newly described complication associated with breast implants. Patients often present with a peri-implant effusion, which is amenable to fine-needle aspiration. The laboratory handling of peri-implant effusions for cytology and ancillary studies is as crucial as recognizing the characteristic cytology of ALCL. All cases of peri-implant effusions were retrieved from the PathWest database between January 2003 and May 2013, yielding four cases of breast implant-associated ALCL and six benign samples. The cytological features were evaluated and information from ancillary studies collated. Clinical and follow-up histology was available in all cases. All ALCL cases contained highly atypical lymphoid cells including 'hallmark' cells. In contrast, benign peri-implant effusions showed a mixture of inflammatory cells, being either neutrophil-rich (three cases) or lymphocyte-rich (three cases). A CD30 positive, ALK1 negative immunophenotype was demonstrated in all cases on cell block immunohistochemistry. Flow cytometry and T-cell receptor clonality studies confirmed aberrant T-cell immunophenotype in four of four and clonally rearranged T-cell receptor antigens in three of three cases. ALCL was identified in three of four subsequent capsulectomies. Staging confirmed disease limited to the capsular tissue or peri-implant effusion in all cases. None of the six patients with benign peri-implant effusions developed lymphoma during follow-up. Cases of ALCL accounted for 40% of peri-implant effusions received over a 10-year period, indicating the rarity of these samples and the high likelihood of malignancy. Awareness of this entity and its presentation should allow for appropriate triage of these specimens and definitive diagnosis on effusion specimens.
