Review Article

Breast Implant–Associated Anaplastic Large Cell Lymphoma: What We Know

Nadia E. K. DePaola, MS, PA-C, and Heather Coggins, MS, PA-C

Memorial Sloan Kettering Cancer Center, New York, New York; and New York—Presbyterian Columbia University, New York, New York

Authors’ disclosures of conflicts of interest are found at the end of this article.

Nadia E. K. DePaola, MS, PA-C, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065. E-mail: kralovin@mskcc.org

ABSTRACT

Abstract

Breast implant–associated anaplastic large cell lymphoma (BIA-ALCL) is a rare peripheral T-cell lymphoma, first reported in 1997. It is pathologically confirmed as a CD30-positive, anaplastic lymphoma kinase (ALK)–negative ALCL by immunohistochemistry. Unlike systemic ALK-negative ALCL, breast implant–associated disease has a much more favorable prognosis overall. In most cases, BIA-ALCL will present with delayed seroma more than 1 year after breast implantation indicated for either cosmetic or reconstructive purposes. The average onset of seroma presentation is 8 to 9 years after implantation. Breast implant–associated anaplastic large cell lymphoma may arise in one of two distinct forms: either in situ or infiltrative disease. In situ disease is confined within a seroma, while infiltrative disease may present with lymph node involvement either with or without palpable breast mass or tumor. Infiltrative disease has an overall worse prognosis in regards to disease-related mortality, up to 40% within 2 years. Appropriate pathological consultation with an experienced hematopathologist and oncologist is imperative when making a diagnosis of BIA-ALCL. There are several theorized risk factors associated with the disease; however, the exact pathophysiology is not yet known. Our objective in writing this review article is to provide an overview of what we know about the epidemiology, disease characteristics, and current management strategies. In doing so, we aim to bring awareness and familiarity to the advanced practitioner population in recognizing and treating BIA-ALCL.

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