L Johnson1, J M O'Donoghue2, N McLean3, P Turton4, A A Khan5, S D Turner6, A Lennard2, N Collis2, M Butterworth7, G Gui8, J Bristol9, J Hurren10, S Smith11, K Grover12, G Spyrou13, K Krupa7, I A Azmy14, I E Young15, J J Staiano16, H Khalil17, F A MacNeill8. 1. St Bartholomews Hospital, West Wing, West Smithfield, London, EC1A 7BE, UK. Electronic address: laura.johnson@bartshealth.nhs.uk. 2. Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, NE7 7DN, UK. 3. Northumbria Healthcare NHS Foundation Trust, Northumberland, NE29 8NH, UK. 4. Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF, UK. 5. The Institute of Cancer Research, Fulham Road, London, SW3 6JB, UK. 6. Department of Pathology, University of Cambridge, Lab Block Level 3, Box 321, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK. 7. St John's Hospital, Lothian University Hospitals NHS Trust, West Lothian, EH54 6PP, UK. 8. The Royal Marsden Hospital, London, England, SW3 6JJ, UK. 9. Cheltenham General Hospital, Cheltenham, GL53 7AN, UK. 10. Portsmouth Hospitals NHS Trust, Portsmouth, PO6 3LY, UK. 11. Broomfield Hospital, Chelmsford, Essex CM1 7ET, UK. 12. Castle Hill Hospital, Hull and East Yorkshire Hospitals NHS Trust, Hull, HU3 2JZ, UK. 13. Pinderfields Hospital, Mid Yorks NHS Trust, Wakefield, WF1 4DG, UK. 14. Chesterfield Royal Hospital NHS Foundation Trust, Derbyshire, S44 5BL, UK. 15. Edinburgh Breast Unit & Queen Margaret Hospital, Dunfermline, KY12 0SU, UK. 16. Staiano Clinic, Edgbaston, Birmingham, B15 1HN, UK. 17. Heart of England NHS Foundation Trust, Good Hope Hospital, Sutton Coldfield, B75 7RR, UK.
Abstract
BACKGROUND: Breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) is a rare, Non-Hodgkin lymphoma arising in the capsule of breast implants. BIA-ALCL presents as a recurrent effusion and/or mass. Tumours exhibit CD30 expression and are negative for Anaplastic Lymphoma Kinase (ALK). We report the multi-disciplinary management of the UK series and how the stage of disease may be used to stratify treatment. METHODS: Between 2012 and 2016, 23 cases of BIA-ALCL were diagnosed in 15 regional centres throughout the UK. Data on breast implant surgeries, clinical features, treatment and follow-up were available for 18 patients. RESULTS: The mean lead-time from initial implant insertion to diagnosis was 10 years (range: 3-16). All cases were observed in patients with textured breast implants or expanders. Fifteen patients with breast implants presented with stage I disease (capsule confined), and were treated with implant removal and capsulectomy. One patient received adjuvant chest-wall radiotherapy. Three patients presented with extra-capsular masses (stage IIA). In addition to explantation, capsulectomy and excision of the mass, all patients received neo-/adjuvant chemotherapy with CHOP as first line. One patient progressed on CHOP but achieved pathological complete response (pCR) with Brentuximab Vedotin. After a mean follow-up of 23 months (range: 1-56) all patients reported here remain disease-free. DISCUSSION: BIA-ALCL is a rare neoplasm with a good prognosis. Our data support the recommendation that stage I disease be managed with surgery alone. Adjuvant chemotherapy may be required for more invasive disease and our experience has shown the efficacy of Brentuximab as a second line treatment.
BACKGROUND: Breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) is a rare, Non-Hodgkin lymphoma arising in the capsule of breast implants. BIA-ALCL presents as a recurrent effusion and/or mass. Tumours exhibit CD30 expression and are negative for Anaplastic Lymphoma Kinase (ALK). We report the multi-disciplinary management of the UK series and how the stage of disease may be used to stratify treatment. METHODS: Between 2012 and 2016, 23 cases of BIA-ALCL were diagnosed in 15 regional centres throughout the UK. Data on breast implant surgeries, clinical features, treatment and follow-up were available for 18 patients. RESULTS: The mean lead-time from initial implant insertion to diagnosis was 10 years (range: 3-16). All cases were observed in patients with textured breast implants or expanders. Fifteen patients with breast implants presented with stage I disease (capsule confined), and were treated with implant removal and capsulectomy. One patient received adjuvant chest-wall radiotherapy. Three patients presented with extra-capsular masses (stage IIA). In addition to explantation, capsulectomy and excision of the mass, all patients received neo-/adjuvant chemotherapy with CHOP as first line. One patient progressed on CHOP but achieved pathological complete response (pCR) with Brentuximab Vedotin. After a mean follow-up of 23 months (range: 1-56) all patients reported here remain disease-free. DISCUSSION: BIA-ALCL is a rare neoplasm with a good prognosis. Our data support the recommendation that stage I disease be managed with surgery alone. Adjuvant chemotherapy may be required for more invasive disease and our experience has shown the efficacy of Brentuximab as a second line treatment.
Authors: Tessa L St Cyr; Barbara A Pockaj; Donald W Northfelt; Fiona E Craig; Mark W Clemens; Raman C Mahabir Journal: Plast Surg (Oakv) Date: 2020-05-21 Impact factor: 0.947
Authors: Monia Orciani; Miriam Caffarini; Matteo Torresetti; Anna Campanati; Piercamillo Parodi; Giovanni Di Benedetto; Roberto Di Primio Journal: Inflammation Date: 2019-04 Impact factor: 4.092
Authors: Christopher S Parham; Summer E Hanson; Charles E Butler; M Bradley Calobrace; Raylene Hollrah; Terri Macgregor; Mark W Clemens Journal: Gland Surg Date: 2021-01
Authors: Julian Kricheldorff; Eva Maria Fallenberg; Christine Solbach; Claudia Gerber-Schäfer; Christoph Rancsó; Uwe von Fritschen Journal: Dtsch Arztebl Int Date: 2018-09-21 Impact factor: 5.594
Authors: Andrés E Quesada; L Jeffrey Medeiros; Mark W Clemens; Maria C Ferrufino-Schmidt; Sergio Pina-Oviedo; Roberto N Miranda Journal: Mod Pathol Date: 2018-09-11 Impact factor: 7.842