title: Anaplastic large cell lymphoma and breast implants: a systematic review.
abstract: BACKGROUND
  In recent years, there have been growing concerns about a possible association of non-Hodgkin's lymphoma--in particular, anaplastic large cell lymphoma (ALCL)--and breast implants. The purpose of this study was to identify and analyze all reported cases of non-Hodgkin's lymphoma occurring in patients with breast implants.
  
  
  METHODS
  The authors conducted a systematic literature review of reported cases of non-Hodgkin's lymphoma in patients with breast implants. Publications were identified with a search algorithm, forward searches, and expert nominations. After references were reviewed and assessed for inclusion or exclusion, case-based data were independently abstracted, reconciled, and adjudicated by multiple investigators. The data were then synthesized and analyzed.
  
  
  RESULTS
  Of 884 identified articles, only 83 were relevant to non-Hodgkin's lymphoma involving the breast, and 34 were included in our study. Thirty-six cases of non-Hodgkin's lymphoma in patients with implants were found, of which 29 (81 percent) were ALCLs. Although detailed clinical information was lacking in many cases, ALCL often involved the capsule and/or presented as an unexplained seroma or mass, was negative for anaplastic lymphoma kinase (ALK) expression, and had a relatively indolent clinical course when it developed adjacent to a breast implant.
  
  
  CONCLUSIONS
  A form of ALCL, which clinically behaves more like the less aggressive primary cutaneous form of ALK-negative ALCL rather than the more aggressive systemic form, may be associated with breast implants. Future research on the epidemiology and biology of this rare disease is clearly needed to better understand its nature.
authors.affiliation: Santa Monica and Los Angeles, Calif.; Boston, Mass.; St. Louis, Mo.; and Ann Arbor, Mich. From RAND Health and Pardee RAND Graduate School, RAND Corporation; the Division of Hematology-Oncology, Department of Medicine, David Geffen School of Medicine at UCLA; Body Aesthetic Research Center; and the Section of Plastic Surgery, Department of Surgery, University of Michigan Health System.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Kim
authors.forename: Carol
authors.initials: C
authors.lastname: Roth
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Chung
authors.forename: V Leroy
authors.initials: VL
authors.lastname: Young
authors.forename: Kristin
authors.initials: K
authors.lastname: van Busum
authors.forename: Christopher
authors.initials: C
authors.lastname: Schnyer
authors.forename: Soeren
authors.initials: S
authors.lastname: Mattke
mesh_terms: D018427:Breast Implants / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D017728:Lymphoma, Large-Cell, Anaplastic / Q000209:etiology* / Q000473:pathology / Q000601:surgery