title: Anaplastic large cell lymphoma associated with breast implants:  a report of 13 cases.
abstract: We report 13 cases of anaplastic large cell lymphoma (ALCL) associated with breast implants. Patient age ranged from 39 to 68 years, and the interval from implant to ALCL was 4 to 29 years. All tumors were composed of large, pleomorphic cells that were CD30 and ALK1, and all 7 cases assessed had monoclonal T-cell receptor γ-chain rearrangements. Two patient subgroups were identified. Ten patients presented with effusion surrounded by fibrous capsule without a grossly identifiable tumor mass. Nine patients had stage I and 1 had stage II disease. Eight patients underwent implant removal and capsulectomy. Four patients received chemotherapy and 4 radiation therapy. All patients were alive without disease at last follow-up. A second subgroup of 3 patients had effusion and a distinct mass adjacent to the implant. One patient had stage I and 2 stage II disease. One patient had a 3-year history of lymphomatoid papulosis, and 1 patient had a 1-year history of CD30 T-cell lymphoma adjacent to the breast before the diagnosis of ALCL associated with breast implant. Two patients received chemotherapy and 1 radiation therapy. Two patients died 2 and 12 years after diagnosis, respectively. We conclude that the clinical behavior of ALCL associated with breast implants is heterogeneous. Patients who present with effusion without a distinct mass have an indolent disease course, similar to CD30 lymphoproliferative disorder of skin. In contrast, patients who present with a distinct mass may have advanced stage or possibly systemic disease and have a poorer prognosis.
authors.affiliation: Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
authors.forename: Tariq N
authors.initials: TN
authors.lastname: Aladily
authors.forename: L Jeffrey
authors.initials: LJ
authors.lastname: Medeiros
authors.forename: Mitual B
authors.initials: MB
authors.lastname: Amin
authors.forename: Nisreen
authors.initials: N
authors.lastname: Haideri
authors.forename: Dongjiu
authors.initials: D
authors.lastname: Ye
authors.forename: Sergio J
authors.initials: SJ
authors.lastname: Azevedo
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Jorgensen
authors.forename: Mariza
authors.initials: M
authors.lastname: de Peralta-Venturina
authors.forename: Eid B
authors.initials: EB
authors.lastname: Mustafa
authors.forename: Ken H
authors.initials: KH
authors.lastname: Young
authors.forename: M James
authors.initials: MJ
authors.lastname: You
authors.forename: Luis E
authors.initials: LE
authors.lastname: Fayad
authors.forename: Ann Marie
authors.initials: AM
authors.lastname: Blenc
authors.forename: Roberto N
authors.initials: RN
authors.lastname: Miranda
mesh_terms: D030301:Activin Receptors, Type II / Q000032:analysis; D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000032:analysis / Q000235:genetics; D019928:Breast Implantation / Q000009:adverse effects* / Q000401:mortality; D018427:Breast Implants / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000737:chemistry / Q000209:etiology* / Q000235:genetics / Q000401:mortality / Q000473:pathology / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D020878:Device Removal; D005260:Female; D015334:Gene Rearrangement, gamma-Chain T-Cell Antigen Receptor; D019676:Genes, T-Cell Receptor delta; D006801:Humans; D017730:Ki-1 Antigen / Q000032:analysis; D017728:Lymphoma, Large-Cell, Anaplastic / Q000737:chemistry / Q000209:etiology* / Q000235:genetics / Q000401:mortality / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D009367:Neoplasm Staging; D018714:Radiotherapy, Adjuvant; D013781:Texas; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor; D017730:Ki-1 Antigen; C425364:ACVRL1 protein, human; D030301:Activin Receptors, Type II