title: Breast implant-associated anaplastic large-cell lymphoma: long-term follow-up of 60 patients.
abstract: OBJECTIVE
  Breast implant-associated anaplastic large-cell lymphoma (ALCL) is a recently described clinicopathologic entity that usually presents as an effusion-associated fibrous capsule surrounding an implant. Less frequently, it presents as a mass. The natural history of this disease and long-term outcomes are unknown.
  
  
  METHODS
  We reviewed the literature for all published cases of breast implant-associated ALCL from 1997 to December 2012 and contacted corresponding authors to update clinical follow-up.
  
  
  RESULTS
  The median overall survival (OS) for 60 patients was 12 years (median follow-up, 2 years; range, 0-14 years). Capsulectomy and implant removal was performed on 56 of 60 patients (93%). Therapeutic data were available for 55 patients: 39 patients (78%) received systemic chemotherapy, and of the 16 patients (28%) who did not receive chemotherapy, 12 patients opted for watchful waiting and four patients received radiation therapy alone. Thirty-nine (93%) of 42 patients with disease confined by the fibrous capsule achieved complete remission, compared with complete remission in 13 (72%) of 18 patients with a tumor mass. Patients with a breast mass had worse OS and progression-free survival (PFS; P = .052 and P = .03, respectively). The OS or PFS were similar between patients who received and did not receive chemotherapy (P = .44 and P = .28, respectively).
  
  
  CONCLUSIONS
  Most patients with breast implant-associated ALCL who had disease confined within the fibrous capsule achieved complete remission. Proper management for these patients may be limited to capsulectomy and implant removal. Patients who present with a mass have a more aggressive clinical course that may be fatal, justifying cytotoxic chemotherapy in addition to removal of implants.
authors: Roberto N. Miranda, Rashmi Kanagal-Shamanna, Luis E. Fayad, Summer E. Hanson, John T. Manning Jr, Zijun Y. Xu-Monette, Patricia Fox, Roland L. Bassett, Ken H. Young, L. Jeffrey Medeiros, The University of Texas MD Anderson Cancer Center; Alonso R. Miranda, University of Houston, Houston; Eid Mustafa, Plastic and Reconstructive Surgery, Wichita Falls; Steven Sanchez, Pathology Associates of Tyler, Tyler, TX; Mitual B. Amin, Oakland University William Beaumont School of Medicine, Royal Oak, MI; Nisreen Haideri, Saint Lukes Cancer Institute, Kansas City, MO; Govind Bhagat, Columbia University Medical Center, New York Presbyterian Hospital and Herbert Irving Comprehensive Cancer Center, New York, NY; Glen S. Brooks, Tufts University, Longmeadow; Ephram P. Hochberg, Massachusetts General Hospital; Matthew J. Carty, Brigham & Women's Hospital, Boston, MA; David A. Shifrin, Advocate Medical Group Plastic Surgery, Oak Lawn, IL; Dennis P. O'Malley, Clarient Laboratories/GE Healthcare, Aliso Viejo, CA; Shiyong Li, Emory University Hospital, Atlanta, GA; John A. Keech Jr, MultiCare Regional Cancer Center, MultiCare Health Systems, Tacoma, WA; Jorge J. Castillo, The Warren Alpert Medical School of Brown University, The Miriam Hospital, Providence, RI; Dongjiu Ye, Bioreference Laboratories, Elmwood Park, NJ; Douglas Clark, New Mexico Cancer Center, Albuquerque, NM; Tariq N. Aladily, The University of Jordan, Amman, Jordan; H. Miles Prince, Chan Y. Cheah, Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, Australia; Daphne de Jong, Vrije Universiteit Medical Center; Jan Paul de Boer, the Netherlands Cancer Institute, Amsterdam, the Netherlands; Carlos E. Bacchi, Gabriela Gualco, Consultoria em Patologia, Botucatu, São Paulo, Brazil; Brady E. Beltran, Edgardo Rebagliati Martins Hospital, Lima, Peru; Zaher Chakhachiro, American University of Beirut Medical Center, Beirut, Lebanon.
authors: Roberto N
authors: RN
authors: Miranda
authors: Tariq N
authors: TN
authors: Aladily
authors: H Miles
authors: HM
authors: Prince
authors: Rashmi
authors: R
authors: Kanagal-Shamanna
authors: Daphne
authors: D
authors: de Jong
authors: Luis E
authors: LE
authors: Fayad
authors: Mitual B
authors: MB
authors: Amin
authors: Nisreen
authors: N
authors: Haideri
authors: Govind
authors: G
authors: Bhagat
authors: Glen S
authors: GS
authors: Brooks
authors: David A
authors: DA
authors: Shifrin
authors: Dennis P
authors: DP
authors: O'Malley
authors: Chan Y
authors: CY
authors: Cheah
authors: Carlos E
authors: CE
authors: Bacchi
authors: Gabriela
authors: G
authors: Gualco
authors: Shiyong
authors: S
authors: Li
authors: John A
authors: JA
authors: Keech
authors: Ephram P
authors: EP
authors: Hochberg
authors: Matthew J
authors: MJ
authors: Carty
authors: Summer E
authors: SE
authors: Hanson
authors: Eid
authors: E
authors: Mustafa
authors: Steven
authors: S
authors: Sanchez
authors: John T
authors: JT
authors: Manning
authors: Zijun Y
authors: ZY
authors: Xu-Monette
authors: Alonso R
authors: AR
authors: Miranda
authors: Patricia
authors: P
authors: Fox
authors: Roland L
authors: RL
authors: Bassett
authors: Jorge J
authors: JJ
authors: Castillo
authors: Brady E
authors: BE
authors: Beltran
authors: Jan Paul
authors: JP
authors: de Boer
authors: Zaher
authors: Z
authors: Chakhachiro
authors: Dongjiu
authors: D
authors: Ye
authors: Douglas
authors: D
authors: Clark
authors: Ken H
authors: KH
authors: Young
authors: L Jeffrey
authors: LJ
authors: Medeiros
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001940:Breast / Q000187:drug effects / Q000473:pathology / Q000601:surgery; D018427:Breast Implants / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D020878:Device Removal / Q000706:statistics & numerical data; D018572:Disease-Free Survival; D004358:Drug Therapy / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017728:Lymphoma, Large-Cell, Anaplastic / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D008875:Middle Aged; D013997:Time Factors; D057832:Watchful Waiting / Q000706:statistics & numerical data