title: Anaplastic large cell lymphoma (ALCL) and breast implants: breaking down the evidence.
abstract: Systemic anaplastic large cell lymphoma (ALCL) is a distinct disease classification provisionally sub-divided into ALCL, Anaplastic Lymphoma Kinase (ALK)(+) and ALCL, ALK(-) entities. More recently, another category of ALCL has been increasingly reported in the literature and is associated with the presence of breast implants. A comprehensive review of the 71 reported cases of breast implant associated ALCL (iALCL) is presented indicating the apparent risk factors and main characteristics of this rare cancer. The average patient is 50 years of age and most cases present in the capsule surrounding the implant as part of the periprosthetic fluid or the capsule itself on average at 10 years post-surgery suggesting that iALCL is a late complication. The absolute risk is low ranging from 1:500,000 to 1:3,000,000 patients with breast implants per year. The majority of cases are ALK-negative, yet are associated with silicone-coated implants suggestive of the mechanism of tumorigenesis which is discussed in relation to chronic inflammation, immunogenicity of the implants and sub-clinical infection. In particular, capsulotomy alone seems to be sufficient for the treatment of many cases suggesting the implants provide the biological stimulus whereas others require further treatment including chemo- and radiotherapy although reported cases remain too low to recommend a therapeutic approach. However, CD30-based therapeutics might be a future option.
authors.affiliation: Prince of Wales Hospital, Randwick, New South Wales, Australia. Electronic address: xuan.ye.888@gmail.com.
authors.forename: Xuan
authors.initials: X
authors.lastname: Ye
authors.affiliation: Mersey Regional Burns and Plastic Surgery Unit, Whiston Hospital, Liverpool L35 5DR, United Kingdom.
authors.forename: Kayvan
authors.initials: K
authors.lastname: Shokrollahi
authors.affiliation: Peter MacCallum Cancer Institute, Melbourne, Victoria, Australia.
authors.forename: Warren M
authors.initials: WM
authors.lastname: Rozen
authors.affiliation: Peter MacCallum Cancer Institute, Melbourne, Victoria, Australia.
authors.forename: Rachel
authors.initials: R
authors.lastname: Conyers
authors.affiliation: Department of Histopathology, Addenbrooke's Hospital, Cambridge, United Kingdom.
authors.forename: Penny
authors.initials: P
authors.lastname: Wright
authors.affiliation: Ludwig Boltzmann Institute for Cancer Research, Wahringerstrasse 13A, Vienna, Austria; Department of Laboratory Animal Pathology, University of Veterinary Medicine Vienna, 1210 Vienna, Austria; European Research Initiative for ALK-related Malignancies (ERIA)(2); Clinical Institute of Pathology, Medical University of Vienna, 1090 Vienna, Austria.
authors.forename: Lukas
authors.initials: L
authors.lastname: Kenner
authors.affiliation: Division of Molecular Histopathology, Department of Pathology, University of Cambridge, Lab Block Level 3, Box 231, Addenbrooke's Hospital, Cambridge CB20QQ, United Kingdom; European Research Initiative for ALK-related Malignancies (ERIA)(2). Electronic address: sdt36@cam.ac.uk.
authors.forename: Suzanne D
authors.initials: SD
authors.lastname: Turner
authors.affiliation: Institute of Life Science, Swansea University College of Medicine, Singleton Park, SA2 8PP Swansea, Wales, United Kingdom.
authors.forename: Iain S
authors.initials: IS
authors.lastname: Whitaker
mesh_terms: D000077548:Anaplastic Lymphoma Kinase; D000818:Animals; D019928:Breast Implantation / Q000009:adverse effects*; D005260:Female; D006801:Humans; D017728:Lymphoma, Large-Cell, Anaplastic / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D008875:Middle Aged; D020794:Receptor Protein-Tyrosine Kinases / Q000235:genetics*; D012307:Risk Factors; D020034:Silicone Gels / Q000009:adverse effects
chemical_list: D020034:Silicone Gels; C000626173:ALK protein, human; D000077548:Anaplastic Lymphoma Kinase; D020794:Receptor Protein-Tyrosine Kinases
keywords: Anaplastic large cell lymphoma; Anaplastic lymphoma kinase; Bioprostheses; Breast implants