title: Anaplastic large cell lymphoma occurring in women with breast implants: analysis of 173 cases.
abstract: BACKGROUND
  The first silicone breast implant was inserted in 1962. In 1997, the first case of anaplastic large cell lymphoma (ALCL) in association with a silicone breast implant was reported. The authors reviewed 37 articles in the world literature reporting on 79 patients and collected another 94 unreported cases as of the date of submission.
  
  
  METHODS
  The world literature was reviewed. Missing clinical and laboratory information was solicited from the authors and treating physicians. As several different specialties were involved, information was not in one place. Many (but not all) authors and treating physicians were responsive, resulting in incomplete data.
  
  
  RESULTS
  ALCL lesions first presented as late peri-implant seromas, a mass attached to the capsule, tumor erosion through the skin, in a regional node, or discovered during revision surgery. The clinical course varied widely from a single positive cytology result followed by apparent spontaneous resolution, to disseminated treatment-resistant tumor and death. There was no preference for saline or silicone fill or for cosmetic or reconstructive indications. Where implant history was known, the patient had received at least one textured-surface device. Extracapsular dissemination occurred in 18 cases; nine of those were fatal. Histochemical markers were primarily CD-30 and Alk-1. Other markers occurred at a lower frequency. Risk estimates ranged from one in 500,000 to one in 3 million women with implants.
  
  
  CONCLUSIONS
  Breast implant-associated ALCL is a novel manifestation of site- and material-specific lymphoma originating in a specific scar location, presenting a wide array of diverse characteristics and suggesting a multifactorial cause.
authors.affiliation: Los Angeles and Duarte, Calif.; Atlanta, Ga.; and Boston, Mass. From the Division of Plastic Surgery, Departments of Epidemiology and Pathology, Keck School of Medicine at the University of Southern California; the Division of Oncology and Hematology, David Geffen School of Medicine at the University of California, Los Angeles; the Division of Plastic Surgery, Emory University School of Medicine; City of Hope Cancer Hospital.
authors.forename: Garry S
authors.initials: GS
authors.lastname: Brody
authors.forename: Dennis
authors.initials: D
authors.lastname: Deapen
authors.forename: Clive R
authors.initials: CR
authors.lastname: Taylor
authors.forename: Lauren
authors.initials: L
authors.lastname: Pinter-Brown
authors.forename: Sarah Rose
authors.initials: SR
authors.lastname: House-Lightner
authors.forename: James S
authors.initials: JS
authors.lastname: Andersen
authors.forename: Grant
authors.initials: G
authors.lastname: Carlson
authors.forename: Melissa G
authors.initials: MG
authors.lastname: Lechner
authors.forename: Alan L
authors.initials: AL
authors.lastname: Epstein
mesh_terms: D018427:Breast Implants / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D005260:Female; D014943:Global Health; D006801:Humans; D015994:Incidence; D017728:Lymphoma, Large-Cell, Anaplastic / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D011183:Postoperative Complications; D012307:Risk Factors