Silicone implants and lymphoma: The role of inflammation.
The risk of hematological malignancies is mainly determined by genetic background, age, sex, race and ethnicity, geographic location, exposure to certain chemicals and radiation; along with the more recently proposed immune factors such as chronic inflammation, immunodeficiencies, autoimmunity, and infections. Paradigmatic examples include the development of lymphoma in Sjögren's syndrome and Hashimoto thyroiditis, gastric MALT lymphoma in Helicobacter pylori infection, or lymphomas associated with infections by Epstein-Barr virus, human herpes virus 8 (HHV 8) and leukemia/lymphoma virus 1 (HTLV-1). A growing number of reports indicates an increased risk of lymphoma, particularly of the anaplastic large cell (ALCL) type. The implants, specifically those used in the past, elicit chronic stimulation of the immune system against the prosthetic material. This is particularly the case in genetically susceptible hosts. We suggest that polyclonal activation may result in monoclonality in those at risk hosts, ultimately leading to lymphoma. We suggest that patients with an inflammatory response against silicone implants be monitored carefully.
The Zabludowicz Center for Autoimmune Diseases, Chaim Sheba Medical Center, Tel-Hashomer, Israel.
Mojca
M
Bizjak
Rheumatology and Clinical Immunology, Humanitas Research Hospital, Milan, Italy; BIOMETRA Department, University of Milan, Milan, Italy.
Carlo
C
Selmi
Department of Rheumatology, University Medical Centre, Ljubljana, Slovenia.
Sonja
S
Praprotnik
The Zabludowicz Center for Autoimmune Diseases, Chaim Sheba Medical Center, Tel-Hashomer, Israel.
Or
O
Bruck
The Zabludowicz Center for Autoimmune Diseases, Chaim Sheba Medical Center, Tel-Hashomer, Israel; Rheumatology, Department of Medicine, Sapienza Univerisity of Rome, Rome, Italy.
Carlo
C
Perricone
The Zabludowicz Center for Autoimmune Diseases, Chaim Sheba Medical Center, Tel-Hashomer, Israel.
Michael
M
Ehrenfeld
The Zabludowicz Center for Autoimmune Diseases, Chaim Sheba Medical Center, Tel-Hashomer, Israel; Incumbent of the Laura Schwarz-kipp Chair for Research of Autoimmune Diseases, Sackler Faculty of Medicine, Tel-Aviv University, Israel. Electronic address: shoenfel@post.tau.ac.il.
Yehuda
Y
Shoenfeld
D015551:Autoimmunity; D018427:Breast Implants / Q000009:adverse effects; D001943:Breast Neoplasms / Q000534:rehabilitation* / Q000601:surgery; D017147:Defibrillators, Implantable / Q000009:adverse effects; D005260:Female; D015490:HTLV-I Infections / Q000150:complications; D050031:Hashimoto Disease / Q000150:complications; D016481:Helicobacter Infections / Q000150:complications; D006566:Herpesviridae Infections / Q000150:complications; D006801:Humans; D007249:Inflammation / Q000139:chemically induced* / Q000276:immunology; D018442:Lymphoma, B-Cell, Marginal Zone / Q000209:etiology; D017728:Lymphoma, Large-Cell, Anaplastic / Q000145:classification / Q000453:epidemiology* / Q000209:etiology*; D008228:Lymphoma, Non-Hodgkin / Q000150:complications; D008297:Male; D015917:Penile Prosthesis / Q000009:adverse effects; D019736:Prostheses and Implants / Q000009:adverse effects*; D011475:Prosthesis Failure / Q000009:adverse effects; D012306:Risk; D020034:Silicone Gels / Q000009:adverse effects*; D012859:Sjogren's Syndrome / Q000150:complications; D013274:Stomach Neoplasms / Q000150:complications
D020034:Silicone Gels
Adjuvant; Breast implant; Chronic immune system stimulation; Lymphoma; Sjögren's syndrome