A proposal for pathologic processing of breast implant capsules in patients with suspected breast implant anaplastic large cell lymphoma

Kirill A. Lyapichev, Sergio Piña-Oviedo, L. Jeffrey Medeiros, Mark G. Evans, Hui Liu, Alonso R. Miranda, Kelly K. Hunt, Mark W. Clemens, John M. Stewart, Mitual B. Amin, Andres E. Quesada, Siaw Ming Chai, Arianna Di Napoli, Arthy Yoga, Sanat K. Dave, Ignacio I. Wistuba, Yun Wu, Carlos E. Bueso-Ramos, Ellen J. Schlette, Maria C. Ferrufino-SchmidtSanam Loghavi, Joseph D. Khoury, Ken H. Young, Roberto N. Miranda

Research output: Contribution to journalArticle

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Abstract

Breast implant anaplastic large cell lymphoma is an entity recently recognized by the World Health Organization. The tumor arises around textured-surface breast implants and is usually confined to the surrounding fibrous capsule. Currently, there are no recommendations for handling and sampling of capsules from patients with suspected breast implant anaplastic large cell lymphoma without a grossly identifiable tumor. We analyzed complete capsulectomies without distinct gross lesions from patients with breast implant anaplastic large cell lymphoma. The gross appearance of the capsules as well as the presence, extent and depth of tumor cells on the luminal side and number of sections involved by lymphoma were determined by review of routine stains and CD30 immunohistochemistry. We then used a mathematical model that included the extent of tumor cells and number of positive sections to calculate the minimum number of sections required to identify 95% of randomly distributed lesions. We identified 50 patients with breast implant anaplastic large cell lymphoma who had complete capsulectomies. The implants were textured in all 32 (100%) cases with available information. Anaplastic large cell lymphoma was found in 44/50 (88%) capsules; no tumor was found in six (12%) patients who had lymphoma cells only in the effusion. The median number of sections reviewed was 20 (range, 2–240), the median percentage of sections involved by tumor was 6% (range, 0–90%), and the median percentage of sections involved by lymphoma was 10% (range, 0–90%). Invasion deep into or through the capsule was identified in 18/50 (36%) patients. In patients with breast implant anaplastic large cell lymphoma without a grossly identifiable tumor we identified a spectrum of involvement and we propose a protocol for handling, sampling and reporting these cases. The number of sections to exclude the presence of lymphoma with more than 95% certainty was supported by a mathematic rationale.

Original languageEnglish (US)
JournalModern Pathology
DOIs
StatePublished - Jan 1 2019

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Anaplastic Large-Cell Lymphoma
Breast Implants
Capsules
Lymphoma
Neoplasms
Mathematics
Theoretical Models
Coloring Agents
Cell Count
Immunohistochemistry

ASJC Scopus subject areas

  • Pathology and Forensic Medicine

Cite this

A proposal for pathologic processing of breast implant capsules in patients with suspected breast implant anaplastic large cell lymphoma. / Lyapichev, Kirill A.; Piña-Oviedo, Sergio; Medeiros, L. Jeffrey; Evans, Mark G.; Liu, Hui; Miranda, Alonso R.; Hunt, Kelly K.; Clemens, Mark W.; Stewart, John M.; Amin, Mitual B.; Quesada, Andres E.; Chai, Siaw Ming; Di Napoli, Arianna; Yoga, Arthy; Dave, Sanat K.; Wistuba, Ignacio I.; Wu, Yun; Bueso-Ramos, Carlos E.; Schlette, Ellen J.; Ferrufino-Schmidt, Maria C.; Loghavi, Sanam; Khoury, Joseph D.; Young, Ken H.; Miranda, Roberto N.

In: Modern Pathology, 01.01.2019.

Research output: Contribution to journalArticle

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title = "A proposal for pathologic processing of breast implant capsules in patients with suspected breast implant anaplastic large cell lymphoma",
abstract = "Breast implant anaplastic large cell lymphoma is an entity recently recognized by the World Health Organization. The tumor arises around textured-surface breast implants and is usually confined to the surrounding fibrous capsule. Currently, there are no recommendations for handling and sampling of capsules from patients with suspected breast implant anaplastic large cell lymphoma without a grossly identifiable tumor. We analyzed complete capsulectomies without distinct gross lesions from patients with breast implant anaplastic large cell lymphoma. The gross appearance of the capsules as well as the presence, extent and depth of tumor cells on the luminal side and number of sections involved by lymphoma were determined by review of routine stains and CD30 immunohistochemistry. We then used a mathematical model that included the extent of tumor cells and number of positive sections to calculate the minimum number of sections required to identify 95{\%} of randomly distributed lesions. We identified 50 patients with breast implant anaplastic large cell lymphoma who had complete capsulectomies. The implants were textured in all 32 (100{\%}) cases with available information. Anaplastic large cell lymphoma was found in 44/50 (88{\%}) capsules; no tumor was found in six (12{\%}) patients who had lymphoma cells only in the effusion. The median number of sections reviewed was 20 (range, 2–240), the median percentage of sections involved by tumor was 6{\%} (range, 0–90{\%}), and the median percentage of sections involved by lymphoma was 10{\%} (range, 0–90{\%}). Invasion deep into or through the capsule was identified in 18/50 (36{\%}) patients. In patients with breast implant anaplastic large cell lymphoma without a grossly identifiable tumor we identified a spectrum of involvement and we propose a protocol for handling, sampling and reporting these cases. The number of sections to exclude the presence of lymphoma with more than 95{\%} certainty was supported by a mathematic rationale.",
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AU - Piña-Oviedo, Sergio

AU - Medeiros, L. Jeffrey

AU - Evans, Mark G.

AU - Liu, Hui

AU - Miranda, Alonso R.

AU - Hunt, Kelly K.

AU - Clemens, Mark W.

AU - Stewart, John M.

AU - Amin, Mitual B.

AU - Quesada, Andres E.

AU - Chai, Siaw Ming

AU - Di Napoli, Arianna

AU - Yoga, Arthy

AU - Dave, Sanat K.

AU - Wistuba, Ignacio I.

AU - Wu, Yun

AU - Bueso-Ramos, Carlos E.

AU - Schlette, Ellen J.

AU - Ferrufino-Schmidt, Maria C.

AU - Loghavi, Sanam

AU - Khoury, Joseph D.

AU - Young, Ken H.

AU - Miranda, Roberto N.

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N2 - Breast implant anaplastic large cell lymphoma is an entity recently recognized by the World Health Organization. The tumor arises around textured-surface breast implants and is usually confined to the surrounding fibrous capsule. Currently, there are no recommendations for handling and sampling of capsules from patients with suspected breast implant anaplastic large cell lymphoma without a grossly identifiable tumor. We analyzed complete capsulectomies without distinct gross lesions from patients with breast implant anaplastic large cell lymphoma. The gross appearance of the capsules as well as the presence, extent and depth of tumor cells on the luminal side and number of sections involved by lymphoma were determined by review of routine stains and CD30 immunohistochemistry. We then used a mathematical model that included the extent of tumor cells and number of positive sections to calculate the minimum number of sections required to identify 95% of randomly distributed lesions. We identified 50 patients with breast implant anaplastic large cell lymphoma who had complete capsulectomies. The implants were textured in all 32 (100%) cases with available information. Anaplastic large cell lymphoma was found in 44/50 (88%) capsules; no tumor was found in six (12%) patients who had lymphoma cells only in the effusion. The median number of sections reviewed was 20 (range, 2–240), the median percentage of sections involved by tumor was 6% (range, 0–90%), and the median percentage of sections involved by lymphoma was 10% (range, 0–90%). Invasion deep into or through the capsule was identified in 18/50 (36%) patients. In patients with breast implant anaplastic large cell lymphoma without a grossly identifiable tumor we identified a spectrum of involvement and we propose a protocol for handling, sampling and reporting these cases. The number of sections to exclude the presence of lymphoma with more than 95% certainty was supported by a mathematic rationale.

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