TY - JOUR
T1 - Breast implant-associated anaplastic large cell lymphoma
T2 - clinical follow-up and analysis of sequential pathologic specimens of untreated patients shows persistent or progressive disease
AU - Evans, Mark G.
AU - Medeiros, L. Jeffrey
AU - Marques-Piubelli, Mario L.
AU - Wang, Huan You
AU - Ortiz-Hidalgo, Carlos
AU - Pina-Oviedo, Sergio
AU - Morine, Angela
AU - Clemens, Mark W.
AU - Hunt, Kelly K.
AU - Iyer, Swaminathan
AU - Hu, Qinglong
AU - Recavarren, Claudia
AU - Demichelis, Roberta
AU - Romero, Martha
AU - Sohani, Aliyah R.
AU - Misialek, Michael
AU - Amin, Mitual B.
AU - Bueso-Ramos, Carlos E.
AU - Carballo-Zarate, Adrian A.
AU - Lee, Hun J.
AU - Ok, Chi Young
AU - Xu, Jie
AU - Miranda, Roberto N.
N1 - Publisher Copyright:
© 2021, The Author(s), under exclusive licence to United States & Canadian Academy of Pathology.
PY - 2021/12
Y1 - 2021/12
N2 - Breast implant-associated anaplastic large cell lymphoma (ALCL) is a distinctive type of T-cell lymphoma that arises around textured-surface breast implants. In a subset of patients, this disease can involve surrounding tissues, spread to regional lymph nodes, and rarely metastasize to distant sites. The aim of this study was to assess sequential pathologic specimens from patients with breast implant-associated ALCL to better understand the natural history of early-stage disease. To achieve this goal, we searched our files for patients who had breast implant-associated ALCL and who had undergone earlier surgical intervention with assessment of biopsy or cytologic specimens. We then focused on the patient subset in whom a definitive diagnosis was not established, and patients did not receive current standard-of-care therapy at that time. We identified a study group of ten patients with breast implant-associated ALCL in whom pathologic specimens were collected 0.5 to 4 years before a definitive diagnosis was established. A comparison of these serial biopsy specimens showed persistent disease without change in pathologic stage in three patients, progression in five patients, and persistence versus progression in two patients. Eventually, six patients underwent implant removal with complete capsulectomy and four underwent partial capsulectomy. Seven patients also received chemotherapy because of invasive disease, three of whom also received radiation therapy, two brentuximab vedotin after chemotherapy failure, and one allogeneic stem cell transplant. Eight patients achieved complete remission and two had partial remission after definitive therapy. At time of last follow-up, six patients were alive without disease, one had evidence of disease, one died of disease, and two patients died of unrelated cancers. In summary, this analysis of sequential specimens from patients with breast implant-associated ALCL suggests these neoplasms persist or progress over time if not treated with standard-of-care therapy.
AB - Breast implant-associated anaplastic large cell lymphoma (ALCL) is a distinctive type of T-cell lymphoma that arises around textured-surface breast implants. In a subset of patients, this disease can involve surrounding tissues, spread to regional lymph nodes, and rarely metastasize to distant sites. The aim of this study was to assess sequential pathologic specimens from patients with breast implant-associated ALCL to better understand the natural history of early-stage disease. To achieve this goal, we searched our files for patients who had breast implant-associated ALCL and who had undergone earlier surgical intervention with assessment of biopsy or cytologic specimens. We then focused on the patient subset in whom a definitive diagnosis was not established, and patients did not receive current standard-of-care therapy at that time. We identified a study group of ten patients with breast implant-associated ALCL in whom pathologic specimens were collected 0.5 to 4 years before a definitive diagnosis was established. A comparison of these serial biopsy specimens showed persistent disease without change in pathologic stage in three patients, progression in five patients, and persistence versus progression in two patients. Eventually, six patients underwent implant removal with complete capsulectomy and four underwent partial capsulectomy. Seven patients also received chemotherapy because of invasive disease, three of whom also received radiation therapy, two brentuximab vedotin after chemotherapy failure, and one allogeneic stem cell transplant. Eight patients achieved complete remission and two had partial remission after definitive therapy. At time of last follow-up, six patients were alive without disease, one had evidence of disease, one died of disease, and two patients died of unrelated cancers. In summary, this analysis of sequential specimens from patients with breast implant-associated ALCL suggests these neoplasms persist or progress over time if not treated with standard-of-care therapy.
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U2 - 10.1038/s41379-021-00842-6
DO - 10.1038/s41379-021-00842-6
M3 - Article
C2 - 34155351
AN - SCOPUS:85108431520
SN - 0893-3952
VL - 34
SP - 2148
EP - 2153
JO - Modern Pathology
JF - Modern Pathology
IS - 12
ER -