Journal of Clinical Oncology & Advanced Therapy

Abstract

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare type of non-Hodgkin lymphoma that can develop in the tissue surrounding breast implants [1]. This is not a type of breast cancer, but a cancer of the immune system. Anaplastic large cell lymphomas (ALCL) are a subset of T-cell lymphomas and are characterized by large T-cells with anaplastic morphology and CD30 positive phenotypes [2]. As reported in nearly all documented cases, BIA-ALCL is known to occur in implants with a textured surface (shell), as opposed to a smooth one [3]. Clinically, BIA-ALCL most commonly presents with breast asymmetry due to delayed peri-implant seroma or periprosthetic effusion surrounding the implant. Less common clinical manifestations include skin changes, capsular contracture or scarring, palpable breast masses, and regional lymphadenopathy [4]. Although the exact pathogenesis remains uncertain, chronic inflammation induced by the textured implant surface, bacterial biofilm formation, persistent T-cell stimulation, and host genetic susceptibility are proposed contributing factors in lymphomagenesis [5]. Diagnosis relies on a combination of clinical suspicion, radiological findings, histopathological examination of the capsule, and cytological evaluation of peri-implant effusion fluid with CD30 immunohistochemistry [4,5]. Imaging modalities such as MRI and PET-CT are often utilized to assess extracapsular spread, regional lymph node involvement, and distant metastases [6]. Standard treatment primarily consists of complete surgical excision including implant removal and total capsulectomy, while advanced cases may additionally require chemotherapy, targeted therapy such as brentuximab vedotin, and/or radiotherapy depending on disease extent [6,7]. The aim of this report is to highlight the importance of considering BIA-ALCL in patients with a history of breast implants presenting with unusual symptoms or masses, even in locations distant from the breast.