Implant Lymphoma: A Case for Staying Current on Rare Diseases
Breast implant-associated anaplastic large cell lymphoma (BI-ALCL), a comparatively rare type of malignancy, is starting to gain notoriety as more cases are reported and published in the literature. The first case was identified in 1986 and found to be associated with a textured implant. Over time there have been a handful of studies attempting to identify a correlation between breast implants and the development of this disease.
Thus far, a common thread in the examined cases is the use of textured-surface implants, which are a relatively more modern type of design invented to improve the aesthetics of the augmentation. Though the connection is not entirely understood, it is thought the “texturization” of the implant may incite a chronic inflammatory response, which subsequently progresses to ALCL. Unlike primary breast ALCL, these tumors arise from the implant scar capsule rather than the breast parenchyma. The behavior of BI-ALCL has been mostly indolent as compared with other primary breast lymphomas, which might advocate an abnormal reactive process.
Although the plastic surgery community is becoming more aware of BI-ALCL as an entity, there has been little guidance made available to radiology and oncology providers concerning the diagnosis, management, and continued surveillance of this disease. The women with confirmed BI-ALCL have presented with different clinical signs and symptoms with the most common being a late seroma unlikely to be residual from the original surgery. In some cases, patients presented with capsular contracture or masses adjacent to the breast implant which were loosely associated with a more dismal prognosis. Most patients with breast implant-associated ALCL who had disease confined within the fibrous capsule achieved complete remission following surgical resection. Proper management for these patients may be limited to capsulectomy and implant removal if they present with a seroma. Patients who present with a mass had a more aggressive clinical course which may justify chemotherapy in addition to removal of implants.
The FDA is not making recommendations to remove or even avoid placing texturized implants at this time, given the extremely low risk associated with the implants. A woman’s risk of being diagnosed with a primary breast malignancy (1/8) or even lung cancer (1/16) is so much greater than that associated with these implants (believed to be closer to 1/3,000,000). Just walking outside and being exposed to the sun for a small amount each day has a higher risk of cutaneous malignancy (1/53) than that known for BI-ALCL with the current statistics.
As with most things in healthcare, knowledge is everything. From Breast Density notification laws to Image Gently campaigns throughout the country, all aspects of medicine, especially radiology, thrive and continue to evolve by staying current with the emerging topics in medicine. Having an awareness of even the rare entities can translate to large strides in providing the best possible care for our patients. Should cases of implant lymphoma increase over time as awareness of its existence grows, then revisiting the recommendations will be in order. However, at this time there is not a formal deterrent to change the routine of a billion dollar global cosmetic and reconstructive industry that benefits millions of women physically, emotionally, and mentally.
Dr. Nicole Saphier holds a seat on the Radiological Society of New Jersey’s Executive Committee and legislative subcommittee, and was recently appointed to the New Jersey Department of Health Breast Imaging Work Group. She is also on the Board of Health and Joint Municipal Alliance in her local area of Morris Township, New Jersey. Dr. Saphier is a Diplomat of the American Board of Radiology and is the recipient of a multitude of research awards, as well is the lead author of numerous peer reviewed journal publications.