Objective
The breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a novel Non-Hodgkin T-cell lymphoma, which is more recently recognized and was provisionally classified in the 2016 revision of the World Health Organization classification of lymphoid neoplasms. The high-surface-area textured implants as the major risk of BIA-ALCLs have been reported. The US Food and Drug Administration (FDA) first elaborated the safety communication as the possible association between breast implants and ALCL in 2011.
Material and Methods
As FDA data in 2019, a total of 33 patients’ global deaths among the 573 global medical device reports. In Asia, few cases of BIA-ALCLs are reported as well as there is no patient with BIA-ALCL in Taiwan, currently. Here, we will present the first case of the BIA-ALCL in Taiwan and perform literature review of BIA-ALCLs.
Results
A 34-year-old woman underwent bilateral breast augmentation through the transaxillary incision with textured surface anatomical shape silicone implants, which were placed into the subglandular pocket. Since June, 2019, she felt left breast itchy initially and then progressive swelling of left breast was mentioned. Breast asymmetry was noted in the following days. The ultrasound examination demonstrated the massive periprosthetic fluid accumulation of left breast without parenchyma lesions. The breast magnetic resonance imaging (MRI) showed double capsules formation outside left breast implant, and the delayed seroma was noted between the fibrous capsule and the silicone implant of left breast. Fine needle aspiration with 50-ml-specimen from the 400 ml effusion was performed. Histological examination revealed abundant large and pleomorphic neoplastic lymphoid cells exhibiting anaplastic nuclei with coarse chromatin and prominent nucleoli. The breast implant-associated anaplastic large cell lymphoma was diagnosed. She underwent bilateral complete capsulectomy with implant through inframammary fold incisions. The pathological TMN stage was pT2NxMx, stage IB. There was no further adjuvant therapy for her depending on the NCCN guideline of BIA-ALCL.
Conclusions
The BIA-ALCL is a novel Non-Hodgkin T-cell lymphoma. The disease most often manifests with a delayed seroma around the breast implant or breast swelling that cannot be explained by infection or trauma. On average, the time intervals between breast implant placement and diagnosis of BIA-ALCL is about 9 years with a range from 1 to 34 years. Therefore, plastic doctors should awareness of delayed seroma formation and keep follow-up after breast implant augmentation or reconstruction, especially with the textured surface anatomical shape silicone implant.