Breast Implant Associated Anaplastic Large Cell Lymphoma

(BIA-ALCL)

• Definition
  • Peripheral T-Cell lymphoma associated with textured surfaces of breast implants
• Incidence
  • Rare (1:10,000)
• Presentation
  • Usually localised disease 10yrs post insertion
  • Seroma 60%
  • Often found incidentally during revision surgery for late-onset seroma
  • Mass 17%
• Aetiology unknown
  • ? Implant induced chronic inflammation, ? Biofilm
  • Association with Allergan BIOCELL textured implants (91% of cases)
• Pathology
  • Large anaplastic pleomorphic cells with abundant cytoplasm, horseshoe nuclei
  • IHC shows strong uniform CD30 staining, ALK negative
  • NB: This can also be seen in inflammation, must have anaplastic morphology and single T-Cell clone also
• Investigations
  • USS guided aspirate of seroma and send for cytology, cultures
• Management
  • Localised disease
    • Surgical removal of implant, associated masses/disease, and total capsulectomy
    • Treatment is usually curative
  • Disseminated disease
    • Systemic chemotherapy
  • SLNB not required, but excision biopsy of suspiciously enlarged nodes performed
  • Regular F/U
• Prognosis
  • Biologically indolent disease with a good prognosis with complete surgical resection provided there is no extension beyond the implant capsule