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Increasing lymphoma as a long-term consequence of breast implants?

HERSHEY. An estimated 10–15 million women worldwide have breast implants, and the number is rising. As the rare anaplastic large cell lymphoma (ALCL) can occur especially with the frequently used roughened implants, experts expect an increasing number of such diseases in the coming years.

So far, 300 cases of ALCL in connection with a breast implant have been reported to the US FDA, nine of those affected have died from the tumor.

Depending on the examination, an incidence of one disease in 4,000–30,000 implant users is assumed, with the diagnosis being made an average of ten years after implantation. Since the disease is so rare and no clear diagnostic criteria have been established, the incidence is uncertain, write plastic surgeons around Dr. Ashley Leberfinger from Penn State Medical Center in Hershey (JAMA Surg 2017, online October 18).

No case reports before 1997

The researchers wanted to learn a little more about the tumor and tried to evaluate all published reports on implant-associated ALCL. The researchers found 115 articles on the topic describing 95 diseases.

The first report appeared in 1997. Before the introduction of roughened implants, there were apparently no case reports related to breast augmentation and reconstruction. Slightly more than half of the 95 people affected had chosen the implant for breast reconstruction after cancer, the rest for cosmetic purposes.

Around 60 percent of women put on silicone implants, the rest on a filling with saline solution. On average, the tumor appeared ten years after implantation.

Chronic inflammatory reactions

In two-thirds the tumor was apparent due to a seroma around the implant, in seven patients due to a cell mass and in six both a seroma and a cell mass. The others suffered mainly from axillary lymphadenopathy, skin lesions, fever, sweating or fatigue.

For diagnosis, the researchers recommend ultrasound or MRI for liver fingers in the case of breast swelling, as well as fine needle aspiration of the fluid around the implant. The cytological analysis of ALCL shows large pleomorphic, epithelioid lymphocytes with a lot of cytoplasm and a kidney-shaped nucleus with clearly recognizable nucleoli.

The diagnosis can be confirmed immunohistochemically; as a rule, the lymphoma cells are CD30-positive and negative for anaplastic lymphoma kinase. If a cell mass is recognizable, a layer-like structure with necrotic and sclerotic regions can often be seen. The tumor stage should preferably be determined by PET-CT, suggest Leberfinger et al.

In women with ALCL, the implants are usually removed - this was the case in 84 percent. 61 percent received chemotherapy, mostly a combination of cyclophosphamide, hydroxydaunorubicin, vincristine and prednisone (CHOP), 30 percent received adjuvant radiotherapy. Most women (70 percent) had stage I of the disease, one stage IV.

An implant-associated ALCL behaves more like a solid tumor, according to the researchers. Most people affected seem to benefit sufficiently from a resection. Doctors and patients pay attention to breast swelling and other symptoms in good time so that the tumor can be removed with a good prognosis.

Chronic inflammatory reactions on the roughened surface of the implant are suspected to be the cause of the disease.