Anaplastic large cell lymphoma associated with breast implants: a report of 13 cases

Am J Surg Pathol. 2012 Jul;36(7):1000-8. doi: 10.1097/PAS.0b013e31825749b1.


We report 13 cases of anaplastic large cell lymphoma (ALCL) associated with breast implants. Patient age ranged from 39 to 68 years, and the interval from implant to ALCL was 4 to 29 years. All tumors were composed of large, pleomorphic cells that were CD30 and ALK1, and all 7 cases assessed had monoclonal T-cell receptor γ-chain rearrangements. Two patient subgroups were identified. Ten patients presented with effusion surrounded by fibrous capsule without a grossly identifiable tumor mass. Nine patients had stage I and 1 had stage II disease. Eight patients underwent implant removal and capsulectomy. Four patients received chemotherapy and 4 radiation therapy. All patients were alive without disease at last follow-up. A second subgroup of 3 patients had effusion and a distinct mass adjacent to the implant. One patient had stage I and 2 stage II disease. One patient had a 3-year history of lymphomatoid papulosis, and 1 patient had a 1-year history of CD30 T-cell lymphoma adjacent to the breast before the diagnosis of ALCL associated with breast implant. Two patients received chemotherapy and 1 radiation therapy. Two patients died 2 and 12 years after diagnosis, respectively. We conclude that the clinical behavior of ALCL associated with breast implants is heterogeneous. Patients who present with effusion without a distinct mass have an indolent disease course, similar to CD30 lymphoproliferative disorder of skin. In contrast, patients who present with a distinct mass may have advanced stage or possibly systemic disease and have a poorer prognosis.

MeSH terms

  • Activin Receptors, Type II / analysis
  • Adult
  • Aged
  • Biomarkers, Tumor / analysis
  • Biomarkers, Tumor / genetics
  • Breast Implantation / adverse effects*
  • Breast Implantation / mortality
  • Breast Implants / adverse effects*
  • Breast Neoplasms / chemistry
  • Breast Neoplasms / etiology*
  • Breast Neoplasms / genetics
  • Breast Neoplasms / mortality
  • Breast Neoplasms / pathology
  • Breast Neoplasms / surgery
  • Chemotherapy, Adjuvant
  • Device Removal
  • Female
  • Gene Rearrangement, gamma-Chain T-Cell Antigen Receptor
  • Genes, T-Cell Receptor delta
  • Humans
  • Ki-1 Antigen / analysis
  • Lymphoma, Large-Cell, Anaplastic / chemistry
  • Lymphoma, Large-Cell, Anaplastic / etiology*
  • Lymphoma, Large-Cell, Anaplastic / genetics
  • Lymphoma, Large-Cell, Anaplastic / mortality
  • Lymphoma, Large-Cell, Anaplastic / pathology
  • Lymphoma, Large-Cell, Anaplastic / surgery
  • Middle Aged
  • Neoplasm Staging
  • Radiotherapy, Adjuvant
  • Texas
  • Time Factors
  • Treatment Outcome


  • Biomarkers, Tumor
  • Ki-1 Antigen
  • ACVRL1 protein, human
  • Activin Receptors, Type II