Anaplastic large cell lymphoma (ALCL) and breast implants: breaking down the evidence

Mutat Res Rev Mutat Res. Oct-Dec 2014;762:123-32. doi: 10.1016/j.mrrev.2014.08.002. Epub 2014 Aug 23.

Abstract

Systemic anaplastic large cell lymphoma (ALCL) is a distinct disease classification provisionally sub-divided into ALCL, Anaplastic Lymphoma Kinase (ALK)(+) and ALCL, ALK(-) entities. More recently, another category of ALCL has been increasingly reported in the literature and is associated with the presence of breast implants. A comprehensive review of the 71 reported cases of breast implant associated ALCL (iALCL) is presented indicating the apparent risk factors and main characteristics of this rare cancer. The average patient is 50 years of age and most cases present in the capsule surrounding the implant as part of the periprosthetic fluid or the capsule itself on average at 10 years post-surgery suggesting that iALCL is a late complication. The absolute risk is low ranging from 1:500,000 to 1:3,000,000 patients with breast implants per year. The majority of cases are ALK-negative, yet are associated with silicone-coated implants suggestive of the mechanism of tumorigenesis which is discussed in relation to chronic inflammation, immunogenicity of the implants and sub-clinical infection. In particular, capsulotomy alone seems to be sufficient for the treatment of many cases suggesting the implants provide the biological stimulus whereas others require further treatment including chemo- and radiotherapy although reported cases remain too low to recommend a therapeutic approach. However, CD30-based therapeutics might be a future option.

Keywords: Anaplastic large cell lymphoma; Anaplastic lymphoma kinase; Bioprostheses; Breast implants.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Anaplastic Lymphoma Kinase
  • Animals
  • Breast Implantation / adverse effects*
  • Female
  • Humans
  • Lymphoma, Large-Cell, Anaplastic / epidemiology
  • Lymphoma, Large-Cell, Anaplastic / etiology*
  • Lymphoma, Large-Cell, Anaplastic / therapy
  • Middle Aged
  • Receptor Protein-Tyrosine Kinases / genetics*
  • Risk Factors
  • Silicone Gels / adverse effects

Substances

  • Silicone Gels
  • ALK protein, human
  • Anaplastic Lymphoma Kinase
  • Receptor Protein-Tyrosine Kinases