A proposal for pathologic processing of breast implant capsules in patients with suspected breast implant anaplastic large cell lymphoma

Abstract

Breast implant anaplastic large cell lymphoma is an entity recently recognized by the World Health Organization. The tumor arises around textured-surface breast implants and is usually confined to the surrounding fibrous capsule. Currently, there are no recommendations for handling and sampling of capsules from patients with suspected breast implant anaplastic large cell lymphoma without a grossly identifiable tumor. We analyzed complete capsulectomies without distinct gross lesions from patients with breast implant anaplastic large cell lymphoma. The gross appearance of the capsules as well as the presence, extent and depth of tumor cells on the luminal side and number of sections involved by lymphoma were determined by review of routine stains and CD30 immunohistochemistry. We then used a mathematical model that included the extent of tumor cells and number of positive sections to calculate the minimum number of sections required to identify 95% of randomly distributed lesions. We identified 50 patients with breast implant anaplastic large cell lymphoma who had complete capsulectomies. The implants were textured in all 32 (100%) cases with available information. Anaplastic large cell lymphoma was found in 44/50 (88%) capsules; no tumor was found in six (12%) patients who had lymphoma cells only in the effusion. The median number of sections reviewed was 20 (range, 2–240), the median percentage of sections involved by tumor was 6% (range, 0–90%), and the median percentage of sections involved by lymphoma was 10% (range, 0–90%). Invasion deep into or through the capsule was identified in 18/50 (36%) patients. In patients with breast implant anaplastic large cell lymphoma without a grossly identifiable tumor we identified a spectrum of involvement and we propose a protocol for handling, sampling and reporting these cases. The number of sections to exclude the presence of lymphoma with more than 95% certainty was supported by a mathematic rationale.

Access options

Rent or Buy article

Get time limited or full article access on ReadCube.

from$8.99

All prices are NET prices.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

References

  1. 1.

    Feldman AL, Harris NL, Stein H, Campo E, Kinney MC, Jaffe ES, et al. Breast implant-associated anaplastic large cell lymphoma, In: Swerdlow SH, Campo E, Harris NL, Jaffe ES, Pileri SA, Stein H, Thiele J, editors. WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues (Revised 4th edition). Lyon: IARC; 2017. p 421–2.

  2. 2.

    de Jong D, Vasmel WL, de Boer JP, Verhave G, Barbe E, Casparie MK, et al. Anaplastic large-cell lymphoma in women with breast implants. JAMA. 2008;300:2030–5.

    Article  Google Scholar 

  3. 3.

    Roden AC, Macon WR, Keeney GL, Myers JL, Feldman AL, Dogan A. Seroma-associated primary anaplastic large-cell lymphoma adjacent to breast implants: an indolent T-cell lymphoproliferative disorder. Mod Pathol. 2008;21:455–63.

    CAS  Article  Google Scholar 

  4. 4.

    Miranda RN, Aladily TN, Prince HM, Kanagal-Shamanna R, de Jong D, Fayad LE, et al. Breast implant-associated anaplastic large-cell lymphoma: long-term follow-up of 60 patients. J Clin Oncol. 2014;32:114–20.

    Article  Google Scholar 

  5. 5.

    Keech JA Jr., Creech BJ. Anaplastic T-cell lymphoma in proximity to a saline-filled breast implant. Plast Reconstr Surg. 1997;100:554–5.

    Article  Google Scholar 

  6. 6.

    Kim B, Predmore ZS, Mattke S, van Busum K, Gidengil CA. Breast implant-associated anaplastic large cell lymphoma: updated results from a structured expert consultation process. Plast Reconstr Surg Glob open. 2015;3:e296.

    Article  Google Scholar 

  7. 7.

    Kricheldorff J, Fallenberg EM, Solbach C, Gerber-Schafer C, Rancso C, Fritschen UV. Breast Implant-Associated Lymphoma. Dtsch Arzteblatt Int. 2018;115:628–35.

    Google Scholar 

  8. 8.

    Aladily TN, Medeiros LJ, Amin MB, Haideri N, Ye D, Azevedo SJ, et al. Anaplastic large cell lymphoma associated with breast implants: a report of 13 cases. Am J Surg Pathol. 2012;36:1000–8.

    Article  Google Scholar 

  9. 9.

    Quesada AE, Medeiros LJ, Clemens MW, Ferrufino-Schmidt MC, Pina-Oviedo S, Miranda RN. Breast implant-associated anaplastic large cell lymphoma: a review. Mod Pathol. 2019;32:166–88.

    Article  Google Scholar 

  10. 10.

    Adrada BE, Miranda RN, Rauch GM, Arribas E, Kanagal-Shamanna R, Clemens MW, et al. Breast implant-associated anaplastic large cell lymphoma: sensitivity, specificity, and findings of imaging studies in 44 patients. Breast Cancer Res Treat. 2014;147:1–14.

    CAS  Article  Google Scholar 

  11. 11.

    Anonym. Revised CAP guidelines for prosthetic breast implants. In: CAP Today. Vol. 9, Chicago: College of American Pathologists; 1995.

  12. 12.

    Zarbo RJ, Nakhleh RE. Surgical pathology specimens for gross examination only and exempt from submission: a College of American Pathologists Q-Probes study of current policies in 413 institutions. Arch Pathol Lab Med. 1999;123:133–9.

    CAS  PubMed  Google Scholar 

  13. 13.

    Lester SC. Manual of Surgical Pathology: Expert Consult. Elsevier Health Sciences. London: Elsevier Health Sciences; 2010.

  14. 14.

    Brody GS, Deapen D, Taylor CR, Pinter-Brown L, House-Lightner SR, Andersen JS, et al. Anaplastic large cell lymphoma occurring in women with breast implants: analysis of 173 cases. Plast Reconstr Surg. 2015;135:695–705.

    CAS  Article  Google Scholar 

  15. 15.

    Clemens MW, Medeiros LJ, Butler CE, Hunt KK, Fanale MA, Horwitz S, et al. Complete surgical excision is essential for the management of patients with breast implant-associated anaplastic large-cell lymphoma. J Clin Oncol. 2016;34:160–8.

    CAS  Article  Google Scholar 

  16. 16.

    Dielman TE. Applied Regression Analysis: A Second Course in Business and Economic Statistics. 4, illustrated ed. Boston, MA: Brooks/Cole Thomson Learning; 2005.

  17. 17.

    Giardini R, Piccolo C, Rilke F. Primary non-Hodgkin’s lymphomas of the female breast. Cancer. 1992;69:725–35.

    CAS  Article  Google Scholar 

  18. 18.

    Administration UFaD. Anaplastic large cell lymphoma (ALCL) in women with breast implants: preliminary FDA findings and analyses. 2011. http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/BreastImplants/ucm239995.htm. Accessed 30 Nov 2014.

  19. 19.

    Gidengil CA, Predmore Z, Mattke S, van Busum K, Kim B. Breast implant-associated anaplastic large cell lymphoma: a systematic review. Plast Reconstr Surg. 2015;135:713–20.

    CAS  Article  Google Scholar 

  20. 20.

    Administration UFaD. FDA medical device communication: Reports of anaplastic large cell lymphoma (ALCL) in women with breast implants. 2011. http://www.fda.gov/medicaldevices/safety/alertsandnotices/ucm240000.htm. 2011. Accessed 5 Dec 2014.

  21. 21.

    McCarthy CM, Loyo-Berrios N, Qureshi AA, Mullen E, Gordillo G, Pusic AL, et al. Patient registry and outcomes for breast implants and anaplastic large cell lymphoma etiology and epidemiology (PROFILE): initial report of findings, 2012–2018. Plast Reconstr Surg. 2019;143:65S–73S.

    CAS  Article  Google Scholar 

  22. 22.

    Taylor CR, Siddiqi IN, Brody GS. Anaplastic large cell lymphoma occurring in association with breast implants: review of pathologic and immunohistochemical features in 103 cases. Appl Immunohistochem Mol Morphol. 2013;21:13–20.

    CAS  PubMed  Google Scholar 

Download references

Acknowledgements

We thank all personnel in the Departments of Hematopathology and Pathology who supported us to perform all that was required for this project.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Roberto N. Miranda.

Ethics declarations

Conflict of interest

RNM received compensation from Allergan Inc. for advisory expert opinion in a one-day meeting. The remaining authors declare that they have no conflict of interest.

Additional information

Publisher’s note: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Lyapichev, K.A., Piña-Oviedo, S., Medeiros, L.J. et al. A proposal for pathologic processing of breast implant capsules in patients with suspected breast implant anaplastic large cell lymphoma. Mod Pathol 33, 367–379 (2020). https://doi.org/10.1038/s41379-019-0337-2

Download citation

Further reading

Search