89th Annual Meeting Abstracts
T-CELL Non Hodgkins Anaplastic Lymphoma Associated With One Style Of Breast Implants
Garry Brody, D Deapen, DPH, P Gill, MD, A Epstein, MD, S Martin, MD, MPH, W. Elatra, MD.
University of Southern California, Keck School of Medicine, Los Angeles, CA, USA.
Background: Primary breast lymphomas occur in 0.5 to 1.5% of breast malignancies with about 900 cases reported annually. Most are of the less virulent B-cell, non Hodgkins type with the more aggressive T-cell variety found in fewer than 5%. Recent isolated reports of T-cell anaplastic non Hodgkins Lymphomas presenting as late seromas around breast implants prompted an exhaustive search of the literature for more cases and possible etiologic factors.
Objectives: To evaluate the relationship between lymphoma of the breast and breast implants.
Method: Two previously unreported patients diagnosed with lymphoma presenting as late seromas around a breast implant, prompted a search of the literature for similar cases. When clinical course, brand and style of implant were not present in the report, the author of each article was contacted for this information. HIPPA concerns limited a response from some authors.
Results: We have located 34 reports of such cases from the world’s literature and 6 previously unreported; all presenting as late peri-implant seromas (25), severe capsular contracture (6), or peri-capsular tumor masses (3). Implant information was available in 25 cases and 23 had the same textured shell characteristics, (McGhan-Allergan 18, Nagor 2: PIP 1,) which have a specific textured surface created by the lost salt method. Both saline and gel implants were involved. Two were polyurethane. (In 8 cases, data to date is only preliminary.) All tumors were Anaplastic T- Cell lymphomas and all but 4 were restricted to the capsule. All but three were treated by total capsulectomy, radiation and/or chemotherapy. One patient refused treatment and in two, their oncologist was not convinced and will be carefully observing his patients. All demonstrated laboratory evidence indicating T-cell non Hodgkin’s anaplastic lymphoma or anaplastic large cell lymphoma.. Only 4 women showed dissemination outside the breast tissue, and 3 achieved complete remission with therapy. All but one were tumor free at the latest report. One patient appears to be resistant to treatment and is reportedly terminal. Available pathology and laboratory studies were consistent with a high degree of malignancy in contrast to what appeared to be a remarkably more benign clinical course than one would anticipate from what is seen in unimplanted women with primary breast T cell lymphoma.
Conclusions: Not all late seromas and contractures are malignant but one should be aware of the possibility and have the fluid and capsule analyzed. Recurrence post aspiration, presence of the identified brand and style of device associated with our cases, or any other uncertainty should prompt open exploration with total capsulectomy with pathologic analysis. As of this writing, absolute evidence of malignancy vs. polyclonal/oligoclonal T cell hyperplasia can not be ruled out in a few of these cases. Ongoing studies will investigate the process of T cell proliferation and/or transformation. As these patients represent only a minuscule fraction of the total of the implant population with these particular implants, a statistically valid relationship cannot as yet be established. To date, the association can only be considered as remarkably co-incidental.