Breast implant-associated anaplastic large cell lymphoma

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare form of T-cell primary breast lymphoma that has primarily been associated with textured breast implants

The entity is rare, with a reported prevalence of between 0.3 in 100,000 to 1 in 1,000 women with breast implants 8,10. The vast majority of cases are associated with textured breast implants 8,10.

Patients may complain of breast swelling, pain, or asymmetry. Clinical breast examination usually reveals a fluid collection (seroma) or mass. Two-thirds of patients present with a late-onset seroma (>1 year from the surgery) and one-third present with a mass 10.

The time of onset is at least a year following breast augmentation surgery. The average time of presentation is 8-10 years after implant placement 8,10.

BIA-ALCL is a T-cell non-Hodgkin lymphoma arising in a peri-implant fluid collection or in the surrounding fibrous capsule 10

The exact etiology remains unclear, however, it is widely thought to be multifactorial in nature, due to a combination of chronic inflammation, implant texture and a subclinical infective pathology related to the formation of a biofilm 10. The end result is thought to be the malignant transformation of T-cells, which become anaplastic lymphoma kinase (ALK) negative and CD30 positive. 

  • textured implant surface (vs smooth implant surface) 10
  • factors that have been shown not to alter risk include 10
    • indication: primary augmentation vs reconstruction
    • type: saline vs silicone
    • location: retroglandular vs retropectoral

BIA-ALCL can be staged using the TNM system 10:

  • stage 1: confined to the external fibrous capsule
  • stage 2: extracapsular mass (locally advanced disease)
  • stage 3: regional and distant metastases

Patients most commonly manifest with a peri-implant effusion (range between 50-1000 mL) only, while a minority have a breast mass +/- effusion 8,10. Nodal disease (axillary, supraclavicular, mediastinal, and/or internal mammary groups) may rarely be involved 10.

Sonography typically demonstrates a fluid collection between the breast implant and the capsule; septa are often seen. Ultrasound is reported to have a sensitivity of 84% and specificity of 75% for detecting effusions and a sensitivity of 46% and specificity of 100% for detecting a BIA-ALCL mass 3

BIA-ALCL related effusions and masses may be appreciated on MRI. Capsular enhancement has also been reported in a small number of cases as has evidence of implant rupture ref.

Lesions typically demonstrate 18F-fluorodeoxyglucose avidity on positron emission tomography. The modality may be used to assess for systemic disease.

On initial workup, tissue sampling should be undertaken, including aspiration of the effusion and/or fine-needle aspiration or core needle biopsy of the mass if present 8.

Management typically involves a complete en-bloc capsulectomy and exploration of the prosthesis with patients subsequently receiving some form of chemotherapy and/or radiotherapy depending on the extent of disease 9

The first case of BIA-ALCL was reported in 1997 by Keech and Creech 6.

Breast imaging and pathology
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Article information

rID: 64844
System: Oncology, Breast
Tag: cases
Synonyms or Alternate Spellings:
  • Breast implant associated - anaplastic large cell lymphoma
  • Breast implant associated - anaplastic large cell lymphoma (BIA-ALCL)

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