Anaplastic Large Cell Lymphoma Associated With Breast Implants: A Report of 13 Cases
Anaplastic Large Cell Lymphoma Associated With Breast Implants: A Report of 13 Cases
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DOI：
10.1097/pas.0b013e31825749b1
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发表时间：
2012-07-01
影响因子：
5.6
通讯作者：
Miranda, Roberto N.
中科院分区：
文献类型：
--
作者：
Aladily, Tariq N.;Medeiros, L. Jeffrey;Miranda, Roberto N.
我们报告了 13 例与乳房植入物相关的间变性大细胞淋巴瘤 (ALCL) 病例。患者年龄为39至68岁，从植入到ALCL的间隔为4至29年。所有肿瘤均由 CD30(+) 和 ALK1(-) 的大多形性细胞组成，所有 7 例评估的病例均存在单克隆 T 细胞受体 γ 链重排。确定了两个患者亚组。十名患者出现积液，周围有纤维包膜，但没有肉眼可识别的肿瘤块。 9 名患者患有 I 期疾病，1 名患者患有 II 期疾病。八名患者接受了植入物移除和囊切除术。 4 名患者接受化疗，4 名患者接受放射治疗。末次随访时所有患者均存活且无疾病。第二组 3 名患者有积液，并且植入物附近有明显的肿块。一名患者患有 I 期和 2 名 II 期疾病。 1 名患者在诊断与乳房植入物相关的 ALCL 之前有 3 年淋巴瘤样丘疹病史，1 名患者有 1 年乳房邻近 CD30(+) T 细胞淋巴瘤病史。两名患者接受化疗，一名患者接受放射治疗。两名患者分别在诊断后 2 年和 12 年死亡。我们的结论是，与乳房植入物相关的 ALCL 的临床行为是异质的。出现积液但无明显肿块的患者病程呈惰性，类似于皮肤 CD30(+) 淋巴增殖性疾病。相反，出现明显肿块的患者可能已处于晚期或可能患有全身性疾病，且预后较差。
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 gamma-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.