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Clinicopathologic Features and Prognostic Impact of Lymph Node Involvement in Patients With Breast Implant-associated Anaplastic Large Cell Lymphoma

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Breast implant-associated anaplastic large cell lymphoma (BI-ALCL) is a rare T-cell lymphoma that arises around breast implants. Most patients manifest with periprosthetic effusion, whereas a subset of patients develops a tumor mass or lymph node involvement (LNI). The aim of this study is to describe the pathologic features of lymph nodes from patients with BI-ALCL and assess the prognostic impact of LNI. Clinical findings and histopathologic features of lymph nodes were assessed in 70 patients with BI-ALCL. LNI was defined by the histologic demonstration of ALCL in lymph nodes. Fourteen (20%) patients with BI-ALCL had LNI, all lymph nodes involved were regional, the most frequent were axillary (93%). The pattern of involvement was sinusoidal in 13 (92.9%) cases, often associated with perifollicular, interfollicular, and diffuse patterns. Two cases had Hodgkin-like patterns. The 5-year overall survival was 75% for patients with LNI and 97.9% for patients without LNI at presentation (P=0.003). Six of 49 (12.2%) of patients with tumor confined by the capsule had LNI, compared with LNI in 8/21 (38%) patients with tumor beyond the capsule. Most patients with LNI achieved complete remission after various therapeutic approaches. Two of 14 (14.3%) patients with LNI died of disease compared with 0/56 (0%) patients without LNI. Twenty percent of patients with BI-ALCL had LNI by lymphoma, most often in a sinusoidal pattern. We conclude that BI-ALCL beyond capsule is associated with a higher risk of LNI. Involvement of lymph nodes was associated with decreased overall survival. Misdiagnosis as Hodgkin lymphoma is a pitfall.
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Keywords: ALCL; CD30; Hodgkin lymphoma; T-cell lymphoma; anaplastic large cell lymphoma; breast implant; lymph node involvement

Document Type: Research Article

Affiliations: 1: Departments of Hematopathology, Cayetano Heredia University, Lima, Peru 2: Departments of Hematopathology 3: Department of Pathology, Xuzhou Medical University, Jiangsu Province, P.R. China 4: Plastic Surgery 5: Surgical Breast Oncology, The University of Texas MD Anderson Cancer Center 6: D├ępartement de Pathologie, CHU Purpan, University Institute of Cancer Oncopole, Toulouse, France 7: Plastic Surgery, Auckland, New Zealand 8: Department of Pathology and Laboratory Medicine, Oakland University William Beaumont School of Medicine, Royal Oak, MI 9: Department of Anatomical Pathology, PathWest Laboratory Medicine, QEII Medical Centre, Perth, WA, Australia 10: Middlemore Hospital 11: Department of Clinical and Molecular Medicine, Pathology Unit, Sant’Andrea Hospital, School of Medicine and Psychology, Sapienza University of Rome, Rome, Italy 12: Department of Pathology, Memorial Sloan-Kettering Cancer Center Weill Cornell Medical College 13: Department of Pathology, Yale School of Medicine and Bridgeport Hospital, New Haven, CT 14: Department of Pathology and Cell Biology, Columbia University Medical Center and New York Presbyterian Hospital, New York, NY 15: SSM Health St. Mary’s Hospital-Jefferson City, Jefferson City, MO 16: Department of Pathology and Laboratory Services, The University of Arkansas for Medical Sciences, Little Rock, AR 17: Tucson Pathology Associates, PC Carondelet St. Joseph Hospital, Tucson, AZ 18: Department of Nuclear Medicine, Virgen Macarena University Hospital 19: Department of Anatomic Pathology, Virgen del Rocio University Hospital, Sevilla 20: Department of Laboratory Medicine and Pathology, Division of Hematopathology, Mayo Clinic, Rochester, MN 21: Department of Pathology, Instituto de Investigaciones Hematologicas Academia de Medicina and FUNDALEU, Buenos Aires, Argentina 22: Diagnostic Tissue/Cytology Group, Meridian, MS 23: Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainsville, FL 24: Department of Laboratory Medicine, University of Washington, Seattle, WA 25: Department of Pathology and Laboratory Medicine, The University of Kansas Medical Center 26: Department of Pathology, Massachusetts General Hospital and Harvard Medical School 27: Department of Pathology, Baystate Health, Springfield, MA 28: St. Joseph Medical Center, Kansas City, MO 29: Department of Pathology, Brigham and Women’s Hospital 30: Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX 31: Department of Pathology, University Hospital of Fuenlabrada 32: University Hospital of Getafe, Madrid, Spain 33: Department of Pathology, Academic Teaching Hospital Feldkirch, Feldkirch 34: Department of Hematology and Oncology, Medical University Innsbruck, Innsbruck, Austria 35: Department of Infectious diseases, University of Texas Health Science Center at Houston

Publication date: March 1, 2018

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