Breast Implant Associated Anaplastic Large cell Lymphoma: two distinct clinicopathological variants with different outcomes
Menée en France à partir des données du réseau Lymphopath incluant 300 patientes atteintes d'un lymphome du sein (âge médian : 61 ans), cette étude évalue l'association entre des implants mammaires et le risque de lymphome T périphérique (in situ ou infiltrant), ainsi que la survie des patientes
Background : ALK-negative Anaplastic Large Cell lymphoma associated with breast implant (i-ALCL) has been recently recognized as a distinct entity. Among 43830 lymphomas registered in the french Lymphopath network since 2010, 300 breast lymphomas comprising 25 peripheral T-cell lymphomas were reviewed. Among peripheral T-cell lymphomas, ALK-negative ALCL was the most frequent and all of them were associated with breast implants. Patients and Methods : Since 2010, all i-ALCL cases were collected from different institutions through Lymphopath. Immuno-morphologic features, molecular data and clinical outcome of 19 i-ALCLs have been retrospectively analyzed. Results : The median age of the patients was 61 years and the median length between breast implant and i-ALCL was 9 years. Most implants were silicone–filled and textured. Implant removal was performed in 17/19 patients with additional treatment based on mostly CHOP or CHOP-like chemotherapy regimens (n=10/19) or irradiation (n=1/19). CHOP alone or ABVD following radiation without implant removal have been given in two patients. The two clinical presentations i.e. effusion and less frequently tumor mass correlated with distinct histopathologic features: in in-situ i-ALCL (anaplastic cell proliferation confined to the fibrous capsule) and infiltrative i-ALCL (pleomorphic cells massively infiltrating adjacent tissue with eosinophils and sometimes Reed-Sternberg-like cells mimicking Hodgkin lymphoma). Malignant cells were CD30 positive, showed a variable staining for EMA and were ALK negative. Most cases had a cytotoxic T-cell immunophenotype with variable T-cell antigen loss and pSTAT3 nuclear expression. T-cell receptor genes were clonally rearranged in 13/13 tested cases. After 18 months of median follow-up, the 2-years overall survival for in-situ and infiltrative i-ALCL was 100% and 52.5%, respectively. Conclusions : in-situ i-ALCLs have an indolent clinical course and generally remain free of disease after implant removal. However infiltrative i-ALCLs could have a more aggressive clinical course that might require additional therapy to implant removal.