Hart Alexandra M, Lechowicz Mary Jo, Peters Kendall K, Holden Jeannine, Carlson Grant W
Dr Hart is a resident in the Department of General Surgery at Emory University.
Dr Lechowicz is an Associate Professor in the Department of Hematology and Medical Oncology, Winship Cancer Institute.
Aesthet Surg J. 2014 Aug;34(6):884-94. doi: 10.1177/1090820X14539503. Epub 2014 Aug 1.
Although primary breast lymphomas are exceedingly rare, cases of breast implant-associated anaplastic large cell lymphoma (iALCL) continue to be reported. The authors describe their experience with 2 patients and review the literature. Both patients presented with periprosthetic fluid collection. Neither had evidence of systemic disease nor received systemic therapy. Both were disease free after bilateral capsulectomies and implant removal without implant replacement, and disease did not recur. During the literature review, 63 cases of iALCL (including our 2 patients) were identified. The median time from implant placement to diagnosis was 9 years. Both saline and silicone implants were associated with iALCL. Of the 26 cases for which implant surface was reported, the surface was textured in 24. Of the 58 patients with an identifiable presentation, 39 had periprosthetic fluid collection, including 7 with an associated mass; 13 had an isolated mass at presentation, including 1 with axillary adenopathy. Forty patients had capsulectomy, 7 of whom underwent implant replacement. Of the 44 patients with known treatment, 33 received chemotherapy and 23 received radiation. Of the 49 patients with known anaplastic large cell lymphoma, 15 had disease recurrence, and 4 patient deaths were reported. Of the 18 patients presenting with a mass, 11 had disease recurrence, including all 4 patients who died. This study represents the largest review of patients with iALCL described to date. Although most cases have an indolent clinical course, the variety of presentations defined as "seroma" vs "capsular involvement" emphasizes the importance of investigating a definitive method of diagnosis, management, and treatment of this disease. LEVEL OF EVIDENCE 5.
尽管原发性乳腺淋巴瘤极为罕见，但与乳房植入物相关的间变性大细胞淋巴瘤（iALCL）病例仍不断有报道。作者描述了他们对2例患者的治疗经验并回顾了相关文献。两名患者均表现为假体周围积液。两人均无全身疾病证据，也未接受全身治疗。双侧包膜切除术并移除植入物且未更换植入物后，两人均无疾病，且疾病未复发。在文献回顾中，共识别出63例iALCL病例（包括我们的2例患者）。从植入植入物到诊断的中位时间为9年。盐水和硅胶植入物均与iALCL有关。在报告了植入物表面情况的26例病例中，24例表面有纹理。在58例有可识别表现的患者中，39例有假体周围积液，其中7例伴有肿块；13例初诊时有孤立肿块，其中1例有腋窝淋巴结病。40例患者接受了包膜切除术，其中7例更换了植入物。在44例已知治疗情况的患者中，33例接受了化疗，23例接受了放疗。在49例已知患有间变性大细胞淋巴瘤的患者中，15例疾病复发，报告了4例患者死亡。在18例以肿块就诊的患者中，11例疾病复发，包括所有4例死亡患者。本研究是迄今为止对iALCL患者进行的最大规模回顾。尽管大多数病例临床病程呈惰性，但定义为“血清肿”与“包膜受累”的多种表现强调了研究该疾病明确诊断、管理和治疗方法的重要性。证据级别5。
