Peters Walter
Division of Plastic Surgery, University of Toronto, Toronto, Ontario.
Plast Surg (Oakv). 2014 Winter;22(4):267-9. doi: 10.4172/plastic-surgery.1000894.
Since 1997, reports from the scientific community have suggested a possible association, without causation, between breast implants and anaplastic large cell lymphoma (ALCL). Analysis of these patients has been challenging. Many studies have been under-reported while others have been duplicated. In 2011, a United States Food & Drug Administration (FDA) 'white paper' analyzed 34 of the 60 cases reported worldwide. All 34 patients had undergone secondary surgery for breast swelling, firmness or pain. ALCL was an incidental finding. Diagnosis of ALCL is made by hematoxylin and eosin histology and immunochemistry for the CD30 marker. ALCL occurred with all types of implants. Subsequent studies have suggested that textured implants may have a greater risk. In all cases, ALCL cells were found in the capsule, in the seroma or within a mass adjacent to the implant. There was no invasion of cells beyond the capsule into the breast parenchyma. From the FDA study, the risk of developing ALCL after receiving implants appears to be approximately one in one million per year. All cases appear to be negative for the anaplastic lymphoma kinase marker. ALCL in most of these patients may represent a new entity with less aggressive behaviour. In most patients with capsule-confined disease, proper management may prove to be implant removal and capsulectomy. Patients with a distinct mass adjacent to their implant may have a more aggressive clinical course that may become systemic. They may require chemotherapy in addition to implant removal and capsulectomy. All cases of ALCL should be referred to an appropriate specialist and reported to the FDA.
自1997年以来，科学界的报告表明，乳房植入物与间变性大细胞淋巴瘤（ALCL）之间可能存在关联，但并非因果关系。对这些患者的分析具有挑战性。许多研究报告不足，而其他研究则存在重复。2011年，美国食品药品监督管理局（FDA）的一份“白皮书”分析了全球报告的60例病例中的34例。所有34例患者均因乳房肿胀、变硬或疼痛接受了二次手术。ALCL是偶然发现的。ALCL的诊断通过苏木精和伊红组织学以及针对CD30标记物的免疫化学进行。所有类型的植入物都可能发生ALCL。随后的研究表明，有纹理的植入物可能风险更大。在所有病例中，均在包膜、血清肿或植入物附近的肿块中发现了ALCL细胞。没有细胞突破包膜侵入乳腺实质。根据FDA的研究，植入乳房植入物后患ALCL的风险似乎约为每年百万分之一。所有病例的间变性淋巴瘤激酶标记物似乎均为阴性。这些患者中的大多数ALCL可能代表一种侵袭性较小的新实体。对于大多数包膜局限型疾病的患者，适当的治疗方法可能是取出植入物和进行包膜切除术。植入物附近有明显肿块的患者可能有更具侵袭性的临床病程，可能会发展为全身性疾病。除了取出植入物和进行包膜切除术外，他们可能还需要化疗。所有ALCL病例均应转诊至合适的专科医生，并向FDA报告。
