Johnson L, O'Donoghue J M, McLean N, Turton P, Khan A A, Turner S D, Lennard A, Collis N, Butterworth M, Gui G, Bristol J, Hurren J, Smith S, Grover K, Spyrou G, Krupa K, Azmy I A, Young I E, Staiano J J, Khalil H, MacNeill F A
St Bartholomews Hospital, West Wing, West Smithfield, London, EC1A 7BE, UK.
Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, NE7 7DN, UK.
Eur J Surg Oncol. 2017 Aug;43(8):1393-1401. doi: 10.1016/j.ejso.2017.05.004. Epub 2017 May 18.
Breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) is a rare, Non-Hodgkin lymphoma arising in the capsule of breast implants. BIA-ALCL presents as a recurrent effusion and/or mass. Tumours exhibit CD30 expression and are negative for Anaplastic Lymphoma Kinase (ALK). We report the multi-disciplinary management of the UK series and how the stage of disease may be used to stratify treatment.
Between 2012 and 2016, 23 cases of BIA-ALCL were diagnosed in 15 regional centres throughout the UK. Data on breast implant surgeries, clinical features, treatment and follow-up were available for 18 patients.
The mean lead-time from initial implant insertion to diagnosis was 10 years (range: 3-16). All cases were observed in patients with textured breast implants or expanders. Fifteen patients with breast implants presented with stage I disease (capsule confined), and were treated with implant removal and capsulectomy. One patient received adjuvant chest-wall radiotherapy. Three patients presented with extra-capsular masses (stage IIA). In addition to explantation, capsulectomy and excision of the mass, all patients received neo-/adjuvant chemotherapy with CHOP as first line. One patient progressed on CHOP but achieved pathological complete response (pCR) with Brentuximab Vedotin. After a mean follow-up of 23 months (range: 1-56) all patients reported here remain disease-free.
BIA-ALCL is a rare neoplasm with a good prognosis. Our data support the recommendation that stage I disease be managed with surgery alone. Adjuvant chemotherapy may be required for more invasive disease and our experience has shown the efficacy of Brentuximab as a second line treatment.
乳房植入物相关间变性大细胞淋巴瘤（BIA-ALCL）是一种罕见的非霍奇金淋巴瘤，发生于乳房植入物的包膜。BIA-ALCL表现为反复出现的积液和/或肿块。肿瘤表达CD30，间变性淋巴瘤激酶（ALK）阴性。我们报告英国系列病例的多学科管理以及如何根据疾病分期进行治疗分层。
2012年至2016年期间，英国15个地区中心诊断出23例BIA-ALCL。18例患者有乳房植入手术、临床特征、治疗及随访数据。
从最初植入到诊断的平均间隔时间为10年（范围：3 - 16年）。所有病例均见于使用带纹理乳房植入物或扩张器的患者。15例有乳房植入物的患者表现为I期疾病（局限于包膜），接受了植入物取出和包膜切除术。1例患者接受了辅助胸壁放疗。3例患者出现包膜外肿块（IIA期）。除了取出植入物、包膜切除和肿块切除外，所有患者均接受以CHOP为一线方案的新辅助/辅助化疗。1例患者在CHOP方案治疗中病情进展，但使用维布妥昔单抗后达到病理完全缓解（pCR）。经过平均23个月（范围：1 - 56个月）的随访，本文报告的所有患者均无疾病复发。
BIA-ALCL是一种预后良好的罕见肿瘤。我们的数据支持I期疾病仅通过手术治疗的建议。对于侵袭性更强的疾病可能需要辅助化疗，我们的经验表明维布妥昔单抗作为二线治疗有效。
