Rastogi P, Deva A K, Prince H Miles
Department of Plastic, Reconstructive & Maxillofacial Surgery - Macquarie University, Sydney, New South Wales, Australia.
Medical Oncology and Cancer Immunology, Epworth Healthcare, 140 Clarendon Street, East Melbourne, Victoria, 3002, Australia.
Curr Hematol Malig Rep. 2018 Dec;13(6):516-524. doi: 10.1007/s11899-018-0478-2.
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a recently recognised malignancy of T lymphocytes exclusively associated with textured breast implants. This review aims to evaluate existing theories regarding the epidemiology, pathogenesis, clinical evaluation and management of the disease.
The true incidence of BIA-ALCL is difficult to define. Prevailing pathogenic theories recognise the interplay between textured implants, Gram-negative bacteria, host genetics (e.g. JAK/STAT, p53) and time. Patients typically present with a delayed seroma and less commonly with a capsular mass or systemic disease at an average of 8-10 years after implantation. BIA-ALCL staging has evolved from a "liquid tumour" model to a "solid tumour" classification. For localised disease, surgery involving complete capsulectomy and implant removal is the cornerstone of treatment. For more advanced disease, treatment includes surgery followed by chemotherapy (combination anthracycline-based), radiotherapy and the antibody drug conjugate (brentuximab vedotin). The interplay between the Gram-negative biofilm, implant texturing, genetic mutations and time has been implicated in pathogenesis of BIA-ALCL. The identification of a putative infectious cause is not unique to lymphomagenesis. Future research, investigating BIA-ALCL genetic mutations and immunological modulation with Gram-negative biofilm in BIA-ALCL models is warranted.
乳房植入物相关间变性大细胞淋巴瘤（BIA-ALCL）是一种最近才被认识的T淋巴细胞恶性肿瘤，仅与带纹理的乳房植入物有关。本综述旨在评估关于该疾病的流行病学、发病机制、临床评估和管理的现有理论。
BIA-ALCL的真实发病率难以确定。流行的致病理论认识到带纹理的植入物、革兰氏阴性菌、宿主遗传学（如JAK/STAT、p53）和时间之间的相互作用。患者通常在植入后平均8至10年出现延迟性血清肿，较少见的是出现包膜肿块或全身性疾病。BIA-ALCL分期已从“液体肿瘤”模型演变为“实体肿瘤”分类。对于局限性疾病，包括完整包膜切除术和植入物取出术的手术是治疗的基石。对于更晚期的疾病，治疗包括手术，随后进行化疗（基于蒽环类药物的联合化疗）、放疗和抗体药物偶联物（维布妥昔单抗）。革兰氏阴性生物膜、植入物纹理、基因突变和时间之间的相互作用与BIA-ALCL的发病机制有关。确定一种假定的感染原因并非淋巴瘤发生所特有。有必要开展未来研究，在BIA-ALCL模型中研究BIA-ALCL基因突变以及革兰氏阴性生物膜对免疫的调节作用。
