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乳房植入物相关间变性大细胞淋巴瘤:全面综述。

Breast implant-associated anaplastic large cell lymphoma: A comprehensive review.

机构信息

Division of Early Drug Development for Innovative Therapies, IEO, European Institute of Oncology IRCCS, Milan, Italy; Department of Oncology and Haemato-Oncology, University of Milano, Milan, Italy.

Haematopathology Division, IEO, European Institute of Oncology IRCCS, Milan, Italy.

出版信息

Cancer Treat Rev. 2020 Mar;84:101963. doi: 10.1016/j.ctrv.2020.101963. Epub 2020 Jan 13.

Abstract

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a recently recognized non-Hodgkin lymphoma of T-cell origin. Despite the low incidence of this new disease, the increasing use of breast implants for cosmetic or post-mastectomy reconstruction purposes places BIA-ALC as an emerging and compelling medical challenge. The real BIA-ALCL pathogenesis has not been fully uncovered so far, while different putative causal factors have been proposed. Breast implants with textured surfaces seem to be associated with nearly all cases of BIA-ALCL, while the real the risk of disease development has not been well estimated so far. Late onset, persistent seroma around breast implant represents the classical clinical presentation. Most of the BIA-ALCL patients presents with localized disease, which confers an excellent prognosis. Unlike other non-Hodgkin lymphomas, surgical excision of the mass has a key role in the treatment. For patients with advanced and disseminated diseases, the treatment did not differ from other types of T-cell lymphoma. For these reasons, BIA-ALCL represents an emerging disease which requires multidisciplinary team approach to well define diagnostic workup and treatment for each patient. This review article aims to summarize available data on BIA-ALCL. First, we will outline available data on BIA-ALCL epidemiology, pathogenesis, diagnostic work-up, and treatment. Second, we will point out the potential psychological implications as well as the risk of perception distortion for women with breast implants, especially for those with previous breast cancer. Lastly, we will summarize the current national recommendations regarding textured breast implants and discuss the diagnostic-therapeutic algorithm for BIA-ALCL management.

摘要

乳房植入物相关性间变性大细胞淋巴瘤(BIA-ALCL)是一种新近被认识的 T 细胞来源的非霍奇金淋巴瘤。尽管这种新疾病的发病率较低,但由于乳房植入物在美容或乳房切除术后重建方面的应用日益增多,BIA-ALCL 成为了一个新出现的、引人关注的医学挑战。迄今为止,这种疾病的确切发病机制尚未完全揭示,而不同的潜在致病因素已被提出。表面纹理化的乳房植入物似乎与几乎所有的 BIA-ALCL 病例都有关联,而目前尚未准确估计出疾病发展的真实风险。乳房植入物周围迟发性、持续性血清肿是其经典的临床表现。大多数 BIA-ALCL 患者表现为局限性疾病,这为其提供了极好的预后。与其他非霍奇金淋巴瘤不同,肿块的手术切除在治疗中起着关键作用。对于晚期和播散性疾病的患者,治疗与其他类型的 T 细胞淋巴瘤并无不同。基于这些原因,BIA-ALCL 是一种新出现的疾病,需要多学科团队合作,以针对每位患者制定明确的诊断和治疗方案。本文旨在总结 BIA-ALCL 的现有数据。首先,我们将概述 BIA-ALCL 的流行病学、发病机制、诊断检查和治疗方面的现有数据。其次,我们将指出乳房植入物女性可能存在的潜在心理影响以及对疾病的感知扭曲风险,特别是对于那些有乳腺癌病史的患者。最后,我们将总结当前关于纹理化乳房植入物的国家建议,并讨论 BIA-ALCL 管理的诊断-治疗算法。

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