Clinicopathologic Features and Prognostic Impact of Lymph Node Involvement in Patients With Breast Implant-associated Anaplastic Large Cell Lymphoma. (March 2018)

• Record Type: Journal Article
• Authors: Ferrufino-Schmidt, Maria C.; Medeiros, L. Jeffrey; Liu, Hui; Clemens, Mark W.; Hunt, Kelly K.; Laurent, Camille; Lofts, Julian; Amin, Mitual B.; Ming Chai, Siaw; Morine, Angela; Di Napoli, Arianna; Dogan, Ahmet; Parkash, Vinita; Bhagat, Govind; Tritz, Denise; Quesada, Andres E.; Pina-Oviedo, Sergio; Hu, Qinlong; Garcia-Gomez, Francisco J.; Jose Borrero, Juan; Horna, Pedro; Thakral, Beenu; Narbaitz, Marina; Hughes, R. Condon; Yang, Li-Jun; Fromm, Jonathan R.; Wu, David; Zhang, Da; Sohani, Aliyah R.; Hunt, John; Vadlamani, Indira U.; Morgan, Elizabeth A.; Ferry, Judith A.; Szigeti, Reka; Tardio, Juan C.; Granados, Rosario; Dertinger, Susanne; Offner, Felix A.; Pircher, Andreas; Hosry, Jeff; Young, Ken H.; Miranda, Roberto N.;
• Is Part Of: American journal of surgical pathology. Volume 42:Number 3(2018)
• Publication Date: 2018-03
• Subjects: breast implant -- ALCL -- T-cell lymphoma -- CD30 -- Hodgkin lymphoma -- anaplastic large cell lymphoma -- lymph node involvement; Pathology, Surgical -- Periodicals; 617.0705
• DOI: 10.1097/PAS.0000000000000985
• Languages: English
• ISSNs: 0147-5185

Abstract

Abstract : Breast implant-associated anaplastic large cell lymphoma (BI-ALCL) is a rare T-cell lymphoma that arises around breast implants. Most patients manifest with periprosthetic effusion, whereas a subset of patients develops a tumor mass or lymph node involvement (LNI). The aim of this study is to describe the pathologic features of lymph nodes from patients with BI-ALCL and assess the prognostic impact of LNI. Clinical findings and histopathologic features of lymph nodes were assessed in 70 patients with BI-ALCL. LNI was defined by the histologic demonstration of ALCL in lymph nodes. Fourteen (20%) patients with BI-ALCL had LNI, all lymph nodes involved were regional, the most frequent were axillary (93%). The pattern of involvement was sinusoidal in 13 (92.9%) cases, often associated with perifollicular, interfollicular, and diffuse patterns. Two cases had Hodgkin-like patterns. The 5-year overall survival was 75% for patients with LNI and 97.9% for patients without LNI at presentation ( P =0.003). Six of 49 (12.2%) of patients with tumor confined by the capsule had LNI, compared with LNI in 8/21 (38%) patients with tumor beyond the capsule. Most patients with LNI achieved complete remission after various therapeutic approaches. Two of 14 (14.3%) patients with LNI died of disease compared with 0/56 (0%) patients without LNI. Twenty percent of patients with BI-ALCL had LNI by lymphoma, most often in a sinusoidal pattern. We conclude that BI-ALCL beyond capsule is associated with a higher risk of LNI. Involvement of lymph nodes was associated with decreased overall survival. Misdiagnosis as Hodgkin lymphoma is a pitfall.