Breast Implant Associated Chronic Inflammatory Malignancies
Megan Fracol, MD1, Roberto Miranda, MD1, Megan Rodriguez, BS1, Fabio Santanelli di Pompeo, MD2, Kelly Hunt, MD1, Mark Clemens, MD1.
1M.D. Anderson Cancer Center, Houston, TX, USA, 2University of Rome, Rome, Italy.
PURPOSE: On September 8th, 2022, the FDA released a safety communication about various lymphomas and squamous cell carcinoma (SCC) arising within breast implant capsules. The purpose of this study is to perform a systematic review of cases world-wide, and describe our institutional experience, which is the largest series to date.METHODS: A systematic review of the literature was performed to identify breast implant-associated malignancies, specifically breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), B cell lymphoma (BIA-BCL) and BIA-SCC. Secondarily, chart review of cases presenting at our institution was performed for presentation, diagnosis, treatment regimens, and outcomes. RESULTS: We report 1,290 cases of BIA-ALCL worldwide, with 69 managed at our institution. All clinical histories when available involved a history of textured devices. The majority of cases were limited to the capsule, with distant spread uncommon. 30 cases of BIA-BCL worldwide have been reported, with eight at our institution. BCLs were heterogeneous, including diffuse large B cell lymphoma, follicular lymphoma, marginal zone lymphoma, Epstein-Barr virus fibrin-associated B-cell lymphoma, plasmablastic lymphoma, as well as several other variants. There have been 16 cases of BIA-SCC reported worldwide, and two institutional cases. Prognosis was more guarded than BIA-ALCL with extracapsular and distant spread significantly more common.CONCLUSION: National Comprehensive Cancer Network (NCCN) guidelines exist for BIA-ALCL management and we present updated recommendations on BIA-BCL and BIA-SCC. Increasing awareness of breast implant associated malignancies is needed to help clinicians diagnose these rare cancers.
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