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

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.
AuthorsMaria C Ferrufino-Schmidt, L Jeffrey Medeiros, Hui Liu, Mark W Clemens, Kelly K Hunt, Camille Laurent, Julian Lofts, Mitual B Amin, Siaw Ming Chai, Angela Morine, Arianna Di Napoli, Ahmet Dogan, Vinita Parkash, Govind Bhagat, Denise Tritz, Andres E Quesada, Sergio Pina-Oviedo, Qinlong Hu, Francisco J Garcia-Gomez, Juan Jose Borrero, Pedro Horna, Beenu Thakral, Marina Narbaitz, R Condon Hughes 3rd, Li-Jun Yang, Jonathan R Fromm, David Wu, Da Zhang, Aliyah R Sohani, John Hunt, Indira U Vadlamani, Elizabeth A Morgan, Judith A Ferry, Reka Szigeti, Juan C Tardio, Rosario Granados, Susanne Dertinger, Felix A Offner, Andreas Pircher, Jeff Hosry, Ken H Young, Roberto N Miranda
JournalThe American journal of surgical pathology (Am J Surg Pathol) Vol. 42 Issue 3 Pg. 293-305 (03 2018) ISSN: 1532-0979 [Electronic] United States
PMID29194092 (Publication Type: Journal Article)
Topics
  • Adult
  • Aged
  • Aged, 80 and over
  • Biopsy
  • Breast Implantation (adverse effects, instrumentation, mortality)
  • Breast Implants (adverse effects)
  • Breast Neoplasms (etiology, mortality, pathology, therapy)
  • Diagnostic Errors
  • Female
  • Hodgkin Disease (pathology)
  • Humans
  • Immunohistochemistry
  • Lymph Nodes (pathology)
  • Lymphoma, Large-Cell, Anaplastic (etiology, mortality, pathology, therapy)
  • Middle Aged
  • Predictive Value of Tests
  • Treatment Outcome

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