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

Authors

Maria C. Ferrufino-Schmidt, Departments of Hematopathology.
L Jeffrey Medeiros, Departments of Hematopathology.
Hui Liu, Department of Pathology, Xuzhou Medical University, Jiangsu Province, P.R. China.
Mark W. Clemens, Plastic Surgery.
Kelly K. Hunt, Surgical Breast Oncology, The University of Texas MD Anderson Cancer Center.
Camille Laurent, Département de Pathologie, CHU Purpan, University Institute of Cancer Oncopole, Toulouse, France.
Julian Lofts, Plastic Surgery, Auckland, New Zealand.
Mitual B. Amin, Department of Pathology and Laboratory Medicine, Oakland University William Beaumont School of Medicine, Royal Oak, MI.
Siaw Ming Chai, Department of Anatomical Pathology, PathWest Laboratory Medicine, QEII Medical Centre, Perth, WA, Australia.
Angela Morine, Middlemore Hospital.
Arianna Di Napoli, Department of Clinical and Molecular Medicine, Pathology Unit, Sant'Andrea Hospital, School of Medicine and Psychology, Sapienza University of Rome, Rome, Italy.
Ahmet Dogan, Department of Pathology, Memorial Sloan-Kettering Cancer Center Weill Cornell Medical College.
Vinita Parkash, Department of Pathology, Yale School of Medicine and Bridgeport Hospital, New Haven, CT.
Govind Bhagat, Department of Pathology and Cell Biology, Columbia University Medical Center and New York Presbyterian Hospital, New York, NY.
Denise Tritz, SSM Health St. Mary's Hospital-Jefferson City, Jefferson City, MO.
Andres E. Quesada, Departments of Hematopathology.
Sergio Pina-Oviedo, Department of Pathology and Laboratory Services, The University of Arkansas for Medical Sciences, Little Rock, AR.
Qinlong Hu, Tucson Pathology Associates, PC Carondelet St. Joseph Hospital, Tucson, AZ.
Francisco J. Garcia-Gomez, Department of Nuclear Medicine, Virgen Macarena University Hospital.
Juan Jose Borrero, Department of Anatomic Pathology, Virgen del Rocio University Hospital, Sevilla.
Pedro Horna, Department of Laboratory Medicine and Pathology, Division of Hematopathology, Mayo Clinic, Rochester, MN.
Beenu Thakral, Departments of Hematopathology.
Marina Narbaitz, Department of Pathology, Instituto de Investigaciones Hematologicas Academia de Medicina and FUNDALEU, Buenos Aires, Argentina.
R Condon Hughes, Diagnostic Tissue/Cytology Group, Meridian, MS.
Li-Jun Yang, Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainsville, FL.
Jonathan R. Fromm, Department of Laboratory Medicine, University of Washington, Seattle, WA.
David Wu, Department of Laboratory Medicine, University of Washington, Seattle, WA.
Da Zhang, Department of Pathology and Laboratory Medicine, The University of Kansas Medical Center.
Aliyah R. Sohani, Department of Pathology, Massachusetts General Hospital and Harvard Medical School.
John Hunt, Department of Pathology, Baystate Health, Springfield, MA.
Indira U. Vadlamani, St. Joseph Medical Center, Kansas City, MO.
Elizabeth A. Morgan, Department of Pathology, Brigham and Women's Hospital.

Document Type

Article

Publication Title

The American journal of surgical pathology

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.

First Page

293

Last Page

305

DOI

10.1097/PAS.0000000000000985

Publication Date

3-1-2018

Recommended Citation

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.; and Morgan, Elizabeth A., "Clinicopathologic Features and Prognostic Impact of Lymph Node Involvement in Patients With Breast Implant-associated Anaplastic Large Cell Lymphoma" (2018). All Research. 224.
https://scholar.bridgeporthospital.org/all_research/224

Identifier

29194092 (pubmed); NIHMS1625815 (mid); PMC7500854 (pmc); 10.1097/PAS.0000000000000985 (doi)