diffuse large cell lymphoma | Breast cancers are frequent tumors

Breast cancers are frequent tumors

There are even rarer or even exceptional forms of breast lesions
Breast sarcomas or large cell anaplastic lymphomas (LALRG), the appearance of which is favoured by external factors such as radiation therapy for breast sarcomas and the presence of a breast implant for anaplastic lymphomas.

These particular cases of large-cell anaplastic lymphomas exist in women with breast implants regardless of the duration of this implantation. The risk is very low according to Professor Gary Brody, a global expert on the subject, who has tried to assess the impact of this disease around the world in the light of literature and its personal cases. He has identified so far 173 cases in the world that have appeared over 15 years.

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The first case was described in 1997, in the world literature 79 cases were reported, to which are added the 94 cases collected by Professor Gary Brody. These cases are not all published yet.

Anaplastic lymphoma with large cells

It occurs most often as a tumor attached to the capsule, present around the prosthesis. Sometimes only a very abundant liquid effusion around the implant will give the alert. The increase in unilateral volume, the recurrent character after the puncture of this fluid effusion, must evoke this disease.

Diagnosis is sometimes difficult because it will be necessary to take the tumor and address it with clinical information indicating the possibility of this disease so that the pathologist carries out the tests necessary to confirm the diagnosis. The pathologist should be asked to search for large cell anaplastic lymphoma ALK negative CD 30 positive. Without these specific markers, the diagnosis is impossible. A specialized network "LYMPHOPAT" is in place in France, and it is necessary to request systematic rereading of the blades by a member of this network for confirmation and compilation of cases.

The treatment of this disease involves the removal of the tumor offshore with the entire peri-prosthetic shell.

When this is feasible the healing rate is very high. When a intramammaire or remote lesion is present, it is a disease with a different natural history, which requires a cancer treatment in a team specialized in the treatment of lymphomas.

So the key problem is the diagnosis. One should not miss the disease that one might take for a simple inflammatory syndrome. It is necessary to act and to remove the tumor or the shell

Periprosthetic to the slightest doubt. The targeted search for negative ALK1 markers and CD 30 must be carried out.

This disease appears to be induced by the inflammation that is created by the surface of the implants. Tissue cultures suggest a possible and rare genetic predisposition. The Periprosthetic biofilm could also play a role.

But it is especially when the periprosthetic texture is important that this pathology appears to appear. This is the case for surfaces made with "lost salt" which gives a very rough surface found on macrotexturés models, which are implicated in more than 80% of the cases described in this article.

It will be necessary to remain very vigilant in these patients, at the slightest clinical modification.

The overall risk is still very low, since it is between a case on 500 000 and a case on 3 million of patients. 80% of the cases are described in the United States and only 20% in the rest of the world including Europe. In France, there are only nine cases to date in Professor BRODY's article.

In more than 80% of cases, diagnosis is made at a stage where the disease is located within. The prognosis is then good if we practice the removal of the whole area concerned. In cases where the disease is metastatic, the prognosis is more reserved and targeted chemotherapy are being studied.

In conclusion:

Large-celled anaplastic lymphoma is a new, fully-fledged cancer entity, often multifactorial in origin. The common main causal factor appears to be the

Textured surface of breast implants and the resulting inflammation. The contents of the implants are not incriminating. The clinical presentation is variable, from very slow scalability to cases with a stormy evolution.

For most patients this lesion remains localized and therefore easily accessible to the surgical treatment. For other cases the prognosis may be more reserved.

The delay between the implants and the onset of the disease is extremely variable from a few months to more than 25 years.

Given the scarcity of this pathology, we must mainly educate and inform all the actors of this follow-up, so as not to miss the diagnosis and therefore not to take a therapeutic delay that could be deleterious for the patient.

In practice, although very exceptional, anaplastic lymphoma is a risk that women candidates for breast implantation must now be systematically informed. In view of the current scientific data which seem to be able to link them to the onset of this disease, macrotexturée surface implants must be subject to complementary scientific studies. Finally, in general, women with breast implants must be regularly and systematically supervised.