Re: Large Cell Lymphoma Arising in a Silicone Breast Implant Capsule

[Guest guest]

Dede and Elvira ... It makes my heart sing to see these articles being circulated. Here are a few on the same subject I posted a while back on Usenet ... we have a huge depository there of studies and articles from the 13 years since I started alt.support.breast-implant.

I met Rogene online there within a few weeks (as well as the then VP of McGhan hiding behind an alias ) .. and for months and months she and I were up all nite it seemed finding everything we could and posting to as many places as were available then.

Check this link out on lymphoma:http://groups.google.com/group/alt.support.breast-implant/browse_thread/thread/6a246de2475b20f8

A few years ago I met a woman at a Halloween Party who had a lymphoma exactly where her rupture had been ... no doctor had even mentioned the possibility of a connection.The industry has a pretty firm hold these days on Wikipedia and Usenet ... but our work is well archived and available!

Thanks to all who keep this information in front of the public.Love from IlenaBreast Implant Awareness BlogBreast Implant Awareness Website

On 8/7/08, Elvira Burton <godessoflight46@...> wrote:

Begin forwarded message:From: DGrahamA@...

Date: August 6, 2008 4:08:40 PM MDT

DGrahamA@...

Subject: Large Cell Lymphoma Arising in a Silicone Breast Implant Capsule

http://arpa.allenpress.com/arpaonline/?doi=10.1043%2F0003-9985(2003)127%3Ce115:ALCLAI%3E2.0.CO%3B2 & request=get-document

Archives of Pathology and Laboratory Medicine: Vol. 127, No. 3, pp. e115–e118.

Anaplastic Large Cell Lymphoma Arising in a Silicone Breast Implant Capsule: A Case Report and Review of the Literature

Sunati Sahoo, MD; P. Rosen, MD; M. Feddersen,MD; S. Viswanatha, MD; A. , MD; Amy Chadburn, MD

from the Department ofPathology, New York Presbyterian Hospital-Weill Cornell Center, NewYork, NY (Drs Sahoo, Rosen, and Chadburn); the Department of Pathology,University of New Mexico School of Medicine, Albuquerque (Drs Feddersenand Viswanatha); and New Mexico Oncology Hematology Consultants,Albuquerque (Dr )

Accepted June 14, 2002Anaplastic large cell lymphoma is a rare type of primary breastlymphoma. We report a case of anaplastic large cell lymphoma, T-cellphenotype, occurring in the periprosthetic capsule of a silicone breastprosthesis 9 years after implantation for augmentation mammoplasty.This case is unique for its unusual presentation.

Since 1962, an estimated 1 to 2 million women have acquired breast implants in the United States.1Approximately 80% of these implants have been placed for breastaugmentation, and almost all of the others have been used forreconstruction after mastectomy due to cancer.1The physical and psychological benefits of breast implants formastectomy patients have been well documented. Despite early reportsthat silicone was biologically inert in human tissue, the safety ofbreast implants for augmentation mammoplasty has been a subject of muchdiscussion with respect to local and potential systemic complications,including carcinogenic effects. An independent panel of US scientistsconvened at the request of Congress concluded that silicone breastimplants do not cause any systemic disease, but these implants can leakand rupture, causing local problems such as scarring, infection, anddisfigurement. There is no convincing evidence that these local effectspredispose women to the development of lymphoma in the breast, althoughthere have been rare reports of lymphoma in the vicinity of breastimplants.2–4This report documents a case of primary anaplastic large cell lymphoma(ALCL) of the breast that arose in the periprosthetic tissue of asilicone implant.

REPORT OF A CASE Return to TOC

A33-year-old woman underwent bilateral cosmetic breast augmentationmammoplasty with double-lumen silicone prostheses in 1986. In August1990, she developed tenderness at the left breast implant site, whichled to the removal of the capsule. Histopathologic examination of thecapsule revealed chronic inflammation, fibrosis, and foreign body giantcell reaction. Two months later, the left breast prosthesis was removedbecause of secondary infection. In February 1991, following antibiotictherapy and surgical debridement, a new silicone gel–filled prosthesiswas placed. The patient was asymptomatic until March 2000, when shepresented with swelling and tenderness at the left breast implant site.At surgery, a substantial amount of straw-colored fluid was drainedfrom the periprosthetic capsular space. The prosthesis was removedfollowed by capsulectomy. Morphologic examination of the capuslectomyspecimen revealed an atypical mononuclear cell infiltrate that,following immunophenotypic and genotypic studies, was diagnosed aslymphoma. Further evaluation of the patient revealed no systemicdisease. She was treated with radiotherapy and 3 cycles ofcyclophosphamide, doxorubicin, vincristine, and prednisone. Twelvemonths after diagnosis, she is alive with no evidence of disease. Her right breast implant was intact.

MATERIALS AND METHODS Return to TOC

Immunohistochemistry

Immunophenotypicanalysis was performed on paraffin-embedded tissue sections using aTechMate 500 automated immunostainer (Ventana Medical Systems, Inc,Tucson, Ariz) according to a modified MIP protocol (Ventana Medical).The monoclonal and polyclonal antibodies to the various antigens andthe corresponding antigen retrieval methods are listed in Table 1 .The ChemMate avidin-biotin complex peroxidase secondary detectionsystem, employing diaminobenzidine as the chromogen (Ventana Medical),was used to detect antigen expression.

Molecular Genetic Studies Tomaximize the isolation of DNA from tumor cells, microdissection wasperformed from tissue sections. DNA was extracted using the QIAampTissue Kit (Qiagen Inc, Santa Clarita, Calif) according to themanufacturer's instructions. Polymerase chain reaction analysis wasperformed along with appropriate positive and negative controls toexamine immunoglobulin heavy chain (IgH), T-cell receptor ß chain, andT-cell receptor ? chain gene rearrangements.

In Situ Hybridization Studies Insitu hybridization for the Epstein-Barr virus was performed onparaffin-embedded tissue sections using an EBER probe ISH kit(Novocastra, Newcastle upon Tyne, United Kingdom), according to themanufacturer's protocol.

PATHOLOGIC FINDINGS Return to TOC

Ongross examination, the capsulectomy specimen consisted of a 10.0 ×8.0-cm fibromembranous sac up to 3.0 cm in thickness. The inner surfaceof the capsule was focally lobulated and covered by necrotic material.The specimen was fixed in 10% buffered formalin and extensively sampledfor histopathologic examination and ancillary studies. Microscopically,a layer of necrotic debris associated with scattered sclerotic nodulescovered the inner surface of the capsule. Immediately beneath thenecrotic layer, an approximately 1-mm-thick infiltrate of largeatypical mono- and multinucleated cells with frequent mitoses waspresent. The neoplastic cells were large and had clear cytoplasm, largenuclei, and prominent nucleoli (Figure, a ).Unstained refractile material consistent with silicone particles wasseen in empty spaces in the sclerotic nodules and the cellularinfiltrate (Figure, b ).Fibrosis and aggregates of chronic inflammatory cells, including smalllymphocytes, plasma cells, and histiocytes, were present outside theneoplastic infiltrate.

RESULTS Return to TOC

The neoplastic cells were positive for the T-cell–associated antigens CD2 and CD43 (Figure, c ) but lacked expression of CD3, consistent with a T-cell neoplasm. The cells were CD30 positive (Figure, d )and focally positive for epithelial membrane antigen. Immunostainingfor ALCL kinase protein (ALK-1), T-cell intracellular antigen, andlatent nuclear antigen of human herpesvirus 8 was negative (Table 1 ).In situ hybridization for the Epstein-Barr virus was also negative. PCRanalysis showed a monoclonal band for T-cell receptor ? and apolyclonal pattern for IgH and T-cell receptor ß. Based on thesestudies, the diagnosis of CD30-positive ALCL was reached.

COMMENT Return to TOC

Primary non-Hodgkin lymphoma of the breast is rare and represents 0.04% to 0.5% of all malignant breast tumors.5The vast majority of breast lymphomas are of B-cell origin. Only rarecases of T-cell breast lymphoma have been reported either as singlecase reports and as part of a series, including one series of 4patients with T-cell neoplasms in the breast.5Included in these reports are lymphoblastic lymphoma, peripheral T-celllymphoma, multilobated T-cell lymphoma, mycosis fungoides, naturalkiller cell lymphoma, and ALCL.

Anaplasticlarge cell lymphoma accounts for approximately 3% of adult non-Hodgkinlymphomas and involves both lymph nodes and extranodal sites.6 Extranodal ALCL has been found in the skin (21%), soft tissues (17%), bone (17%), lung (11%), and liver (8%).6Involvement of the breast is rare in ALCL. There have been only 3reports of primary breast ALCL, including one case in proximity to asaline-filled implant.2,5,7 Furthermore, 3 additional cases of secondary ALCL of the breast have been reported.8,9 The demographic and follow-up data on these previously reported ALCLs of the breast are summarized in Table 2 .Preliminary data suggest that the most important prognostic indicatorof ALCL is ALK-1 positivity, which has been associated with a favorableprognosis. The overall 5-year survival rate in ALK-1–positive ALCL isclose to 80%, in contrast to only 40% in ALK-1–negative cases.6 In only 1 of 6 previously reported cases was the ALK-1 stain reported to be positive7;in the remaining cases the ALK-1 status was unknown. The present caseof ALCL was ALK-1 negative and was limited to the breast, and thepatient showed resolution of her lymphoma after chemotherapy. Fromthese isolated cases, with the limited follow-up data and unknownstatus of ALK-1 expression, it is difficult to predict the clinicalcourse of primary CD30-positive ALCL of the breast.

Thepresenting symptom in virtually all cases of primary breast lymphoma isa mass-type lesion, which is sometimes painful and is located mostoften in the upper outer quadrant.10In contrast, patients who developed breast lymphoma followingprosthesis implantation had implant-related symptoms with or without amass-type lesion. Table 3 summarizes the clinical and pathologic features of lymphoma in thepatients with either primary or secondary ALCL of the breast associatedwith an implant, including the current case (case 1). In case 2, acomputed tomography scan of the chest demonstrated circumferentialencasement of the right breast implant with tumor.2In case 3, a computed tomography scan of the chest revealed fluidaccumulation between the capsule and implant, but a magnetic resonanceimage of the breast was unremarkable. Aspiration of the effusion wasdiagnostic of a CD30-positive, CD43-positive B-cell lymphoma.3In case 4, the patient developed discomfort in the breast, and physicalexamination revealed a significant capsular contracture and a smallpalpable nodule.4In all 4 patients with primary CD30-positive lymphoma, the neoplasticprocess was detected during the workup of implant-relatedcomplications, and in 2 patients (including the woman of this report),the diagnosis of lymphoma was made only after pathologic examination.These cases emphasize the need for careful pathologic examination oftissue removed because of implant-related complications.

Currently,there is no evidence available directly relating lymphoma to siliconebreast prostheses. The sporadic cases of lymphoma developing in breastswith implants and in lymph nodes with silicone granulomas have occurredin patients with draining prosthestic joint replacements for fingerjoint arthritis.11–13Because only 4 cases of implant-related lymphoma in the breast havebeen reported from among more than 1 million women with breastimplants, the occurrence of lymphoma in these women may be unrelated tothe implants. Nonetheless, the localization of lymphoma inperiprosthetic breast tissue is noteworthy.

References Return to TOC

1. Noone RB. A review of the possible health implications of silicone breast implants. Cancer 1997;79:1747–1756.

2. Keech JA, Creech BJ. Anaplastic T-cell lymphoma in proximity to a saline-filled breast implant. Plast Reconstr Surg 1997;100:554–555. [PubMed Citation]

3. Said JW, Tasaka T, TakeuchiS. et al. Primary effusion lymphoma in women: report of two cases ofKaposi's sarcoma herpes virus-associated effusion-based lymphoma inhuman immunodeficiency virus-negative women. Blood 1996;88:3124–3148. [PubMed Citation]

4. Cook PD, Osborne BM, ConnorRL, Strauss JF. Follicular lymphoma adjacent to foreign bodygranulomatous inflammation and fibrosis surrounding silicone breastprosthesis. Am J Surg Pathol 1995;19:712–717. [PubMed Citation]

5. Aguilera NS, Tavassoli FA,Chu WS, Abbondanzo SL. T-cell lymphoma presenting in the breast: ahistologic, immunophenotypic and molecular genetic study of four cases.Mod Pathol 2000;13:599–605. [PubMed Citation]

6. Delsol G, Ralfkiaer E, SteinH, D, Jaffe ES. Anaplastic large cell lymphoma. In: Jaffe ES, NL, Stein H, Vardiman JW, eds. World Health Organization Clasification of Tumours. Pathology & Genetics of Tumours of Haematopoietic and Lymphoid Tissues. Lyon, France: IRAC Press; 2001:230–235.

7. Pillay P, Chetty R. Anaplastic large cell lymphoma of the breast. Int J Surg Pathol 1999;7:171–174. 8. Lin Y, Govindan R, Hess JL. Malignant hematopoietic breast tumors. Am J Clin Pathol 1997;107:177–186. [PubMed Citation]

9. Tan PH, Sng ITY. Breast lymphoma—a pathologic study of 14 cases. Ann Acad Med Singapore 1996;25:783–790. [PubMed Citation]

10. Rosen PP. Lymphoid and hematopoietic tumors. In: Rosen's Breast Pathology. New York, NY: Lippincott-Raven; 1997:757–778. 11. E, Ahmed A, RashioATMF, DH. Silicone lymphadenopathy: a report of two cases, onewith concomitant malignant lymphoma. Diagn Histopathol 1982;5:133–141. [PubMed Citation]

12. Digby JM. Malignant lymphoma with intranodal silicone rubber particles following metacarpophalangeal joint replacements. Hand 1982;14:326–328. 13. Murakata LA, Ruagwala AF. Silicone lymphadenopathy with concomitant malignant lymphoma. J Rheumatol 1989;16:1481–1483.

Tables Return to TOC

Table 1.Immunophenotypic Analysis: Methods and Results Table 2.Summary of Previous Reports of CD30-Positive Anaplastic Large Cell Lymphoma of the Breast

Table 3.Summary of Previously Reported Breast Lymphomas Associated With ImplantsFigures Return to TOC

Click on thumbnail for full-sized image.

a,Neoplastic breast cells are large and have clear cytoplasm, largenuclei, and prominent nucleoli. An overlying layer of fibrinousmaterial is also present (hematoxylin-eosin, original magnification×20). b, Empty spaces containing unstained refractile materialconsistent with silicone particles (black arrows) are often in closeproximity to the tumor cells (white arrow) (hematoxylin-eosin, originalmagnification ×40). c, Neoplastic cells express the T-cell–associatedantigen CD43 (immunoperoxidase, original magnification ×20). d, Tumorcells are strongly positive for CD30 (BerH2, immunoperoxidase, originalmagnification ×20)

Corresponding author: Amy Chadburn, MD, Department of Pathology, New YorkPresbyterian Hospital-Weill Cornell Center, 1300 York Ave, Room C 302,New York, NY 10021 (E-mail: achadbur@...)

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-- Ilena's Health Lover Blog<http://ilenarose.blogspot.com>Breast Implant Awareness Blog

<http://breastimplantawareness.blogspot.com>

[Guest guest]

O Lea ... how wonderful that you educated this woman ... you never cease to amaze me.I agree ... we need to get these studies and this information in as many forums as possible ... the PR teams are filling the rest of the internet with all their 'good news' about implants. Dede is doing a great service to womankind by researching and posting these today.

Tell SuperMan I love & miss you both!Elvira ... thanks for all your work on distributing these too!

[Guest guest]

Oh, Ilena, we love you so much. We miss you, too, and thank you for continuing your fight for all of us. Where are you now, or is that still a secret? I always tell our that you are in the jungle with your little family.

I really want to do something drastic; however, someone is still watching me. had to put McAfee protection software on our main computer, because his university's licence allows it. The first scan found 92 Trojans! This is crazy! Dr. Blais is still angry that I have been gagged.

Take care of our Special Angel...love you, Lea and Superman

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Re: Large Cell Lymphoma Arising in a Silicone Breast Implant Capsule

O Lea ... how wonderful that you educated this woman ... you never cease to amaze me.I agree ... we need to get these studies and this information in as many forums as possible ... the PR teams are filling the rest of the internet with all their 'good news' about implants. Dede is doing a great service to womankind by researching and posting these today.Tell SuperMan I love & miss you both!Elvira ... thanks for all your work on distributing these too!