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

Maria 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 BorreroPedro Horna, Beenu Thakral, Marina Narbaitz, R. Condon Hughes, 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

Research output: Contribution to journalArticlepeer-review

76 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)293-305
Number of pages13
JournalAmerican Journal of Surgical Pathology
Issue number3
StatePublished - 2018


  • ALCL
  • CD30
  • Hodgkin lymphoma
  • T-cell lymphoma
  • anaplastic large cell lymphoma
  • breast implant
  • lymph node involvement

ASJC Scopus subject areas

  • Anatomy
  • Surgery
  • Pathology and Forensic Medicine


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