ALCLs From Other Implants, Too

Accumulating anecdotal case reports suggest other types of implant-associated ACLCs might also be occurring. 

Earlier this year, a possible case of gluteal implant-associated, ALK-negative ALCL in a middle-aged patient was reported by authors at USC in Los Angeles.5 The woman, aged 49 years, died of kidney and respiratory failure. A biopsy of a lung mass revealed “horseshoe”-shaped lymphoma cell nuclei — a hallmark of ALCL. There were inflammatory reactions, a skin rash, and lymphadenopathy near the gluteal implants, bolstering suspicion that the woman might have developed disseminated implant-associated ALCL.

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But her rapid deterioration precluded surgical removal of the implants before her death, and her family later refused permission for an autopsy and did not sign a permission form for clinicians to retrieve details about the gluteal implants from the private plastic surgery practice that placed them. That precluded biopsy of peri-implant fluids for ALCL in the implant capsule.

“The family was emotionally exhausted and we do not push the matter in such cases,” commented Dr Gould. 

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Dr Gould, who in addition to being a plastic surgeon is also a materials bioengineer, learned in August 2019 of a second gluteal implant-associated ALCL. He is preparing to detail this case report in a forthcoming paper, he told Cancer Therapy Advisor

Cases of ALK-negative ALCL also have been anecdotally reported at the sites of an aortic prosthesis,6 an Allergan LAP-BAND Adjustable Silicone Gastric Band bariatric implant (made of silicone elastomer),7 dental implants,8 and anchor sutures used to reattach torn rotator cuff tissue back onto bone after surgical repair.9 Dr Gould has also found a case of facial nerve stimulator implant-associated ALCL and a separate case of penile prosthesis-associated ALCL, which will all be published as case reports in the near future, he said.

“The point is, ALCL was previously seen as a disease of just breast implants, but we already knew from the literature that there were cases of other implant-associated lymphomas,” Dr Gould said. “It’s not simply an issue of breast implants – and it’s wrong to say we need to regulate breast implants and remove those from the market because of the BIA-ALCL issue. All implanted devices provoke an immune response and capsule formation, which can ultimately degenerate into [an] autoimmune condition similar to lymphoma, or lymphoma. That is a very rare, but natural byproduct of our efforts to improve patients’ lives with these implanted devices.”

Nonetheless, said Dr Gould, “We should keep doing what we’re doing. Patients need and deserve implants as an option.”

Dental implants have also been found in dozens of cases to be associated with oral squamous cell carcinoma (OSCC), frequently involving (in 43%-67% of the time) implant-adjacent recurrence of a previous OSCC.10 Time lags between implant placement and implant-adjacent OSCC diagnosis has ranged from 2 years to 8 years; chronic oral inflammation, tobacco, or alcohol consumption is thought to be associated with a higher risk of implant-associated OSCC recurrences.10