A case report describing the diagnosis of anaplastic large cell lymphoma (ALCL) in a woman who underwent cosmetic placement of bilateral, textured silicone gluteal implants was published online in Aesthetic Surgery Journal. 1
The US Food and Drug Administration (FDA) recently issued an update regarding the number of reported cases of breast implant-associated ALCL (BIA-ALCL), a rare form of T-cell non-Hodgkin lymphoma typically occurring in the periprosthetic fluid or capsule around textured silicone implants, in a relatively small percentage of women with and without a prior history of breast cancer who had undergone breast implantation.2
Early diagnosis and treatment of BIA-ACLC has been associated with a favorable clinical course, although a small percentage of cases have resulted in death.2 There have been no previously reported cases of implant-associated ALCL occurring at sites other than the breast.
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This case report described the clinical course of a 49 year-old woman presenting with recurrent pericardial effusion and abdominal pain. Biopsy of a lung mass revealed histologic findings consistent with ALK-negative ALCL. Fluid collection and enhancement was also noted in the area of the gluteal implants. Bilateral skin ulceration overlaying the implants was noted 2 month following initiation of chemotherapy. The patient died of renal and respiratory failure several months following initial presentation.
As the diagnosis of implant-associated ALCL was only considered subsequent to the patient’s death, fluid sampling at the site of the implant was only cultured for infection (and cultures were negative). While this case is suggestive of disseminated ALK-negative gluteal implant-associated ALCL, it was not possible to perform an autopsy.
The study authors wrote that “in this instance, it can only be concluded that the patient’s condition may have been associated with placement of textured silicone gluteal implants, but still lack[s] evidence of causation.” They also point out that skin ulceration and highly aggressive disease are not typically characteristic of BIA-ALCL.
Nevertheless, the authors wrote in summary that “it is imperative that all physicians recognize that patients with textured silicone implants other than breast implants may also be at risk of ALCL. Immunohistochemical analysis of aspirated seroma fluid from the implant capsule is still currently the most sensitive screening and diagnostic tool available for assessing patients with textured implants that present with late-onset seroma or other cardinal signs of implant-associated ALCL.”
References
- Shauly O, Gould DJ, Siddiqi I, Patel KM, Carey J. The first reported case of gluteal implant-associated anaplastic large cell lymphoma (ALCL) [published online February 15, 2019]. Aesthet Surg J. doi: 10.1093/asj/sjz044
- United States Food and Drug Administration. Statement from Binita Ashar, MD, of the FDA’s Center for Devices and Radiological Health on agency’s continuing efforts to educate patients on known risk of lymphoma from breast implants. Published February 6, 2019. Accessed February 25, 2019.
