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An Updated Approach and Understanding of Breast Implant–Associated Anaplastic Large Cell Lymphoma

Neha Mehta-Shah and Paola Ghione

Breast implant–associated anaplastic large cell lymphoma (BIA-ALCL) is a rare subtype of T-cell non-Hodgkin lymphoma that is usually localized to the fluid and capsule surrounding a breast implant. There have only been <1,000 cases and 36 deaths reported to date and the average patient presents 7 to 10 years following initial breast implant placement. Most patients present with delayed seromas, a breast mass, capsular abnormalities, lymphadenopathy, or cutaneous masses. Unlike other forms of non-Hodgkin lymphoma, most cases are cured with surgery alone. The challenge of BIA-ALCL surrounds its rarity—in regard to both its diagnosis as well as the limited available data to guide therapy for more advanced cases. Careful pathology evaluation to analyze both the fluid surrounding the capsule and the capsule itself is critical. Studies to identify which patients are at greater risk of development of this rare entity are ongoing.

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T-Cell Lymphomas, Version 2.2022, NCCN Clinical Practice Guidelines in Oncology

Steven M. Horwitz, Stephen Ansell, Weiyun Z. Ai, Jeffrey Barnes, Stefan K. Barta, Jonathan Brammer, Mark W. Clemens, Ahmet Dogan, Francine Foss, Paola Ghione, Aaron M. Goodman, Joan Guitart, Ahmad Halwani, Bradley M. Haverkos, Richard T. Hoppe, Eric Jacobsen, Deepa Jagadeesh, Allison Jones, Avyakta Kallam, Youn H. Kim, Kiran Kumar, Neha Mehta-Shah, Elise A. Olsen, Saurabh A. Rajguru, Sima Rozati, Jonathan Said, Aaron Shaver, Lauren Shea, Michi M. Shinohara, Lubomir Sokol, Carlos Torres-Cabala, Ryan Wilcox, Peggy Wu, Jasmine Zain, Mary Dwyer, and Hema Sundar

Peripheral T-cell lymphomas (PTCLs) are a heterogeneous group of lymphoproliferative disorders arising from mature T cells, accounting for about 10% of non-Hodgkin lymphomas. PTCL-not otherwise specified is the most common subtype, followed by angioimmunoblastic T-cell lymphoma, anaplastic large cell lymphoma, anaplastic lymphoma kinase–positive, anaplastic large cell lymphoma, anaplastic lymphoma kinase–negative, and enteropathy-associated T-cell lymphoma. This discussion section focuses on the diagnosis and treatment of PTCLs as outlined in the NCCN Guidelines for T-Cell Lymphomas.