Breast implant-associated
anaplastic large cell lymphoma (BIA-ALCL) has been included as a provisional entity in the revised version of the World Health Organization Classification of
Tumors of Haematopoietic and Lymphoid Tissue. To increase opportunities to intervene with early diagnosis, treatment, and possible prevention, it is important to consider that BIA-ALCL may evolve from a preexisting
lymphoproliferative disorder characterized by (1) an indolent localized (in situ) disease in approximately 80 percent of reported cases; (2) a requirement for external
cytokine stimulation for cell survival; (3) CD30 cells in some clinically benign
seromas/capsules; (4) undetected T-cell clonality in some cases; (5) JAK/STAT mutations in only a minority of cases; and (6) cure by capsulectomy and implant removal in most cases. BIA-ALCL resembles CD30 cutaneous
lymphoproliferative disorder: ALK, CD30 anaplastic cells with an aberrant T-cell phenotype; overexpression of oncogenes (JUNB, SATB1, pSTAT3, SOCS3) in
lymphomatoid papulosis; frequent apoptosis; complete
spontaneous regression in
lymphomatoid papulosis; and partial
spontaneous regression in cutaneous ALCL. Unlike CD30 cutaneous
lymphoproliferative disorder, BIA-ALCL cannot be readily observed over time to study the different steps in progression to ALCL. BIA-ALCL also shares features of
lymphomas of mucosa-associated lymphoid tissue, which are clinically indolent, initially localized,
antigen driven, and caused by Gram-negative bacteria. Further studies of
cytokines, clonality, mutations, and other
biomarkers are needed to identify possible premalignant steps in the evolution of benign late
seromas to BIA-ALCL.