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Reverse strategy to locally advanced breast implant-associated anaplastic large cell lymphoma: A case report

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare T-cell lymphoma associated with textured breast implants. The most common presentation is a periprosthetic seroma that occurs at least 1 year after an aesthetic or reconstructive implantation, and in these cases, the surgi...

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Autores principales: Cappelli, Sonia, Marchesi, Francesco, Clementi, Marco, Perracchio, Letizia, Palombi, Francesca, Pelle, Fabio, Botti, Claudio, Costantini, Maurizio
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9872134/
https://www.ncbi.nlm.nih.gov/pubmed/36703782
http://dx.doi.org/10.3389/fonc.2022.1062389
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author Cappelli, Sonia
Marchesi, Francesco
Clementi, Marco
Perracchio, Letizia
Palombi, Francesca
Pelle, Fabio
Botti, Claudio
Costantini, Maurizio
author_facet Cappelli, Sonia
Marchesi, Francesco
Clementi, Marco
Perracchio, Letizia
Palombi, Francesca
Pelle, Fabio
Botti, Claudio
Costantini, Maurizio
author_sort Cappelli, Sonia
collection PubMed
description Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare T-cell lymphoma associated with textured breast implants. The most common presentation is a periprosthetic seroma that occurs at least 1 year after an aesthetic or reconstructive implantation, and in these cases, the surgical treatment seems to be successful. More rarely, BIA-ALCL presents with locally advanced mass-formed disease and a related regional lymph node involvement. In all these cases with worse prognosis, a multidisciplinary approach is required, including adjuvant chemotherapy, radiation therapy, and surgery. We present a clinical case of a 49-year-old woman who developed on the left side of the breast a mass-formed stage 3 BIA-ALCL 15 years after a bilateral breast augmentation with textured silicone implant. Our multidisciplinary team (MDT) scheduled the patient for a “reverse-strategy” sequential approach consisting of induction chemotherapy, hematopoietic stem cell mobilization, and harvest followed by autologous stem cell transplant (ASCT). After 100 days from the stem cell transplant, the patient showed a complete pathologic response and was a candidate for radical surgery. She underwent removal of both implants with total en bloc capsulectomy. On the left site, the periprosthetic mass was also en bloc removed. We did not perform any axillary dissection. Our surgical and hemato-oncological teams followed the patient every 3 months, and no local or systemic recurrences were observed 24 months after surgery. This case report has demonstrated the effectiveness of neoadjuvant chemotherapy as part of a “reverse strategy” in selected cases of advanced-stage BIA-ALCL in which it was not possible to perform an immediate radical surgery. Furthermore, in our case, the de-escalation strategy adopted permitted a less demolitic surgery with good functional and aesthetic results.
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spelling pubmed-98721342023-01-25 Reverse strategy to locally advanced breast implant-associated anaplastic large cell lymphoma: A case report Cappelli, Sonia Marchesi, Francesco Clementi, Marco Perracchio, Letizia Palombi, Francesca Pelle, Fabio Botti, Claudio Costantini, Maurizio Front Oncol Oncology Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare T-cell lymphoma associated with textured breast implants. The most common presentation is a periprosthetic seroma that occurs at least 1 year after an aesthetic or reconstructive implantation, and in these cases, the surgical treatment seems to be successful. More rarely, BIA-ALCL presents with locally advanced mass-formed disease and a related regional lymph node involvement. In all these cases with worse prognosis, a multidisciplinary approach is required, including adjuvant chemotherapy, radiation therapy, and surgery. We present a clinical case of a 49-year-old woman who developed on the left side of the breast a mass-formed stage 3 BIA-ALCL 15 years after a bilateral breast augmentation with textured silicone implant. Our multidisciplinary team (MDT) scheduled the patient for a “reverse-strategy” sequential approach consisting of induction chemotherapy, hematopoietic stem cell mobilization, and harvest followed by autologous stem cell transplant (ASCT). After 100 days from the stem cell transplant, the patient showed a complete pathologic response and was a candidate for radical surgery. She underwent removal of both implants with total en bloc capsulectomy. On the left site, the periprosthetic mass was also en bloc removed. We did not perform any axillary dissection. Our surgical and hemato-oncological teams followed the patient every 3 months, and no local or systemic recurrences were observed 24 months after surgery. This case report has demonstrated the effectiveness of neoadjuvant chemotherapy as part of a “reverse strategy” in selected cases of advanced-stage BIA-ALCL in which it was not possible to perform an immediate radical surgery. Furthermore, in our case, the de-escalation strategy adopted permitted a less demolitic surgery with good functional and aesthetic results. Frontiers Media S.A. 2023-01-10 /pmc/articles/PMC9872134/ /pubmed/36703782 http://dx.doi.org/10.3389/fonc.2022.1062389 Text en Copyright © 2023 Cappelli, Marchesi, Clementi, Perracchio, Palombi, Pelle, Botti and Costantini https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Oncology
Cappelli, Sonia
Marchesi, Francesco
Clementi, Marco
Perracchio, Letizia
Palombi, Francesca
Pelle, Fabio
Botti, Claudio
Costantini, Maurizio
Reverse strategy to locally advanced breast implant-associated anaplastic large cell lymphoma: A case report
title Reverse strategy to locally advanced breast implant-associated anaplastic large cell lymphoma: A case report
title_full Reverse strategy to locally advanced breast implant-associated anaplastic large cell lymphoma: A case report
title_fullStr Reverse strategy to locally advanced breast implant-associated anaplastic large cell lymphoma: A case report
title_full_unstemmed Reverse strategy to locally advanced breast implant-associated anaplastic large cell lymphoma: A case report
title_short Reverse strategy to locally advanced breast implant-associated anaplastic large cell lymphoma: A case report
title_sort reverse strategy to locally advanced breast implant-associated anaplastic large cell lymphoma: a case report
topic Oncology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9872134/
https://www.ncbi.nlm.nih.gov/pubmed/36703782
http://dx.doi.org/10.3389/fonc.2022.1062389
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