{"entity":{"id":"breast-implant-associated-alcl","kind":"cancer","name":"Breast implant-associated anaplastic large cell lymphoma","aka":["BIA-ALCL","Breast implant-associated ALCL","Breast implant-associated anaplastic large-cell lymphoma","Implant-associated ALCL","Breast implant lymphoma"],"tldr":"A rare lymphoma that grows in the scar capsule the body forms around a breast implant, usually many years after the operation, and usually shows itself as sudden swelling of the breast from fluid around the implant. It is linked to textured implants, and when it is confined to the capsule it is usually cured by removing the implant and the capsule whole.","summary":"What it is. A T-cell lymphoma that arises in the fibrous capsule the body builds around a breast implant. In most women it stays inside that capsule and in the fluid between the capsule and the implant, and does not invade. WHO-HAEM5 describes it as an entity distinct from other ALK-negative anaplastic large cell lymphomas, usually non-invasive, arising in association with textured-surface implants, and associated with an excellent outcome, and adds that invasion of adjacent structures worsens the outlook.\n\nHow it shows itself, and the one thing that must not be missed. The usual presentation is a late seroma: the reconstructed or augmented breast swells, often suddenly, more than a year after the operation and typically many years after it. The rule that follows is simple and is the single most useful sentence on this page. A late seroma around a breast implant is aspirated, and the fluid is sent for cytology and for CD30 immunohistochemistry, rather than simply drained. Less often the disease presents as a mass in the capsule or as contracture of the capsule, and those carry a worse outlook because the disease has left the fluid.\n\nHow it differs from the lymphoma it is named after. It carries CD30 and lacks ALK, like systemic ALK-negative anaplastic large cell lymphoma, and it behaves nothing like it. The systemic disease is treated with combination chemotherapy and is cured in a minority; this one, confined to the capsule, is treated surgically and is cured in almost everybody.\n\nWhy the implant matters. The cases are almost exclusively in women with textured implants. In the Dutch series, 23 of the 28 implants of known type in the lymphoma cases were macrotextured, 82 per cent, against 45 per cent of implants sold in the same country over the same years. The meta-analysis found the same risk whether the implant was placed for reconstruction after cancer or for cosmetic reasons. WHO-HAEM5 describes the biology as involving an allergic inflammatory response, escape from the immune system through amplification at 9p24.1 and overexpression of PD-L1 in more than half of cases, and constant activation of the JAK-STAT pathway through mutations of STAT3, STAT5B, JAK1 and JAK2 and loss-of-function mutations of SOCS1 and SOCS3.\n\nWhat the treatment is. Complete removal of the implant together with the whole capsule, intact where possible, and removal of any mass, which for disease confined to the capsule is usually the whole of the treatment. Disease that has spread beyond the capsule or formed a mass is staged and treated systemically, as a CD30-positive T-cell lymphoma. Women with implants and no symptoms are not advised to have them removed; the advice rests on recognising a late seroma and investigating it properly.","asOf":"2026-09-29","wikipedia":"https://en.wikipedia.org/wiki/Anaplastic_large-cell_lymphoma","links":[{"label":"WHO Classification of Haematolymphoid Tumours, 5th edition: lymphoid neoplasms (Alaggio, Leukemia 2022)","url":"https://doi.org/10.1038/s41375-022-01620-2"},{"label":"International Consensus Classification of Mature Lymphoid Neoplasms (Campo, Blood 2022)","url":"https://doi.org/10.1182/blood.2022015851"},{"label":"Breast implants and the risk of anaplastic large-cell lymphoma in the breast, Dutch nationwide pathology registry (de Boer, JAMA Oncology 2018)","url":"https://doi.org/10.1001/jamaoncol.2017.4510"},{"label":"Risk of breast implant-associated anaplastic large cell lymphoma, systematic review and meta-analysis (Aesthetic Plastic Surgery 2024)","url":"https://doi.org/10.1007/s00266-024-03956-9"}],"tags":["heme","lymphoma","subtype-page"],"related":["alk-negative-anaplastic-large-cell-lymphoma","alk-positive-anaplastic-large-cell-lymphoma","peripheral-t-cell-lymphoma","breast-cancer","non-hodgkin-lymphoma"],"cancers":[],"sections":[],"technologies":["histopathology-ihc"],"targets":["cd30"],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":["bia-alcl","lymphoma-classification-2022","lymphoma-nodal-versus-extranodal","lymphoma-b-versus-t-cell"],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"group":"haematologic","burden":"Rare in absolute terms, and strongly concentrated in women with textured implants. In the Dutch nationwide pathology registry, which identified every primary breast lymphoma between 1990 and 2016, 32 of 43 women with anaplastic large cell lymphoma of the breast had an implant on the same side, against 1 of 146 women with other primary breast lymphomas. The cumulative risk in women with implants was 29 per million at age 50 and 82 per million at 70, and the authors calculated that 6,920 women would need an implant to cause one case before the age of 75. A later meta-analysis across 525,475 patients with implants and 254 cases put the median time from implant to diagnosis at 13.16 years. The glossary entry written for the breast cancer pages carries the full set of figures.","subtypes":["Confined to the seroma and the capsule, the great majority of breast implant-associated ALCL, usually cured by complete removal","With a mass or invasion beyond the capsule, which carries a worse outlook and needs systemic treatment"],"biomarkers":["CD30 on the large cells in the seroma fluid, which is how the diagnosis is made","Absence of ALK, as in systemic ALK-negative anaplastic large cell lymphoma","Whether the disease is confined to the capsule or has formed a mass or invaded, which is the main determinant of outcome","The implant surface: cases are almost exclusively associated with textured implants","Amplification at 9p24.1 with PD-L1 overexpression in more than half of cases, and activating mutations of STAT3, STAT5B, JAK1 and JAK2"],"standardOfCare":[{"setting":"A late swelling around a breast implant","approach":"A seroma appearing around a breast implant more than a year after the operation is aspirated and the fluid sent for cytology and for CD30 immunohistochemistry, rather than simply drained. That single step is what makes the diagnosis, and draining without testing is how it is missed. The same applies to a new mass in the capsule or to capsular contracture appearing years after surgery. Imaging, usually ultrasound in the first instance, maps the fluid and any mass.","refs":["histopathology-ihc","cd30","bia-alcl"],"guideline":{"version":"WHO Classification of Haematolymphoid Tumours, 5th edition (2022), with the International Consensus Classification (2022) where they differ","url":"https://doi.org/10.1038/s41375-022-01620-2"}},{"setting":"Disease confined to the capsule","approach":"Complete removal of the implant together with the whole capsule, intact where it can be done, and removal of any associated mass. For disease that has not left the capsule this is usually the whole of the treatment, and WHO-HAEM5 describes the entity as usually non-invasive and associated with an excellent outcome. Removal of an implant on the other side is discussed case by case. Women with implants and no symptoms are not advised to have them removed.","refs":["bia-alcl","histopathology-ihc"],"guideline":{"version":"NCI PDQ: adult non-Hodgkin lymphoma treatment","url":"https://www.cancer.gov/types/lymphoma/hp/adult-nhl-treatment-pdq"}},{"setting":"Disease that has formed a mass or spread","approach":"Staged and treated as a CD30-positive T-cell lymphoma, on the pathway used for systemic anaplastic large cell lymphoma, because WHO-HAEM5 records that invasion of adjacent structures worsens the outlook. Radiotherapy to the chest wall is used in some series for disease that cannot be removed completely. The evidence is case series; there are no trials and there will not be, because the great majority of patients are cured by surgery.","refs":["alk-negative-anaplastic-large-cell-lymphoma","brentuximab-vedotin","lymphoma-tx-radiotherapy","peripheral-t-cell-lymphoma"],"guideline":{"version":"NCI PDQ: adult non-Hodgkin lymphoma treatment","url":"https://www.cancer.gov/types/lymphoma/hp/adult-nhl-treatment-pdq"}}],"stateOfArt":[],"history":[{"year":2016,"title":"Recognised as a provisional entity","note":"The revised fourth edition of the WHO classification named breast implant-associated anaplastic large cell lymphoma as a provisional entity separate from systemic ALK-negative disease.","refs":[]},{"year":2018,"title":"The size of the risk measured in a national registry","note":"The Dutch pathology registry found an implant on the same side in 32 of 43 women with breast anaplastic large cell lymphoma against 1 of 146 with other primary breast lymphomas, and put the cumulative risk in women with implants at 29 per million by age 50 and 82 per million by 70.","refs":[]},{"year":2022,"title":"Confirmed as a distinct entity","note":"WHO-HAEM5 lists it as one of the three anaplastic large cell lymphomas, describes it as usually non-invasive and associated with an excellent outcome, and records that invasion of adjacent structures worsens the outlook.","refs":["lymphoma-classification-2022"]}],"pipeline":[],"openProblems":["The absolute risk is small and the exposure is very common, so the right advice to a woman who already has textured implants and no symptoms is a question about communication rather than about oncology; current guidance is not to remove them.","Why a textured surface and not a smooth one is not fully explained, and the proposed mechanisms, chronic inflammation and an allergic response to the surface, have not been shown to be the cause.","Because the disease is almost always cured by surgery, there are no randomised trials and there will not be, so the management of the minority with invasive disease rests on case series."],"parent":"peripheral-t-cell-lymphoma"},"route":"/cancers/breast-implant-associated-alcl/","neighbours":{"cancer":[{"id":"alk-negative-anaplastic-large-cell-lymphoma","kind":"cancer","name":"ALK-negative anaplastic large cell lymphoma","route":"/cancers/alk-negative-anaplastic-large-cell-lymphoma/"},{"id":"alk-positive-anaplastic-large-cell-lymphoma","kind":"cancer","name":"ALK-positive anaplastic large cell lymphoma","route":"/cancers/alk-positive-anaplastic-large-cell-lymphoma/"},{"id":"breast-cancer","kind":"cancer","name":"Breast cancer (all types)","route":"/cancers/breast-cancer/"},{"id":"non-hodgkin-lymphoma","kind":"cancer","name":"Non-Hodgkin lymphoma (all types)","route":"/cancers/non-hodgkin-lymphoma/"},{"id":"peripheral-t-cell-lymphoma","kind":"cancer","name":"Peripheral T-cell lymphomas (including cutaneous T-cell lymphoma)","route":"/cancers/peripheral-t-cell-lymphoma/"}],"technology":[{"id":"histopathology-ihc","kind":"technology","name":"Histopathology & immunohistochemistry","route":"/technologies/histopathology-ihc/"}],"target":[{"id":"cd30","kind":"target","name":"CD30","route":"/targets/cd30/"}],"term":[{"id":"lymphoma-b-versus-t-cell","kind":"term","name":"B-cell, T-cell and NK-cell lymphoma","route":"/terms/lymphoma-b-versus-t-cell/"},{"id":"bia-alcl","kind":"term","name":"Breast implant-associated anaplastic large cell lymphoma","route":"/terms/bia-alcl/"},{"id":"lymphoma-nodal-versus-extranodal","kind":"term","name":"Nodal and extranodal lymphoma","route":"/terms/lymphoma-nodal-versus-extranodal/"},{"id":"lymphoma-tx-radiotherapy","kind":"term","name":"Radiotherapy in lymphoma: involved-site fields, 24 Gy, 4 Gy and total skin electron therapy","route":"/terms/lymphoma-tx-radiotherapy/"},{"id":"lymphoma-classification-2022","kind":"term","name":"The two lymphoma classifications of 2022 (WHO-HAEM5 and ICC)","route":"/terms/lymphoma-classification-2022/"}],"drug":[{"id":"brentuximab-vedotin","kind":"drug","name":"Brentuximab vedotin","route":"/drugs/brentuximab-vedotin/"}]}}