ﻟﻨﻔﻮم T cell، ﻋﺎرﺿﻪ دﯾﺮرس ﻣﺮﺗﺒﻂ ﺑﺎ ﭘﺮوﺗﺰ Textured ﭘﺴﺘﺎن، ﻣﻘﺎﻟﻪ ﻣﺮوري

Breast Implant Associated Anaplastic Large Cell Lymphoma, (BIA-ALCL) Review Article

BIA-ALCL ﯾﮏ ﻟﻨﻔﻮم ﻧﺎدر T cell ﭘﺴﺘﺎن ﮐﻪ از ﺳﺎل 1997 ﺗﻮﺻﯿﻒ ﺷﺪ، ﻣﯽﺑﺎﺷﺪ. ﻫﻤﺮاﻫﯽ اﯾﻦ ﻧﻮع ﻟﻨﻔﻮم ﭘﺴﺘﺎن ﺑﺎ ﭘﺮوﺗﺰ اﯾﻤﭙﻠﻨﺖ( ﭘﺴﺘﺎن اﺛﺒﺎت ﺷﺪه و ﺗﻘﺮﯾﺒﺎً اﮐﺜﺮ ﻣﻮارد ﺑﯿﻤﺎري در ﭘﺮوﺗﺰﻫﺎي Textured ﻣﺸﺎﻫﺪه ﺷﺪه اﺳﺖ. ﺑﻌﺪ از ﮔﺰارش FDA در ﻣﻮرد اﯾﻦ ﺑﯿﻤﺎري در ﺳﺎل 2011، ﺳﺎزﻣﺎنﻫﺎ و ﻧﻬﺎدﻫﺎي دوﻟﺘﯽ و ﺑﯿﻦ اﻟﻤﻠﻠﯽ در ﻣـﻮرد اﻧﺴﺪاﻧﺲ، روشﻫﺎي ﺗﺸﺨﯿـﺺ و درﻣﺎن آن ﺗﺤﻘﯿـﻖ ﮐـﺮدهاﻧﺪ. در ﺣﺎل ﺣﺎﺿﺮ ﺣﺪود 500 BIA-ALCL در دﻧﯿﺎ ﮔﺰارش ﺷﺪه اﺳﺖ. اﻏﻠﺐ ﻣﻮارد ﺑﯿﻤﺎري ﺑﻪ دﻧﺒﺎل اﯾﺠﺎد ﺳﺮوﻣﺎي ﺗﺄﺧﯿـﺮي )ﺑﻌﺪ از ﯾﮏ ﺳﺎل( در اﻃﺮاف ﭘﺮوﺗﺰ ﭘﺴﺘﺎن )ﺑﻪ ﺻﻮرت ﺷﺎﯾﻌﺘﺮ( و ﯾﺎ اﯾﺠﺎد ﺗﻮده ﭘﺴﺘﺎن )ﺑﺼﻮرت ﻧﺎدرﺗﺮ( اﯾﺠﺎد ﻣﯽﮔﺮدد. در ﺻﻮرت ﺷﮏ ﺑﻪ BIA-ALCL اﺑﺘﺪا ﺗﺼﻮﯾﺮﺑﺮداريﻫﺎﯾﯽ ﻣﺎﻧﻨﺪ PET، ﺳﯽ ﺗﯽ اﺳﮑـﻦ ﯾﺎ ﺳﻮﻧﻮﮔﺮاﻓﯽ اﻧﺠـﺎم ﻣﯽﮔﺮدد و ﺳﭙﺲ آﺳﭙﯿﺮاﺳﯿﻮن ﺑﺎ ﺳﻮزن ﯾﺎ ﻧﻤﻮﻧﻪﺑﺮداري از ﮐﭙﺴﻮل اﻧﺠﺎم ﻣﯽﮔﺮدد و ﺟﻬﺖ ﺑﺮرﺳﯽ ﭘﺎﺗﻮﻟﻮژي ارزﯾﺎﺑﯽ ﻣﯽﺷﻮد. در ﺻﻮرت اﺛﺒﺎت ﺗﺸﺨﯿﺺ ﮐﭙﺴﻮﻟﻮﺗﻮﻣﯽ ﮐﺎﻣﻞ و ﺑﺮداﺷﺘﻦ ﭘﺮوﺗﺰ ﭘﺴﺘﺎن در اﯾﻦ ﺑﯿﻤﺎران اﻧﺪﯾﮑﺎﺳﯿﻮن دارد.

BI-ALCL is an uncommon T-cell lymphoma. In 2011 FDA suggested that breast implants are possibly associated with development of BI-ALCL, since then more cases of BI-ALCL were reported. It is estimated that to this date more than 500 cases have been diagnosed as BI-ALCL around the world. In most of these cases implant surface was textured rather than smooth. Both silicone and saline filled implants have been reported to develop this problem. BIA-ALCL has two different presentations. Two-thirds of the cases present as periprosthetic fluid collection one year or later after implant insertion, and the remaining one-third as a capsular mass around breast implant. These presentations seem to be different stages of one disease. Although the best imaging-based screening is not identified, sonography, PET and CT are appropriate methods. Mammography has low sensitivity for screening of BI-ALCL. Every suspicious case should be confirmed with fine-needle aspiration and pathological examination for IHC (CD30) with insistence to rule out BI-ALCL before surgery. Operative treatment of confirmed cases should include removal of bilateral implants, total capsulectomy, and complete excision of any suspicious lymph node. The role of adjuvant treatments is under investigation. Although BIA-ALCL is rare lymphoma of breast, early diagnosis and appropriate treatment is necessary in the patients. Death has been reported in 9 patients in the U.S.