乳房假体相关间变性大细胞淋巴瘤最新进展及建议

Recent progress and suggestions about breast implant associated-anaplastic large cell lymphoma

乳房假体相关间变性大细胞淋巴瘤(BIA-ALCL)高发于乳房假体置入术后7~10年,患病率为(23~33)/100万。主要临床表现为伴血清肿的乳房肿胀、乳房肿物及淋巴结肿大。发病机制尚不明确,可能与毛面假体诱发的局部CD30+T细胞克隆扩增及免疫反应、JAK-STAT等基因突变及某些病原体感染有关。常用的诊断方法有乳腺超声检查、假体周围渗液的细胞学检查、免疫表型检查及乳房肿块的组织活检。治疗方法主要依靠手术治疗。作者对BIA-ALCL相关文献进行总结并提出建议:(1)警惕当今中国整形美容医疗环境下漏诊的风险,建议针对性收集亚裔人群临床数据。(2)BIA-ALCL发生概率极低,而且预后较好,已经置入毛面假体的患者不必过分担忧。(3)建议从毛面假体工艺、JAK-STAT等突变及病原体感染等方面对致病机制做深入全面研究,倡导多学科合作共同应对该疾病的诊疗。

BIA-ALCL often occurs 7-10 years after breast reconstruction surgery with breast implants and its incidence is about 23-33 per million.The most common symptoms include breast swelling with seroma,breast mass and lymphadenopathy.It’s assumed that BIA-ALCL is associated with immune response induced by textured breast implants with clonal expansion of local CD30+T cell,some gene mutations such as JAK1 and STAT3 mutations as well as pathogen infections.Currently,ultrasonography,cytological and immunological tests of exudate as well as biopsy of breast mass are commonly applied for diagnosis.From the perspective of oncology,we propose the following suggestions:(1)We should be alert to the risk of missed diagnosis in the current medical environment,and clinical information is suggested to be collected especially for Asian patients.(2)Due to the low incidence and good prognosis of BIA-ALCL,those who have used textured implants don’t need to be over-worried.(3)It is suggested that researches about manufacturing technology of textured breast implants,JAK-STAT mutations and pathogen infections should be carried out to explore the pathogenic mechanisms of BIA-ALCL,and multi-disciplinary cooperation should be advocated to cope with the diagnosis and treatment of this disease.