怀疑乳房假体相关间变性大细胞淋巴瘤的患者是否应行T细胞受体基因重排检测?

Should patients with suspected breast implant-associated anaplastic large cell lymphoma be tested for T-cell receptor gene rearrangement?

乳房假体相关间变性大细胞淋巴瘤(BIA-ALCL)是一种罕见的T细胞淋巴瘤,尽管亚洲报道的BIA-ALCL病例很少,但尽早诊断至关重要。包膜内积液中ALK^(-)和CD30^(+)T细胞数>10%是其重要诊断标准。T细胞受体(TCR)基因重排检测是辅助复杂T细胞疾病病理诊断和免疫诊断的常用手段,但在BIA-ALCL早期是否存在TCR基因单克隆重排目前尚未见报道。该文报道了1例双侧假体隆乳术后20余年的56岁女性患者,因左侧乳房变硬、增大伴轻微刺痛于2023年1月就诊于上海交通大学医学院附属第九人民医院,MRI提示假体破裂,遂于2023年2月2日行双侧假体取出术。患者左侧假体包膜积液病理切片中发现少量ALK^(-)和CD30^(+)T细胞,TCRγ基因重排呈单克隆性,疑为BIA-ALCL早期改变,需要长期随访。作者建议对怀疑为BIA-ALCL的患者在行细胞形态学、免疫学检查的同时应进行TCR基因重排检测,可以为此类患者的诊治和必要的长期随访提供借鉴。

Breast implant-associated anaplastic large cell lymphoma(BIA-ALCL)is a rare type of T-cell lymphoma.Despite the scarcity of reported BIA-ALCL cases in Asia,it is imperative to research early diagnosis.The crucial diagnostic criteria for BIA-ALCL include the presence of ALK^(-)and CD30^(+)T cells exceeding 10%in the delayed seroma fluid.Furthermore,laboratory tests,such as histological examination of capsulectomies and analysis of clonal T-cell receptor(TCR)gene rearrangements,serve as important auxiliary diagnostic indicators.This article reported the case of a 56-year-old female patient who underwent bilateral breast augmentation with implants over 20 years ago.She presented with hardness,enlargement,and mild discomfort in her left breast.She was admitted to Shanghai Ninth People’s Hospital,Shanghai Jiao Tong University School of Medicine in January 2023.MRI suggested implant rupture.Therefore,bilateral implant removal surgery was performed on February 2,2023.Pathological examination of the fluid within the capsule of the left implant revealed a small number of ALK^(-)and CD30^(+)T cells,with monoclonality observed in TCRγgene rearrangement,indicating early changes suggestive of BIA-ALCL.Long-term follow-up is needed.The authors suggest that patients suspected of BIA-ALCL should undergo TCR gene rearrangement testing in addition to cytological and immunological examinations,which can provide guidance for the diagnosis,treatment,and necessary long-term follow-up of these patients.