有症状毛面乳房植入物相关的间变性大细胞淋巴瘤的筛查流程研究

Screening process of breast implant associated-anaplastic large cell lymphoma in symptomatic patients withtexturedbreastimplants

目的探讨有症状毛面乳房植入物相关的间变性大细胞淋巴瘤临床筛查流程, 为毛面乳房植入物患者的管理提供经验。方法回顾性纳入2019年1月至2021年9月北京协和医院整形外科收治有症状毛面乳房植入物患者23例, 年龄29~52岁, 平均36.2岁。所有患者均同意手术取出假体, 术前或术中对假体周围积液、包膜组织行细胞学、流式细胞仪、免疫组织化学检查, 完善间变性大细胞淋巴瘤筛查流程。结果 23例患者均表现为单侧乳房假体周围积液, 积液量20~130 ml, 其中合并包膜挛缩者7例。术中完整取出假体及周围包膜组织, 假体周围积液及包膜组织病理检测均未发现恶性肿瘤细胞, 间变性大细胞淋巴瘤(CD 30、ALK)病理学筛查结果均为阴性。术后无出血、感染、伤口裂开等并发症。结论对有症状乳房毛面假体植入患者开展个性化临床筛查流程。重视影像学检查、病理检查。

Objective To summarize the clinical diagnosis and treatment process of breast implant associated-anaplastic large cell lymphoma(BIA-ALCL)in symptomatic patients with textured breast implants in Peking Union Medical College Hospital in order to provide reference for the management of such patients in China.Methods From January 2019 to September 2021,23 symptomatic patients with textured breast implants were admitted to the Peking Union Medical College Hospital,aged 29-52 years,with an average of 36.2 years.All patients agreed to remove the prosthesis by surgery,and accepted cytology,flow cytometry,and immunohistochemical examination of the fluid around the implants and capsule tissue before or during the operation to complete the BIA-ALCL screening process.Results All 23 patients presented with unilateral periprosthetic fluid accumulation,with fluid volume ranging from 20 to 130 ml,of which 7 cases were combined with periprosthetic contracture.No tumor cells were found in the pathological findings of effusion and the capsule tissue,and the BIA-ALCL pathologic screening results(CD 30 and ALK)were all negative.No bleeding,infection,wound dehiscence and other complications occurred after the operation.Conclusions A personalized clinical process should be developed for symptomatic patients with textured breast implants.Attention should be paid to imaging and pathological examinations.