BACKGROUND: Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a recently discovered malignancy of T-cell type, correlated with the use of silicone breast implants. It has been theorized that the etiology may be linked to bacterial growth and long-term inflammation. The afflicted patient usually presents with breast swelling due to peri-implant fluid accumulation. Currently, the diagnosis is achieved by ultrasound, biopsy and testing for certain biomarkers. Following this, the treatment is achieved by complete surgical excision, or by capsulectomy and exchange with smoother surfaced implants. The aim of this study was to identify and report 50 most cited articles related to the field of BIA--ALCL. METHODS: The Web of Science Citation Index was used to identify 325 articles pertaining to BIA-ALCL. The 50 most cited articles among these were included in this study. The title, author name, journal and year of publication, country and institute of origin, level of evidence (LoE), type of study (clinical or basic), and topic of study (pathophysiology, oncologic management, diagnosis, case report and case series) were recorded. RESULTS: This study includes articles from the period 1997-2018 with an average citation rate of 65.5. The majority of the top cited articles (36%; N = 18) were found to be case reports, followed by case series (18%; N = 9), systemic reviews (12%; N = 6) and studies focused on the pathophysiology (16%; N = 8), oncologic management (6%; N = 3), databases (6%; N = 3), diagnostics (4%; N = 2) and informed consent (2%; N = 1). The articles were published across 30 journals and originated from 35 institutes. The United States was found to be the country of origin of most of the studies. While none of the articles achieved LoE 1, many were found to have LoE 4 (N = 11) or 5 (N = 19). Most of the articles (N = 42), were clinical research studies. CONCLUSION: According to this citation analysis, a large fraction of the existing high impact literature on BIA-ALCL is focused on disease monitoring. Through this study, we hope to present a simple educational tool to better appreciate the research in this relatively young field.

• Klíčová slova
• BIA-ALCL, breast implant illness, breast implant lymphoma, breast implant-associated anaplastic large cell lymphoma,
• MeSH
• anaplastický velkobuněčný lymfom * etiologie   MeSH
• lidé MeSH
• nádory prsu * etiologie   MeSH
• prsní implantáty * škodlivé účinky   MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) is a rare peripheral T cell lymphoma. BIA-ALCL is a disease of the fibrous capsule surrounding the implant and occurs in patients after both breast reconstruction and augmentation. More than 300 cases have been reported so far, including two in a transgender patient. Here we describe BIA-ALCL presented with a mass in a transgender patient and the first case of BIA-ALCL in the Czech Republic. In 2007, a 33-year-old transgender male to female underwent bilateral breast augmentation as a part of his transformation to female. In June 2014, the patient developed a 5-cm tumorous mass in her left breast. Magnetic resonance imaging of the chest revealed a ruptured implant and a tumorous mass penetrating into the capsule and infiltrating the pectoral muscle. An R0 surgery was indicated-the implant, silicone gel and capsule were removed, and the tumorous mass was resected together with a part of the pectoral muscle. Histology revealed anaplastic large-cell lymphoma. The patient underwent standard staging procedures for lymphoma including a bone marrow trephine biopsy, which confirmed stage IE. The patient was treated with the standard chemotherapy for systemic ALCL-6 cycles of CHOP-21. The patient was tumor-free at the 2-year follow-up. BIA-ALCL has been reported mostly in women who received implants for either reconstructive or aesthetic augmentation. This is the third report of BIA-ALCL in a transgender person, the first in the Czech Republic. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

• Klíčová slova
• Breast implant-associated anaplastic large-cell lymphoma, Silicone breast implants, Transgender patient,
• MeSH
• anaplastický velkobuněčný lymfom diagnostické zobrazování   etiologie   terapie   MeSH
• cyklofosfamid MeSH
• doxorubicin MeSH
• implantace prsní náhrady škodlivé účinky   metody   MeSH
• imunohistochemie MeSH
• jehlová biopsie MeSH
• kombinovaná terapie MeSH
• lidé MeSH
• magnetická rezonanční tomografie metody   MeSH
• nádory prsu diagnostické zobrazování   etiologie   terapie   MeSH
• následné studie MeSH
• odstranění implantátu MeSH
• PET/CT MeSH
• prednison MeSH
• protokoly protinádorové kombinované chemoterapie MeSH
• prsní implantáty škodlivé účinky   MeSH
• silikonové gely škodlivé účinky   MeSH
• transgender osoby MeSH
• vinkristin MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• Názvy látek
• cyklofosfamid MeSH
• doxorubicin MeSH
• prednison MeSH
• silikonové gely MeSH
• vinkristin MeSH

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a distinct subtype of T-cell non-Hodgkin lymphoma that arises in the context of prolonged exposure to textured breast implants. The intent of this manuscript is to explore whether the bacterial presence in biofilms on these implants is a mere incidental finding or plays a pivotal role in the pathogenesis of BIA-ALCL. Our goal is to delineate the extent of bacterial involvement, offering insights into potential underlying mechanisms, and establishing future research priorities aimed at resolving the remaining uncertainties surrounding this complex association. A comprehensive systematic review of several databases was performed. The search strategy was designed and conducted by an experienced librarian using controlled vocabulary with keywords. The electronic search identified 442 publications. After evaluation, six studies from 2015 to 2021 were included, encompassing 201 female patients aged 23 to 75. The diagnosis span post-implantation ranged from 53 to 135.6 months. Studies consistently found bacteria near breast implants in both BIA-ALCL cases and controls, with varied microbial findings. Both BIA-ALCL cases and controls exhibited the presence of specific bacteria, including Pseudomonas aeruginosa, Klebsiella oxytoca, Staphylococcus aureus, and Ralstonia spp., without any statistically significant differences between groups. The use of antiseptic and antimicrobial agents during implant insertion did not demonstrate any impact on reducing or altering the risk of developing BIA-ALCL. Our systematic review reveals that the current evidence is inadequate to link bacterial etiology as a central factor in the development of BIA-ALCL. The limitations in the existing data prevent a complete dismissal of the role of biofilms in its pathogenesis. The observed gap in knowledge underscores the need for more focused and comprehensive research, which should be structured in a multi-faceted approach. Initially, this involves the utilization of sophisticated genomic and proteomic methods. Following this, it is crucial to delve into the study of immunological reactions specifically induced by biofilms. Finally, this research should incorporate extended observational studies, meticulously tracking the evolution of biofilm development and its correlation with the emergence of BIA-ALCL. In light of the inconclusive nature of current findings, further investigation is not only justified but urgently needed to clarify these unresolved issues.

• Klíčová slova
• BIA-ALCL, bacterial etiology, biofilms, breast implants, molecular pathway,
• MeSH
• anaplastický velkobuněčný lymfom * etiologie   MeSH
• Bacteria MeSH
• lidé MeSH
• proteomika MeSH
• prsní implantáty * škodlivé účinky   MeSH
• prsy MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH
• systematický přehled MeSH

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is an uncommon T cell Non-Hodgkin Lymphoma (NHL) associated with breast implants. Raising awareness of the possibility of BIA-ALCL in anyone with breast implants and new breast symptoms is crucial to early diagnosis. The tumour begins on the inner aspect of the peri-implant capsule causing an effusion, or less commonly a tissue mass to form within the capsule, which may spread locally or to more distant sites in the body. Diagnosis is usually made by cytological, immunohistochemical and immunophenotypic evaluation of the peri-implant fluid: pleomorphic lymphocytes are characteristically anaplastic lymphoma kinase (ALK) negative and strongly positive for CD30. BIA-ALCL is indolent in most patients but can progress rapidly. Surgical removal of the implant with the intact surrounding capsule (total en-bloc capsulectomy) is usually curative. Late diagnosis may require more radical surgery and systemic therapies and although these are usually successful, poor outcomes and deaths have been reported. By adopting a structured approach, as suggested in these guidelines, early diagnosis and successful treatment will minimize the need for systemic treatments, reduce morbidity and the risk of poor outcomes. These guidelines provide an evidence-based and systematic framework for the assessment and treatment of patients with suspected or proven BIA-ALCL and are aimed at all clinicians involved in the care of people with breast implants.

• Klíčová slova
• BIA-ALCL, breast implants, lymphoma, reconstructive breast surgery, treatment guidelines,
• MeSH
• anaplastický velkobuněčný lymfom diagnóza   etiologie   patologie   terapie   MeSH
• lidé MeSH
• nádory prsu diagnóza   etiologie   patologie   terapie   MeSH
• protinádorové látky terapeutické užití   MeSH
• prsní implantáty škodlivé účinky   MeSH
• radioterapie MeSH
• staging nádorů MeSH
• určení symptomu MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH
• směrnice pro lékařskou praxi MeSH
• Názvy látek
• protinádorové látky MeSH

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is an uncommon T-cell non-Hodgkin Lymphoma (NHL) associated with breast implants. Raising awareness of the possibility of BIA-ALCL in anyone with breast implants and new breast symptoms is crucial to early diagnosis. The tumour begins on the inner aspect of the peri-implant capsule causing an effusion, or less commonly a tissue mass to form within the capsule, which may spread locally or to more distant sites in the body. Diagnosis is usually made by cytological, immunohistochemical and immunophenotypic evaluation of the aspirated peri-implant fluid: pleomorphic lymphocytes are characteristically anaplastic lymphoma kinase (ALK)-negative and strongly positive for CD30. BIA-ALCL is indolent in most patients but can progress rapidly. Surgical removal of the implant with the intact surrounding capsule (total en-bloc capsulectomy) is usually curative. Late diagnosis may require more radical surgery and systemic therapies and although these are usually successful, poor outcomes and deaths have been reported. By adopting a structured approach, as suggested in these guidelines, early diagnosis and successful treatment will minimise the need for systemic treatments, reduce morbidity and the risk of poor outcomes.

• Klíčová slova
• BIA-ALCL, breast implants, lymphoma, reconstructive breast surgery, treatment guidelines,
• MeSH
• anaplastický velkobuněčný lymfom diagnóza   etiologie   patologie   terapie   MeSH
• lidé MeSH
• management nemoci MeSH
• plastická chirurgie škodlivé účinky   MeSH
• prsní implantáty škodlivé účinky   MeSH
• zákroky plastické chirurgie škodlivé účinky   MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• směrnice pro lékařskou praxi MeSH
• Geografické názvy
• Spojené království MeSH

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is an uncommon T cell Non-Hodgkin Lymphoma (NHL) associated with breast implants. Raising awareness of the possibility of BIA-ALCL in anyone with breast implants and new breast symptoms is crucial to early diagnosis. The tumour begins on the inner aspect of the peri-implant capsule causing an effusion, or less commonly a tissue mass to form within the capsule, which may spread locally or to more distant sites in the body. Diagnosis is usually made by cytological, immunohistochemical and immunophenotypic evaluation of the aspirated peri-implant fluid: pleomorphic lymphocytes are characteristically anaplastic lymphoma kinase (ALK) negative and strongly positive for CD30. BIA-ALCL is indolent in most patients but can progress rapidly. Surgical removal of the implant with the intact surrounding capsule (total en-bloc capsulectomy) is usually curative. Late diagnosis may require more radical surgery and systemic therapies and although these are usually successful, poor outcomes and deaths have been reported. By adopting a structured approach, as suggested in these guidelines, early diagnosis and successful treatment will minimize the need for systemic treatments, reduce morbidity and the risk of poor outcomes.

• Klíčová slova
• BIA-ALCL, Breast implants, Lymphoma, Reconstructive breast surgery, Treatment guidelines,
• MeSH
• anaplastický velkobuněčný lymfom diagnóza   etiologie   terapie   MeSH
• lidé MeSH
• mamoplastika normy   MeSH
• nádory prsu MeSH
• plastická chirurgie * MeSH
• počítačové zpracování obrazu MeSH
• prsní implantáty škodlivé účinky   MeSH
• směrnice pro lékařskou praxi jako téma * MeSH
• společnosti lékařské * MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH
• Geografické názvy
• Spojené království MeSH

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a CD30-positive, anaplastic lymphoma kinase-negative T-cell lymphoma. Where implant history is known, all confirmed cases to date have occurred in patients with exposure to textured implants. There is a spectrum of disease presentation, with the most common occurring as a seroma with an indolent course. A less common presentation occurs as locally advanced or, rarely, as metastatic disease. Here we review the immunological characteristics of BIA-ALCL and potential triggers leading to its development. BIA-ALCL occurs in an inflammatory microenvironment with significant lymphocyte and plasma cell infiltration and a prominent Th1/Th17 phenotype in advanced disease. Genetic lesions affecting the JAK/STAT signaling pathway are commonly present. Proposed triggers for the development of malignancy include mechanical friction, silicone implant shell particulates, silicone leachables, and bacteria. Of these, the bacterial hypothesis has received significant attention, supported by a plausible biologic model. In this model, bacteria form an adherent biofilm in the favorable environment of the textured implant surface, producing a bacterial load that elicits a chronic inflammatory response. Bacterial antigens, primarily of Gram-negative origin, may trigger innate immunity and induce T-cell proliferation with subsequent malignant transformation in genetically susceptible individuals. Although much remains to be elucidated regarding the multifactorial origins of BIA-ALCL, future research should focus on prevention and treatment strategies, recognizing susceptible populations, and whether decreasing the risk of BIA-ALCL is possible.

• Klíčová slova
• T-cells, antigens, bacterial, breast implants, lymphoma,
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

Lymphomas of the breast are rare neoplasms that arise from breast lymphoid tissue and are characterised by neoplastic B or T cells. Breast lymphomas arising from B cells include, but are not limited to, diffuse large B cell lymphoma, follicular lymphoma, extra-nodal marginal zone lymphoma and Burkitt lymphoma. Anaplastic large cell lymphoma (ALCL) is of a T cell origin and both anaplastic lymphoma kinase (ALK)-positive and ALK-negative presentations have been noted in the breast. In addition, there is a more recently identified presentation of ALK-negative ALCL that arises around textured breast implants and is usually confined to a periprosthetic fibrous capsule. Here, we discuss the clinical presentations, histological and immunohistochemical features and treatment options for each type of primary breast lymphoma. We hope that this review will highlight the importance of the timely and accurate diagnosis of breast lymphoma in order to tailor the most appropriate treatment. We also wish to raise awareness of the breast implant-associated lymphomas, with the goal of stimulating work that will aid our understanding of their epidemiology and pathogenesis.

• Klíčová slova
• BIA-ALCL, breast implant lymphoma, breast implants, breast lymphoma, non-Hodgkin lymphoma,
• Publikační typ
• časopisecké články MeSH

There is extensive coverage in the existing literature on implant-associated lymphomas like anaplastic large-cell lymphoma, but breast implant-associated squamous cell carcinoma (BIA-SCC) has received limited scholarly attention since its first case in 1992. Thus, this study aims to conduct a qualitative synthesis focused on the underexplored association between breast implants and BIA-SCC. A systematic review was conducted utilizing the PubMed, Web of Science, and Cochrane databases to identify all currently reported cases of BIA-SCC. Additionally, a literature review was performed to identify potential biochemical mechanisms that could lead to BIA-SCC. Studies were vetted for quality using the NIH quality assessment tool. From an initial pool of 246 papers, 11 met the quality criteria for inclusion, examining a total of 14 patients aged between 40 and 81 years. BIA-SCC was found in a diverse range of implants, including those with smooth and textured surfaces, as well as those filled with saline and silicone. The condition notably manifested a proclivity for aggressive clinical progression, as evidenced by a mortality rate approximating 21.4% within a post-diagnostic interval of six months. Our literature review reveals that chronic inflammation, driven by various external factors such as pathogens and implants, can initiate carcinogenesis through epigenetic modifications and immune system alterations. This includes effects from exosomes and macrophage polarization, showcasing potential pathways for the pathogenesis of BIA-SCC. The study highlights the pressing need for further investigation into BIA-SCC, a subject hitherto inadequately addressed in the academic sphere. This necessitates the urgency for early screening and intervention to improve postoperative outcomes. While the review is confined by its reliance on case reports and series, it serves as a valuable reference for future research endeavors.

• Klíčová slova
• BIA-SCC, clinical cases, molecular pathways,
• MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• nádory prsu * genetika   patologie   MeSH
• prsní implantáty * škodlivé účinky   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• spinocelulární karcinom * genetika   etiologie   patologie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• systematický přehled MeSH

Breast aplasia and hypoplasia are found most frequently in Poland's syndrome but may also be the consequence of damage to the germ of the mammary gland in childhood. The authors present two cases of breast aplasia in which reconstruction was implemented by free transfer of a TRAM flap. The internal mammary vessels were used as recipient vessels, the condition of which was tested before surgery by Doppler. In both instances the reconstruction was implemented at the age of 19 years, and subsequently the areolomammillary complex was created and the contralateral breast corrected to achieve symmetry. The use of autologous tissue in the form of a free TRAM flap provides, in this indication, very good results that are permanent, and the problems associated with the use of implants are eliminated.

• MeSH
• chirurgické laloky * MeSH
• dospělí MeSH
• lidé MeSH
• mamoplastika metody   MeSH
• nehodgkinský lymfom chirurgie   MeSH
• Polandův syndrom chirurgie   MeSH
• pooperační komplikace chirurgie   MeSH
• předškolní dítě MeSH
• prsy abnormality   růst a vývoj   chirurgie   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• předškolní dítě MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH