Mammography is limited in its capacity to detect lymphomas that present as a diffuse infiltration or a small mass (Figure 4).

Breast implant-associated ALCL is extremely rare. It affects around 80 in every million people who have had breast implants. It is more common in people with implants that have a rough, textured surface than people with smooth implants.

ALK-positive systemic ALCL is relatively less aggressive and carries a better prognosis than ALK-negative systemic ALCL. Primary cutaneous-ALCL is typically ALK negative. However, a few cases with ALK positivity have been reported with similar prognosis.

Anaplastic large cell lymphoma (ALCL), anaplastic lymphoma kinase (ALK)-positive (ALK+ ALCL) is an aggressive CD30-positive T-cell lymphoma that exhibits a chromosomal translocation involving the ALK gene and the expression of ALK protein. No particular risk factor has been clearly identified for ALCL.

The main symptoms of BIA-ALCL are persistent swelling, presence of a mass or pain in the area of the breast implant. These symptoms may occur well after the surgical incision has healed, often years after implant placement.

ALCL is potentially a curable disease. The prognosis is dependent on ALK status and the IPI score. Overall survival (OS) for all patients with ALK positive ALCL is 70 to 90% at 5 years, with a failure free survival (FFS) of approximately 60%.

Usually, it takes at least two years after surgery for symptoms to emerge. However, the average length of time before symptoms appear is eight years. Symptoms of BIA-ALCL may include: Swelling or fluid accumulation in the breast or around an implant.

The causes of anaplastic large cell lymphoma (ALCL) are mostly unknown. Breast implant-associated ALCL is more common in people who have an implant with a rough textured surface. It is thought that it may be caused by an inflammatory reaction to the implant, although this is not certain.

ALCL comprises about one percent of all NHLs and approximately 16 percent of all T cell lymphomas. A diagnosis of ALCL requires taking a biopsy (small sample of tumor tissue or abnormal skin tissue) and looking at the cells under a microscope.

Patients with pediatric ALCL commonly present at an advanced stage of disease and, unlike adult ALCL, the majority of pediatric cases demonstrate overexpression of anaplastic lymphoma kinase (ALK). Despite a range of treatment strategies, event-free survival has remained stagnant at 65–75%.

If this occurs, it is usually treated like systemic ALCL. Patients with systemic ALCL are divided into two groups: ALK-positive and ALK-negative ALCL. Although both systemic lymphomas are treated as aggressive lymphomas, the disease course may be different.

In contrast, while most people with ALK-negative ALCL initially respond to treatment as well, the disease is more likely to relapse (disease returns after treatment) within five years. Sometimes, ALK-negative patients are treated more aggressively, often with a stem cell transplant after remission.