Megaprosthesis use in Paprosky III/IV femoral defects in non-oncological patients: analysis of survival, clinical, and functional outcomes after an average follow-up of five years.

PURPOSE: To determine the survival and patient-reported outcomes in non-oncological patients treated with proximal femoral resection (PFR) using MEG for femoral reconstruction. MATERIALS AND METHODS: This retrospective study included 16 patients. Demographic variables and complications developed were analyzed. Clinical-functional outcomes were measured using the modified Harris score (mHSS), numeric Pain Rating Scale (NPRS) and Musculoskeletal Tumor Society (MSTS) score. MEG survival was estimated using a Kaplan-Meier survival analysis. RESULTS: Average follow-up was 5 years (range, 1-9). The 75% of patients were overweight and women with an average age of 74.2 ± 5.9-years (BMI of 28.5 ± 4.2 kg/m2). The main cause of MEG was periprosthetic infection (43.7%). The 50% of patients had post-surgical complications regarding with MEG, being the most frequent seromas and MEG dislocation. Implant survival was 93.4% and 80.9% at 3 and 7 years of follow-up, respectively. The functional results at the end of the follow-up with respect to the pre-surgical state improved from 9.5 ± 2.6 to 3 ± 0.9 mean NPRS and 26.5 ± 6.8 to 69.5 ± 13.5 mean mHHS, p < 0.001, respectively. The mean MSTS score was 68.1% that these results were considered excellent. CONCLUSIONS: The MEG for reconstruct III-IV femoral defects is a good therapeutic option that offers an acceptable clinical-functional result. Short-term and medium-term survival was greater than 80%. The most frequent complications are seromas and MEG dislocation. The use of constrained liner and abductor system reconstruction is essential to prevent the dislocation.

Diagnosis of breast implant associated anaplastic large cell lymphoma by analysis of cytokines in peri-implant seromas.

More than 1300 women with breast implants have developed an anaplastic large cell lymphoma (ALCL) in fluid (seroma) around their implant. More often, seromas are due to benign causes, for example, capsule contracture, leakage, or trauma. Our report in American Journal of Hematology identified several cytokines (IL-9, IL-10, IL-13) as significantly elevated only in seromas due to ALCL. We further showed that the most robust biomarker, IL-10, could be detected by a lateral flow assay (similar to COVID detection) within minutes allowing physicians to quickly plan management, eliminate or reduce costly testing and patient time away from family. Early detection of ALCL in seromas before infiltration may avoid need for cytotoxic or immunotherapy and is possibly life-saving.

The effect of immediate lymphatic reconstruction on the post-operative drain output after axillary lymph node dissection for breast cancer: A retrospective comparative study.

INTRODUCTION: Axillary lymph node dissection (ALND) for breast cancer has been considered to be associated with a variety of complications, such as excessive postoperative wound drainage, prolonged drain placement, or seroma formation in the short term, or arm lymphedema in the long run. Immediate lymphedema reconstruction (ILR) has been proposed to reduce the occurrence of arm lymphedema by anastomosing the transected arm lymphatics to nearby branches of the axillary vein immediately after ALND. This study aims to demonstrate that ILR can also reduce the postoperative drainage amount. PATIENTS AND METHODS: Between April 2020 and January 2022, a total of 76 breast cancer patients receiving ALND were reviewed. Forty four of them also received ILR immediately after ALND. The assignment of ILR surgery was non-random, based on patients' willingness and plastic surgeons' availability. The lymphatic vessels in the axillary wound were anastomosed with nearby terminal branches of the axillary vein under surgical microscope. Patients' characteristics, including age, body mass index (BMI), neoadjuvant therapy, type of breast surgery, the occurrence of seroma formation, number of removed lymph nodes, number of positive nodes, and the drainage amount from the operative wounds were compared between ILR and non-ILR groups. RESULTS: No statistically significant difference was noted between groups in terms of age (56.5 ± 9.8 vs. 60.9 ± 10.7, p = .09), BMI (22.6 ± 3.7 vs. 23.7 ± 3.8, p = .27), type of breast surgery (p = .32), the occurrence of seroma formation (p = 1.0), the likelihood of receiving neoadjuvant therapy (p = .12), number of lymph nodes removed (17.5 ± 7.6 vs. 17.4 ± 8.3, p = .96), or number of positive nodes on final pathology (3.7 ± 5.4 vs. 4.8 ± 8.5, p = .53) except the ILR group had statistically significantly less drainage amount than non-ILR group (39.3 ± 2.6 vs. 48.3 ± 3.7, p = .046). CONCLUSION: For breast cancer patients receiving ALND, the immediate lymphatic reconstruction can reduce the postoperative drainage amount from the operative wound.

Prediction of seroma after total mastectomy using an artificial neural network algorithm.

Seroma is a common complication after mastectomy. To the best of our knowledge, no prediction models have been developed for this. Henceforth, medical records of total mastectomy patients were retrospectively reviewed. Data consisting of 120 subjects were divided into a training-validation data set (96 subjects) and a testing data set (24 subjects). Data was learned by using a 9-layer artificial neural network (ANN), and the model was validated using 10-fold cross-validation. The model performance was assessed by a confusion matrix in the validating data set. The receiver operating characteristic curve was constructed, and the area under the curve (AUC) was also calculated. Pathology type, presence of hypertension, presence of diabetes, receiving of neoadjuvant chemotherapy, body mass index, and axillary lymph node (LN) management (i.e., sentinel LN biopsy and axillary LN dissection) were selected as predictive factors in a model developed from the neural network algorithm. The model yielded an AUC of 0.760, which corresponded with a level of acceptable discrimination. Sensitivity, specificity, accuracy, and positive and negative predictive values were 100%, 52.9%, 66.7%, 46.7%, and 100%, respectively. Our model, which was developed from the ANN algorithm can predict seroma after total mastectomy with high sensitivity. Nevertheless, external validation is still needed to confirm the performance of this model.

Use of flow cytometry and cytology to differentiate breast implant-associated anaplastic large cell lymphoma from reactive seromas in Brazilian patients.

INTRODUCTION: The combination of cytology and multiparametric flow cytometry (MFC) may be useful in the diagnosis of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) and may be a practical way to differentiate lymphoma from benign and reactive seromas. Although the Brazilian breast implant market is the second largest in the world, with several manufacturers and the almost exclusive use of textured implants, the occurrence of BIA-ALCL in Brazil is underreported. METHODS: One hundred seventeen sequential collections of suspicious periprosthetic fluid (PF) from 105 Brazilian patients registered between March/2018 and March/2021 were evaluated by routine cytomorphology and flow cytometry. The combination of CD30, HLA-DR, and CD25 was used together with T and B lymphocyte and monocyte evaluation. The PF samples were divided into positive, acute reactive (neutrophilic exudate), or chronic reactive (macrophage or lymphocyte rich), and unavailable samples. RESULTS: Nine BIA-ALCL positive cases (7.7%) were identified, with typical morphology and increased FSC/SSC dispersion, bright expression of CD30, CD25 and HLA-DR, and absence or weakness of T-cell antigens (CD3, CD8, CD4, CD5, and CD7). Reactive samples were acute (n = 18, 15.4%) and chronic (n = 70, 59.8%). Twenty samples were excluded. The mean age of BIA-ALCL patients was 50 years (31-57 years) and 35 years in reactive patients (20-69 years). CONCLUSION: Use of MFC with a comprehensive antibody panel consisting of CD30 in conjunction with CD25 and HLA-DR can discriminate anaplastic cells of BIA-ALCL from lymphoid or neutrophilic reactive cells and should be considered in the initial evaluation of seroma.

A Radiation-Crosslinked Gelatin Hydrogel That Promotes Tissue Incorporation of an Expanded Polytetrafluoroethylene Vascular Graft in Rats.

A prosthetic vascular graft that induces perigraft tissue incorporation may effectively prevent serious sequelae such as seroma formation and infection. Radiation-crosslinked gelatin hydrogel (RXgel) mimics the chemical and physical properties of the in vivo extracellular matrix and may facilitate wound healing by promoting tissue organization. Fibroblasts cultured on RXgel actively migrated into the gel for up to 7 days. RXgels of three different degrees of hardness (Rx[10], soft; Rx[15], middle; Rx[20], hard) were prepared, and small disc-like samples of RXgels were implanted into rats. In vitro and in vivo results indicated that Rx[10] was too soft to coat vascular grafts. Thus, expanded polytetrafluoroethylene (ePTFE) vascular grafts coated with RXgel were developed using Rx[15] and Rx[20] gels, and ring-shaped slices of the graft were implanted into rats. Alpha-smooth muscle actin (αSMA) and type III collagen (Col-III) levels were detected by immunohistochemistry. Immunohistochemical staining for αSMA and Col-III demonstrated that RXgel-coated vascular grafts induced more granulation tissue than non-coated grafts on days 14 and 28 after implantation. RXgel-coated ePTFE vascular grafts may provide a solution for patients by reducing poor perigraft tissue incorporation.

Comparing Outcomes of Robotically Assisted Latissimus Dorsi Harvest to the Traditional Open Approach in Breast Reconstruction.

BACKGROUND: Robotically assisted latissimus dorsi harvest permits harvest of the latissimus dorsi muscle without a back incision, as compared to the traditional open technique. The authors hypothesized that robotic harvest has lower donor-site complication rates, decreased opioid requirements, and a shorter length of stay than the traditional open technique. METHODS: A retrospective review was performed of all consecutive pedicled latissimus dorsi flaps for breast reconstruction between 2011 and 2015. All procedures were conducted by two surgeons who performed both robotic and open cases. RESULTS: Fifty-two patients were identified; 25 underwent robotically assisted latissimus dorsi harvest and 27 underwent the open technique. Demographic data between the two groups were similar. Median length of stay for robotic harvest was shorter than that for the traditional technique (2 days versus 3 days; p = 0.031). Postoperative morphine requirement was less in the robotic compared to the traditional technique, but the difference was not significant (158 mg versus 184 mg; p = 0.826). Seroma rate was higher in the robotic group (16 percent versus 0 percent; p = 0.034). The mean duration of surgery was longer in the robotic cohort (388 minutes versus 311 minutes; p = 0.002). CONCLUSIONS: This study demonstrates robotically assisted latissimus dorsi harvest as an effective alternative to the traditional open technique in select patients. Advantages of robotic harvest include no back scar, a shorter length of stay, and lower opioid requirements, although the difference was not significant; disadvantages include longer operative time and a higher seroma rate. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Primer caso en Panamá de linfoma anaplásico de células grandes asociado a implantes mamarios (LACG-AIM) / First case in Panama of breast implant associated anaplastic large cell lymphoma (BIA-ALCL)

El linfoma anaplásico de células grandes asociado a implantes mamarios (LACG-AIM), es una enfermedad sumamente rara. Hasta noviembre 2019 solo se habían reportado 573 casos a nivel mundial. Sin embargo, ya en Panamá, un país pequeño con una población de 4.2 millones, se presentó el primer caso. Se trata de una paciente de 65 años, con seroma tardío en la mama derecha de 7 días de evolución e historia de implantes mamarios macrotexturizados durante los últimos 5 años. El análisis histopatológico de la pieza quirúrgica (capsulectomia completa) y del líquido de seroma confirmaron el diagnóstico de LACG-AIM. La enfermedad estaba limitada al liquido del seroma sin invasión de la cápsula periprotésica (T1AN0M0). El tratamiento consistió en retirada de los implantes, capsulectomía bilateral en bloque, y remplazo inmediato de los implantes. La evolución postoperatoria fue satisfactoria. En los controles clínicos y por imagen a los 2 años la paciente está libre de recurrencia local o enfermedad sistémica

Breast implant associated anaplastic large cell lymphoma (BIA.ALCL) is an extremely rare disease with only 573 cases reported worldwide up to November 2019. However, in Panama a small country with a population of 4.2 million, the first case already showed up. The patient is a 65-year-old female who presents with a one-week history of a delayed seroma on the right breast and a history of having macrotexture breast implants for the past 5 years. The diagnosis was confirmed with histopathological analysis of the complete capsule and the seroma fluid. The disease was confined to the seroma fluid without capsule invasion (T1AN0M0). Treatment consisted of bilateral implant removal with en bloc capsulectomies and immediate implant replacement. Her post op course has been uneventful with normal follow up. She remains free of local recurrence or distant disease up to 24 months post op

Total endoscopic-assisted linea alba reconstruction (TESLAR) for treatment of umbilical/paraumbilical hernia and rectus abdominus diastasis is associated with unacceptable persistent seroma formation: a single centre experience.

PURPOSE: Umbilical hernia with concomitant rectus abdominus diastasis (RAD) is potentially associated with higher recurrence. Open and laparoscopic techniques have already been described, however, recent endoscopic methods show great promise. Therefore, our aim was to establish the risks and benefits of performing total endoscopic-assisted linea alba reconstruction (TESLAR). METHODS: A retrospective review from 28/03/2018 to 01/05/2019 of TESLAR patients was undertaken. Data collected included medical history, operative notes and postoperative course. Statistical analyses were performed using univariate analysis. Operative technique began with a subcutaneous dissection from the lateral borders of anterior rectus sheath, lower costal margin, and pubic bone. The defect was defined and subsequently reduced. Anterior rectus sheath was subsequently plicated and if a mesh was inserted, an on-lay mesh was placed. RESULTS: 21 patients were identified with an 8:13 male to female ratio. Mean age and BMI were 53.1 and 29.7, respectively. 19/21 patients reported post-operative complications requiring reintervention. 17/21 patients had a seroma, all requiring draining with a minority (5/21) requiring formal excision. Univariate analysis showed age (p < 0.001), BMI (p < 0.001) and female gender (p = 0.022) were significantly associated with repeated number of seroma aspirations. CONCLUSION: TESLAR is associated with high rates of seroma and reintervention, including revisional surgery. Open repair should be considered as an alternative strategy for hernia and RAD repair.

The Effects of Platelet-Rich Plasma to Decrease the Risk of Seroma Formation After Mastectomy and Axillary Dissection.

BACKGROUND: Seroma, which is the most common complication after mastectomy and axillary dissection, is the leakage of the lymphovascular fluid into the dead space. It can cause local complications varying from delayed wound healing to infection and skin flap necrosis. The aim of this study was to evaluate whether platelet-rich plasma (PRP) reduces the risk of seroma formation. MATERIALS AND METHODS: A total of 24 Wistar albino rats were randomly divided into three groups of eight rats in each. For the rats in group 1, no additional procedures were carried out. The rats in groups 2 and 3 were applied with 0.25 and 0.5 mL/cm2 PRP, respectively, to the operation site. The groups were compared in respect of adhesion scores, histopathologic examination, and tissue seroma volume. RESULTS: The mean seroma volume was 2.19 ± 0.78 mL in group 1, 1.43 ± 0.35 mL in group 2, and 0.96 ± 0.24 mL in group 3. The seroma volumes of groups 3 and 2 were significantly lower than those in group 1. In the macroscopic assessment the mean general adhesion score was 6 ± 0.75 in group 3. The other general adhesion scores were 5.25 ± 0.70 and 2.12 ± 0.64 in groups 2 and 1, respectively. The adhesion scores of groups 3 and 2 were significantly higher than those of group 1. The mean inflammatory cell score was 0.87 ± 0.83 in group 3, 2.0 ± 0.92 in group 2, and 3.0 ± 0.53 in group 1. There were significantly lower levels of inflammatory cells in group 3 than in the other groups and the group 2 inflammatory cell count was lower than that of group 1. Fibroblast density score was significantly higher in group 3 (2.50 ± 1.06) compared with the other groups. Neovascularization was significantly higher in groups 3 and 2 compared with group 1. The mean neovascularization score was 2.25 ± 1.16 and 2.12 ± 1.12 in groups 2 and 3, respectively. There were no statistically significant differences between the groups in respect of collagen levels. CONCLUSIONS: Local application of PRP in rats after experimental mastectomy and axillary dissection was observed to decrease seroma formation and to increase neovascularization and fibroblast density.

Reducing the seroma volume by quilting suture after breast reconstruction with a latissimus dorsi flap: Single institutional experience.

INTRODUCTION: After breast reconstruction (BR) with latissimus dorsi flap (LDF) postoperative seroma is a frequent source of functional discomfort. The aim of this study was to evaluate the quilting suture on reducing the seroma volume by reducing the dead space created by LDF harvest for BR. MATERIAL AND METHODS: This retrospective monocenter study was designed to compare patients who underwent BR using LDF with or without quilting suture. The primary endpoint was the seroma volume drained during hospitalization and percutaneous puncture. Complications and painful or functional sequelae were also evaluated in both groups. RESULTS: One hundred eight patients were included in the study. The mean (standard deviation, SD) age of our population was 49.7 years (9.3) and the mean body mass index (BMI) 26.9kg/m2 (4.1). Sixty-nine patients (63%) underwent quilting suturing in the latissimus dorsi compartment, 41% with overedge and 59% with simple stitches. The mean total volume of fluid drainage was 1238mL (1111). In multivariate analysis, the use of quilting suture was associated with a significant reduction in the total volume of drainage (-502mL, P=0.03); reduction was greater using overedge stitches than simple stitches (P=0.02). The beneficial effect of quilting suture appears to be more important in patients with a BMI greater than 30kg/m2 (interaction test, P=0.01). CONCLUSION: This study shows the efficacy of quilting suture in reducing postoperative seroma formation in BR using LDF. Efficacy was greater when overedge stitches were used. Obese patients benefited more from quilting suture than patients with BMI<25.

Efficacy and safety of topical nitroglycerin in the prevention of mastectomy flap necrosis: a systematic review and meta-analysis.

Flap necrosis is a common complication after mastectomy, and nitroglycerin (NTG) ointment has been used successfully to treat it. However, it is not clear whether topical NTG can completely prevent the occurrence of flap necrosis after breast cancer surgery, and it is also unclear whether this treatment may cause side effects. Three randomized controlled trials (RCTs) and two retrospective cohort studies (RCSs) were included in our investigation. This meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We found that NTG significantly reduced the rates of mastectomy flap necrosis, full-thickness flap necrosis, and debridement as well as the rate of early complications other than flap necrosis. However, there was no significant difference in drug-related adverse reactions, explantation, superficial flap necrosis, infection, hematoma or seroma between the NTG and placebo groups.

Is tacking the lax transversalis fascia an easy, safe and effective way to reduce the occurrence of seroma after laparoscopic inguinal hernioplasty? A propensity score-matched and -adjusted analysis.

BACKGROUND: Post-operative seroma formation rate is higher in laparoscopic hernioplasty as compared with open repair. Tacking of lax transversalis fascia of direct inguinal hernia is one of the many methods described to reduce the incidence of seroma after laparoscopic inguinal hernioplasty. Our objective is to investigate whether this technique is simple and reliable in reducing the incidence of seroma. METHODS: A retrospective analysis of 548 patients who underwent laparoscopic inguinal hernioplasty between January 2011 and December 2017 was conducted. Patients demographics, operative data and post-operative complications were collected. 38 patients with transversalis fascia tacking were matched using one-to-one propensity score matching with another 38 patients without transversalis fascia tacking. Propensity score-matched analysis and propensity score-adjusted analysis were performed. RESULTS: Patients who underwent transversalis fascia tacking (tacking group) had a significant lower incidence of post-operative seroma, compared to the non-tacking group tacking vs non-tacking: 5.6% vs 28.6% (p = 0.0097) in propensity-score matched analysis and 5.6% vs 21.3% (p = 0.0153) in propensity-score adjusted analysis. There was no difference noted in the duration of the operation and post-operative complications, in particular post-operative pain. CONCLUSIONS: Tacking of lax transversalis facia to the symphysis pubis and Cooper's ligament is a simple yet safe and effective way to reduce the occurrence of seroma after laparoscopic inguinal hernioplasty.

Kikuchi-Fujimoto Disease-Like Inflammatory Reaction in a Silicone Breast Implant Seroma.

INTRODUCTION: Kikuchi-Fujimoto disease (KFD) may have an autoimmune etiology and some cases have been associated with silicone breast implants. Cytomorphologic features of the disease have been well characterized by fine-needle aspiration of lymph nodes. They are so specific as to permit a precise cytologic diagnosis. Cytologic features have not been reported in fluid specimens. CASE: A 33-year-old female presented with a unilateral periprosthetic silicone breast seroma. The fluid was drained, and cytological analysis revealed numerous lymphocytes with no neutrophils, karyorrhectic nuclear debris, and peculiar histiocytes with eccentrically located nuclei showing a crescentic shape. Many of those histiocytes showed intracellular apoptotic debris. CONCLUSION: A Kikuchi disease-like inflammatory reaction is possible not only in axillary and cervical lymph nodes of patients with silicone breast implants but also in breast seromas. There is still not enough evidence to establish if there is an association between KFD and breast implants. A detailed cytologic examination of periprosthetic silicone breast seromas may help answer this question. In any case, pathologists must be aware of this possibility. Cytologic features are characteristic enough to permit differentiation from breast implant-associated anaplastic large-cell lymphoma.

Validation of a CD30 Enzyme-Linked Immunosorbant Assay for the Rapid Detection of Breast Implant-Associated Anaplastic Large Cell Lymphoma.

BACKGROUND: Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is an uncommon type of non-Hodgkin lymphoma occurring in the fluid or capsule adjacent to textured breast implants. Diagnosis of BIA-ALCL of symptomatic patients requires demonstration of large anaplastic cells with uniform expression of CD30 protein on immunohistochemistry. OBJECTIVES: The authors investigated a novel, rapid, office-based, and economic in-situ enzyme-linked immunosorbent assay (ELISA) for screening BIA-ALCL patients. METHODS: A commercially available in-situ ELISA was standardized and validated for patients with confirmed BIA-ALCL diagnosis with clinical isolates. A panel of 9 pathologically confirmed BIA-ALCL patients was screened by serum, plasma, and periprosthetic effusion specimens and compared against serum, plasma, and nonneoplastic delayed seromas in 7 control patients. Statistical analysis demonstrated assay consistency and reliability. RESULTS: All BIA-ALCL effusions demonstrated CD30 ELISA detection at full and all serial concentrations. BIA-ALCL serum specimens and all control specimens were negative at full concentration and serial dilutions (1:100, 1:250, 1:500, and 1:1000). BIA-ALCL plasma specimens were weakly positive at full concentration and revealed no activity with serial dilution. CONCLUSIONS: This is the first study to demonstrate a viable alternative to CD30 immunohistochemistry for the screening of BIA-ALCL. Our study demonstrates 100% sensitivity in seroma fluid with no detectable CD30 in benign seroma samples. A CD30 ELISA represents a novel, low-cost screening test, which may be used to screen suspicious aspirations of delayed periprosthetic fluid collections in an office-based setting.

Linfoma anaplásico de células grandes asociado a implantes mamarios. Cuatro casos diagnosticados en la provincia de Alicante, España / Breast implant associated anaplastic large cell lymphoma. Four cases diagnosed in the province of Alicante, Spain

Introducción y Objetivo. El linfoma anaplásico de células grandes asociado a implantes mamarios es un subtipo de linfoma de células T periférico que se puede encontrar en la cápsula periprotésica, el fluido entre implante y cápsula en forma de seroma o en casos avanzados como enfermedad metastásica. Aportamos 4 casos clínicos de este tipo de linfoma diagnosticados en la provincia de Alicante, España, siendo de interés por ser escasa la incidencia reportada y pocos los trabajos científicos publicados a nivel nacional sobre esta patología. Material y método. Describimos estos 4 casos registrando: edad, antecedentes, indicación del implante, detalles de la cirugía previa, tipo de superficie y marca del implante, presentación clínica del cuadro y tratamiento administrado. Resultados. Dos casos correspondieron a cirugía estética y 2 a cirugía reconstructiva, la presentación clínica en 3 casos fue como seroma tardío y en 1 como linfadenopatía. Tres implantes eran de superficie texturizada y 1 de poliuretano. En todos los casos se realizó capsulectomía bilateral. Conclusiones. La aportación de nuestra serie contribuye a destacar la importancia de reportar los casos diagnosticados dada la escasa incidencia de la enfermedad y el reducido número de publicaciones sobre la misma en el ámbito iberolatinoamericano

Background and Objective. The anaplastic large cell lymphoma associated with breast implants is a subtype of peripheral T cell lymphoma that can be found in the periprosthetic capsule, the fluid between the implant and the capsule in the form of a seroma, or in advanced cases such as metastatic disease. We provide 4 clinical cases diagnosed in the province of Alicante, Spain, being of interest because of the low incidence reported and few published scientific papers nationwide. Methods. We describe these 4 clinical cases and recorded: age, history, implant indication, previous surgery details, implant type of surface and brand, clinical presentation of the pathology and treatment. Results. Two cases corresponded to cosmetic surgery and 2 to reconstructive surgery; clinical presentation in 3 cases was late seroma and lymphadenopathy in 1. Three implants had textured surface and one was of polyurethane. Bilateral capsulectomy was performed in all cases. Conclusions. The main contribution of our cases is to highlight the importance of informing about diagnosed cases, because of the rare incidence of the disease and the lack of publications about this theme in the Ibero-Latinamerican environment

Primer caso en la Región de Murcia (España) de linfoma anaplásico de células grandes asociado a implantes mamarios / First case in region of Murcia (Spain) of breast implant-associated anaplastic large cell lymphoma

El linfoma anaplásico de células gigantes asociado a implantes mamarios es una entidad extremadamente rara de la que, hasta enero de 2019, han sido diagnosticados 656 casos en 34 países con 17 muertes comunicadas. Se postula que su etiología es el resultado de una reacción a un cuerpo extraño como la prótesis y la inflamación crónica persistente que se deriva. Presentamos el primer caso de esta patología diagnosticado y tratado en la Región de Murcia, España. Se trata de una paciente con seroma crónico recidivante que aparece a los 5 años de la colocación de implantes mamarios tras diagnóstico y tratamiento por cáncer de mama. El diagnóstico definitivo se obtuvo en el estudio anatomopatológico e inmunohistoquímico de la cápsula periprotésica tras cirugía de retirada de implantes y capsulectomía completa bilateral. Se administró quimioterapia postoperatoria por recomendación del Comité de Tumores hospitalario

Breast implant-associated large cell anaplastic lymphoma is an extremely rare entity of which, until January 2019, 656 cases have been diagnosed in 34 countries with 17 reported deaths. It's etiology is postulated as the result of a foreign body reaction to the implant and the resultant chronic and persistent inflammation. We present the first case of this pathology diagnosed and treated in the Region of Murcia, Spain. A patient with chronic relapsing seroma that appears 5 years after breast implant placement after diagnosis and treatment for breast cancer. The definitive diagnosis was obtained in the pathological and immunohistochemical study of the periprosthetic capsule after implant removal surgery and bilateral complete capsulectomy. Postoperative chemotherapy was administered on the recommendation of the hospital Tumor Committee

Limitaciones diagnósticas de las determinaciones inmunohistoquímicas preoperatorias en el linfoma anaplásico de células grandes asociado a implante mamario (LACG-AIM) / Diagnostic limitations of preoperative immunohistochemical determinations in breast implant associated anaplastic large cell lymphoma (BIA-ALCL)

Presentamos un caso de linfoma anaplásico de células grandes asociado a implante mamario (LACG-AIM) que debutó como seroma periprotésico unilateral izquierdo de características acelulares en su estudio inicial. Esto limitó la determinación inmunohistoquímica de marcadores CD30 y cinasa del linfoma anaplásico (ALK) y su diagnóstico preoperatorio. La paciente fue intervenida quirúrgicamente realizándose retirada del implante y capsulectomía completa bilateral. El estudio anatomopatológico de la cápsula periprotésica izquierda mostró un linfoma anaplásico de células grandes. Dado que algunos casos de LACG-AIM pueden presentarse sin celularidad en el seroma periprotésico, limitando la efectividad de las determinaciones inmunohistoquímicas preoperatorias, en casos de alta sospecha clínica cabría plantearse un tratamiento quirúrgico de forma precoz que iniciase el tratamiento oncológico sin demora y aportase un diagnóstico definitivo

We present a case of breast implant associated anaplastic large cell lymphoma (BIA-ALCL) that debuted as a left unilateral periprosthetic seroma of acellular features in its initial study. This aspect limited the immunohistochemical determination of CD30 markers and anaplastic lymphoma kinase (ALK) and its preoperative diagnosis. Patient was operated performing implant removal and bilateral complete capsulectomy. The pathological study of the left periprosthetic capsule showed an anaplastic large cell lymphoma. Since some cases of BIA-ALCL can occur without cellularity in the periprosthetic seroma, limiting the effectiveness of preoperative immunohistochemical determinations, in cases of high clinical suspicion an early surgical treatment could be considered in order to begin the oncological treatment without delay and providing a definitive diagnosis

Sentinel lymph node biopsy in patients with malignant melanoma: analysis of post-operative complications.

BACKGROUND: This study investigates the incidence of post-operative complications and risk factors of sentinel lymph node biopsy (SLNB) in melanoma patients. METHODS: A retrospective cohort study was conducted at a single cancer institution on 408 consecutive SLNBs. RESULTS: Fifty-five post-operative complications occurred in 39 (9.5%) patients and included: wound infection in 24 (5.9%), seroma and lymphorrhea in 15 (3.7%), wound dehiscence in seven (1.7%), lymphocele in six (1.5%) and others in three (0.7%). Univariate analysis failed to identify possible risk factors (i.e. gender, age, lymph node region, number of excised lymph nodes, Breslow index, pT levels, comorbidities, length of surgery and hospital stay). Metastatic sentinel nodes occurred in four of 135 (3%) patients with thin melanoma (Breslow <1 mm) and in 68 of 262 (25.9%) patients with Breslow >1 mm. CONCLUSION: For patients with thin melanoma in whom the incidence of lymph node metastasis is low, the reported post-operative morbidity of almost 10% of SLNB highlights the need for careful patient selection.