Ep26: Sometimes It’s a Zebra: Breast Pathology

In medical circles, we say, “When you hear hoofbeats, look for horses, not zebras,” as a reminder that when people present with a given set of symptoms, the diagnosis is generally something common. But sometimes it IS a zebra, and patients sometimes DO have a rare condition like the one we’re exploring in this episode—breast implant associated lymphoma or BIA-ALCL. 

On this episode of Inside the Lab, our hosts Dr. Dan Milner and Ms. Kelly Swails are joined by Dr. Kirill Lyapichev, MD, Molecular Genetic Pathology Fellow at MD Anderson Cancer Center in Houston, Texas, and soon-to-be Hematopathology Director at the University of Texas Medical Branch in Galveston, and Dr. Deniz Peker, MD, Associate Professor in the Department of Pathology and Laboratory Medicine at Emory University in Atlanta, Georgia, to discuss breast implant associated ALCL. 

Dr. Lyapichev shares the history of breast implants in general and BIA-ALCL specifically, walking us through two case studies of the entity with very different outcomes. Dr. Peker describes her approach to diagnosing breast implant associated ALCL, and our panelists explain the clinical signs associated with the rare condition. Listen in for insight on the treatment options available to patients and learn what pathologists need to know about the epidemiology of BIA-ALCL.  

Topics Covered  

· Two contrasting case studies of patients with breast implant associated ALCL
· What we know about the epidemiology of BIA-ALCL and its relationship with chronic inflammation
· Why BIA-ALCL is considered a very rare entity
· Diagnosing BIA-ALCL and hesitations around making a diagnosis based on cytology alone
· The role molecular clonality test plays in diagnosing BIA-ALCL and how common clonality is in published cases of the entity
· How to recognize the clinical signs of breast implant associated ALCL
· Insight on the history of breast implants in general and BIA-ALCL specifically
· The excellent prognosis for patients diagnosed with BIA-ALCL in its early stages (and why reconstructive surgery patients with the condition are caught earlier than cosmetic cases)  
· What treatment options are available for patients with breast implant associated ALCL
· The latest developments in BIA-ALCL and why pathologists need to be familiar with it 

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Connect with Dr. Peker
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Dr. Peker at Emory Winship Cancer Institute 

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Resources
Thomas Cronin & Frank Gerow
Inside the Lab in the ASCP Store