Silicone implants and lymphoma: The role of inflammation

• Chronic infection and inflammation have been implicated as the causative mechanisms in the development of lymphomas.
• The connection between ALCL and breast implants has been hypothesized for several years. Since the earliest report in 1997, numerous cases were described, with 173 cases of breast-implant associated ALCL being recently reported.
• An immune reaction to silicone or other substances used in manufacturing process of breast implants, might cause T cell infiltration with later clonal expansion of T lymphocytes. The T-cell response may be as well reaction to biofilms.
• Skin injuries and Sjögren's syndrome are two conceptual models providing intriguing insight to the connection between silicone implants and ALCL.

The risk of hematological malignancies is mainly determined by genetic background, age, sex, race and ethnicity, geographic location, exposure to certain chemicals and radiation; along with the more recently proposed immune factors such as chronic inflammation, immunodeficiencies, autoimmunity, and infections. Paradigmatic examples include the development of lymphoma in Sjögren's syndrome and Hashimoto thyroiditis, gastric MALT lymphoma in Helicobacter pylori infection, or lymphomas associated with infections by Epstein–Barr virus, human herpes virus 8 (HHV 8) and leukemia/lymphoma virus 1 (HTLV-1). A growing number of reports indicates an increased risk of lymphoma, particularly of the anaplastic large cell (ALCL) type. The implants, specifically those used in the past, elicit chronic stimulation of the immune system against the prosthetic material. This is particularly the case in genetically susceptible hosts. We suggest that polyclonal activation may result in monoclonality in those at risk hosts, ultimately leading to lymphoma. We suggest that patients with an inflammatory response against silicone implants be monitored carefully.