Fig. 10

Hypothesis of tumor progression of breast implant ALCL: a Breast implant ALCL arises as single cells surrounding a textured implant; proliferating cells initially manifest as necrotic effusion (improperly called seroma) around the implant. b Eventually cells attach to the luminal surface of the capsule. c The textured surface of the implant is usually intact albeit covered by a layer of fibrino-necrotic material. d The capsule progressively becomes thicker due to fibrosis, inflammatory cells, and lymphoma cell infiltration. e A mass detected clinically or by imaging studies indicates that the lymphoma cells have infiltrated beyond the capsule. f Approximately 20% of patients with breast implant ALCL have lymph node involvement