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High-Throughput Molecular Characterization of the Microbiome in Breast Implant-Associated Anaplastic Large Cell Lymphoma and Peri-Implant Benign Seromas
by
, , , , , , , , , and
Evelina Rogges
1,2
,
Giorgio Bertolazzi
3,
Davide Vacca
4,
Marina Borro
5,6,7,
Gianluca Lopez
8,
Maurizio Simmaco
5,6,7,
Anna Scattone
9,
Guido Firmani
10,
Michail Sorotos
10,
Fabio Santanelli di Pompeo
10
,
Niccolò Noccioli
8,
Emanuele Savino
11,
Andrea Vecchione
2 and
Arianna Di Napoli
2,* 1
Department of Medical and Surgical Sciences and Translational Medicine, PhD School in Translational Medicine and Oncology, Sapienza University of Rome, Faculty of Medicine and Psychology, 00189 Rome, Italy
2
Pathology Unit, Department of Clinical and Molecular Medicine, Sant’Andrea University Hospital, Sapienza University of Rome, 00189, Rome, Italy
3
Department of Medicine and Surgery, Kore University of Enna, 94100 Enna, Italy
4
Tumor Immunology Unit, Department of Health Sciences, University of Palermo, 90127 Palermo, Italy
5
Center for Precision Medicine (CPM), Sant’Andrea University Hospital, 00189 Rome, Italy
6
Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University of Rome, 00189 Rome, Italy
7
Unit of Laboratory Analysis and Advanced Molecular Diagnostics, Department of Diagnostic Sciences, Sant’Andrea University Hospital, 00189 Rome, Italy
8
Morphologic and Molecular Pathology Unit, St. Andrea University Hospital, Sapienza University of Rome, 00189 Rome, Italy
9
Department of Pathology, IRCCS Istituto Tumori ‘Giovanni Paolo II’, 70124 Bari, Italy
10
Plastic Surgery Unit, Department of Neuroscience, Mental Health, and Sense Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University of Rome, 00189 Rome, Italy
11
Advanced Pathology Laboratory, IFOM ETS-The AIRC Institute of Molecular Oncology, 20139 Milan, Italy
*
Author to whom correspondence should be addressed.
Cancers 2025, 17(23), 3839; https://doi.org/10.3390/cancers17233839 (registering DOI)
Submission received: 23 October 2025
/
Revised: 24 November 2025
/
Accepted: 26 November 2025
/
Published: 29 November 2025
(This article belongs to the Special Issue Oncogenesis of Lymphoma)
Simple Summary
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare type of T-cell lymphoma linked to textured breast implants. A leading hypothesis suggests that chronic inflammation, possibly triggered by bacteria forming biofilms on the implant surface, may play a role in its development. However, previous studies based on breast implant capsules have yielded inconsistent results. In our study, we investigated the microbiota in late-onset seromas from 10 BIA-ALCL patients and 12 with a non-neoplastic effusion. Using two different next-generation sequencing methods, we found no single bacterial species or family specifically associated with BIA-ALCL. Instead, BIA-ALCL samples showed a higher abundance of non-aerobic bacteria, which aligns with prior evidence of a hypoxic (low-oxygen) tumor environment. Our findings suggest that while bacteria may foster chronic inflammation, BIA-ALCL likely stems from a combination of factors, rather than a specific infectious cause.
Abstract
Background: Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a mature T-cell lymphoma linked to textured breast implants. A leading hypothesis suggests that chronic inflammation, combined with immunological and genetic factors, drives its pathogenesis. Two previous studies investigating bacterial biofilms on breast implant capsules have produced conflicting results, particularly regarding the enrichment of Ralstonia spp. Methods: We analyzed the microbiota profiles in seroma samples from 10 BIA-ALCL patients and 12 patients with non-neoplastic effusion, subclassified into acute-, mixed-, and chronic-type based on cellular composition. We used two metagenomic approaches: 16S rRNA gene sequencing and Nanopore sequencing with the “What’s in My Pot?” (WIMP) taxonomic classifier. Our analyses included alpha and beta diversity metrics, as well as comparisons of Gram status and oxygen requirements. Results: Both sequencing methods identified Staphylococcaceae, Propionibacteriaceae, and Bradyrhizobiaceae as the most prevalent bacterial families in both BIA-ALCL and benign seroma samples. Notably, the Burkholderiaceae family was more abundant in some of the benign seromas according to the 16S rRNA sequencing, but Ralstonia spp. were not detected. BIA-ALCL showed higher richness (based on Nanopore data) and higher evenness (based on 16S rRNA data) compared to acute-type seromas, indicating a more homogenous representation of the different taxa identified. BIA-ALCL seromas did not cluster together based on Nanopore data, but they did form a distinct cluster with 16S rRNA data. This cluster was differentiated from the other two clusters by a relatively balanced presence of multiple families without overt dominance. We observed no significant differences in Gram staining between BIA-ALCL and benign samples using either method. However, non-aerobic bacterial families were enriched in BIA-ALCL cases only when analyzed with the Nanopore pipeline. Conclusions: Overall, our findings did not identify a distinctive microbial signature specifically associated with BIA-ALCL.
Keywords:
BIA-ALCL; microbiome; NGS
