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Breast-nonmalignant

Inflammatory / infectious

Silicone implants-breast

 

Reviewer: Hind Nassar, M.D. in January 2009 (see Authors page)

Revised: 30 September 2012, last major update April 2010

Copyright: (c) 2002-2010, PathologyOutlines.com, Inc.

 

Definition

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● Important to document gross and histologic findings associated with implant related specimens

 

Terminology

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Epidemiology

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Sites

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Etiology

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Clinical features

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● Implants are used for breast construction post-mastectomy or for breast augmentation; consist of elastomer shell filled with silicone gel

● Do not cause systemic disease, but can leak and rupture, causing local scarring, infection and disfigurement

● Ruptures can cause intrapulmonary and cutaneous siliconomas (Breast J 2009;15:496, Clin Exp Dermatol 2009;34:e99)

● Implant related infections are rare (Diagn Microbiol Infect Dis 2009;63:390)

● Recommended to photograph and describe surface of removed implant for possible litigation (Mod Pathol 2000;13:1050)

● Can chemically identify silicone inclusions with Raman spectroscopy (Mod Pathol 1999;12:714)

● Implant-associated mesenchymal tumors are rare, and most are fibromatoses (Hum Pathol 2009;40:1564)

● Associated with anaplastic large cell lymphoma adjacent to implants (Mod Pathol 2008;21:455, Arch Pathol Lab Med 2003;127:e115, Am J Surg Pathol 2008;32:1265, Diagn Pathol 2009 Apr 2;4:11)

 

Prognostic factors

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Case reports

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25 year old woman with capsular synovial metaplasia mimicking silicone leak of breast prosthesis (J Med Case Reports 2008;2:277)

● 48 year old woman with synovial metaplasia of periprosthetic breast capsule (Arch Pathol Lab Med 1994;118:249)

● 56 year old woman with follicular lymphoma and adjacent granulomatous response to foreign material next to silicone implant (Am J Surg Pathol 1995;19:712)

● Leaky implant associated with Kikuchi-Fujimoto disease (Arch Pathol Lab Med 1996;120:380)

● With pneumonitis and silicone in alveolar histiocytes after implant rupture (Ir J Med Sci 2010;179:141)

 

Treatment

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Clinical images

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Drawings

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Silicone implant

 

Gross description (Macroscopy)

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Micro description (Histopathology)

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● Chronic inflammatory response (plasma cells, B and T cells and foamy macrophages) with fibrotic capsule around the implant causing contracture of prosthesis (Aesthetic Plast Surg 2010 Mar 13 [Epub ahead of print])

● Lining cells may resemble synovium (synovial metaplasia, Mod Pathol 1994;7:310)

● Gel may seep through intact implant shells

● May have foreign body reaction with sinus tracts

● Numerous cystic spaces and vacuoles may exist where silicone dissolves during processing

 

Micro images

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Refractile silicone and giant cell reaction                   Polyurethane implant - Polyurethane

(arrow at doubly-refractile silicone)                              (arrow) and silicone (round globules)

 

 

  

Silicone mastitis

 

 

            

Silicone globules, giant cell inflammatory reaction, fibrosis

 

 

  

Capsular synovial metaplasia

 

Other images: #1#2#3

 

Virtual Slides

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Foreign body reaction

 

Videos

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Cytology description

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Cytology images

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Positive stains

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Negative stains

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Electron microscopy descriptions

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Electron microscopy images

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Molecular / cytogenetics description

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Molecular / cytogenetics images

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Differential Diagnosis

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Additional references

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Am J Surg Pathol 1995;19:433, Mod Pathol 1999;12:706, Mod Pathol 1994;7:728, Hum Pathol 1985;16:19, eMedicine, Wikipedia

 

End of Breast-nonmalignant > Inflammatory / infectious > Silicone implants-breast

 

 

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