Lymph nodes - not lymphoma
Inclusions, pigment, ectopic cells or tissue
Silicone

Author: Jaya Balakrishna, M.D. (see Authors page)
Editor: Abdelsalam Sharabi, M.D.

Revised: 27 June 2018, last major update August 2014

Copyright: (c) 2003-2018, PathologyOutlines.com, Inc.

PubMed Search: Silicone [title] lymph nodes

Cite this page: Balakrishna, J. Silicone. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/lymphnodessiliconeimplant.html. Accessed August 16th, 2018.
Definition / general
  • Rare enlargement of regional lymph nodes caused by the presence of silicone carried from tributary organs
  • Either an incidental finding or causes painful / enlarged lymph node
  • May be associated with granulomatous inflammation (Histol Histopathol 1997;12:1003)
Terminology
  • Silicone lymphadenopathy
Sites
Pathophysiology
  • Silicone is widely used in implants, especially augmentation mammoplasty and joint prostheses (Hum Pathol 1980;11:240)
  • Once released into tissue, silicone migrates to distant sites through lymphatic channels and bloodstream
  • Once it reaches lymph nodes, it elicits a reaction and cause silicone lymphadenopathy
Etiology
  • Rupture / leak of the implant, or implant 'bleeds', or releases microparticles into blood / lymphatics
Clinical features
  • Enlarged lymph nodes
  • Asymptomatic or with pain
Diagnosis
  • Biopsy
Radiology description
  • Ultrasonogram: hyperechoeic (increased echogenicity of the lymph node mediastinum with dirty acoustic shadowing), beginning in the hilum and progressing outward through the cortex with time and amount of silicone
  • In severe cases, snowstorm appearance
Prognostic factors
  • Depends upon the amount of silicone and severity of the reaction
Case reports
Treatment
  • Removal of lymph nodes
Clinical images

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Various images

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Rupture of implant

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Various images

Gross description
  • No specific gross features
  • Enlarged and firmer than normal
  • Extreme cases show distorted architecture and fibrosis
Gross images

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Calcified silicone capsule

Microscopic (histologic) description
  • Diffuse follicular hyperplasia
  • Histiocytes with vacuolated cytoplasm especially inside the sinusoids
  • Histiocytes cause foreign body granulomatous reaction, giant cells and empty vacuoles
  • Giant cells have refractile and non-birefringent particles
  • Asteroid bodies may be seen
  • Silicone from orthopedic devices: prominent granulomatous reaction with clumps of granular yellowish refractile material
  • Silicone from mammary prostheses: finer vacuolated deposits
Microscopic (histologic) images

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Silicone in axillary lymph node,
courtesy of Dr. Mark R. Wick



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Material consistent with silicone

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Liquid silicone droplets

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Various images

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Subcapsular sinus diffusely expanded

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Vacuoles which contain refractile material

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Foreign body granuloma

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Silicone creates a foamy or bubbly appearance

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Silicone droplets appearing as round vacuoles

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Germinal centers surrounded by sinuses

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Silicone leakage

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Silicone particles in cystic spaces

Cytology description
  • Numerous multi-vacuolated histiocytic cells both scattered individually as well as in aggregates
  • Contain clear, refractile but non-polarizable material
  • Background may show scattered lymphocytes
Positive stains
Negative stains
Electron microscopy description
  • Electron opaque fragmented spicules or flakes
Differential diagnosis