Breast

Inflammatory

Silicone leak / lymphadenopathy


Editorial Board Members: Gary Tozbikian, M.D., Julie M. Jorns, M.D.
Maria A. Arafah, M.D.
Afaf M. Alsharhan, M.D.

Topic Completed: 18 May 2021

Minor changes: 20 May 2021

Copyright: 2002-2021, PathologyOutlines.com, Inc.

PubMed Search: Silicone breast implants [TI] "last 5 years"[dp]

Maria A. Arafah, M.D.
Afaf M. Alsharhan, M.D.
Page views in 2020: 5,170
Page views in 2021 to date: 4,350
Cite this page: Arafah MA, Alsharhan AM. Silicone leak / lymphadenopathy. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/breastsiliconebreastimplants.html. Accessed October 15th, 2021.
Definition / general
  • Foreign body inflammatory reaction induced by silicone
    • Diffuse in the breast → silicone mastitis
    • Nodular in the breast → silicone granulomas
    • Leakage to regional lymph nodes → silicone lymphadenitis
Essential features
  • Complication of leakage or rupture of silicone containing breast prosthesis or as a reaction to silicone injection
  • Foreign body inflammatory reaction induced by silicone
  • Most common sites: breast, regional lymph nodes
Terminology
  • Silicone granuloma
  • Silicone mastitis
  • Silicone lymphadenopathy
ICD coding
  • ICD-10: T85.49XA - other mechanical complication of breast prosthesis and implant, initial encounter
  • ICD-11: PK9B.2 - general or plastic surgery devices associated with injury or harm, prosthetic or other implants, materials or accessory devices
Epidemiology
Sites
  • Breast and regional lymph nodes
Pathophysiology
Etiology
  • Leakage of silicone gel contained in prostheses
Clinical features
Diagnosis
  • Can be suspected clinically and radiologically
  • Histopathology is the gold standard for a definitive diagnosis
Radiology description
  • Mammography: radiopaque silicone outside the implant shell in the breast or lymph nodes with or without irregular and coarse calcifications
  • Ultrasound: extracapsular silicone in the breast or lymph nodes (snowstorm sign) (Indian J Radiol Imaging 2016;26:216)
  • Magnetic resonance imaging: high signal intensity deposits in the breast or lymph nodes
Radiology images

Images hosted on other servers:
Rupture of silicone implant (mammography)

Rupture of silicone implant (mammography)

Snowstorm sign (ultrasound)

Snowstorm sign (ultrasound)

Extracapsular free silicone conglomerates (MRI)

Extracapsular free silicone conglomerates (MRI)

Case reports
Treatment
Gross description
  • Firm to hard nodular surface, gritty if there is calcification (Insights Imaging 2018;9:59)
  • Cystic spaces containing thick pale yellow or white material
Gross images

Images hosted on other servers:
Fibrous capsule

Fibrous capsule

Silicone lymphadenopathy

Silicone lymphadenopathy

Microscopic (histologic) description
  • Features are not specific:
    • Chronic inflammatory cells, foreign body giant cell reaction and fibrosis
    • Fat necrosis → histiocytes containing clear, refractile, nonpolarizable material within cytoplasmic vacuoles
    • Extracellular silicone can also be seen as nonbirefringent crystals or particles within empty spaces
  • Later features include:
    • Fibrous capsule or bursa: well defined band of collagenized fibrous tissue and mixed chronic inflammatory cells
    • Calcifications in the capsule or around: globular aggregates, may have bone formation
Microscopic (histologic) images

Contributed by Syed Hoda, M.B.B.S. and Julie M. Jorns, M.D.
Capsule with silicone

Capsule with silicone

Silicone and synovial metaplasia

Silicone and synovial metaplasia

Foamy histiocytes Foamy histiocytes

Foamy histiocytes


Clinically ruptured silicone implant Clinically ruptured silicone implant

Clinically ruptured silicone implant

Silicone lymphadenitis Silicone lymphadenitis Silicone lymphadenitis

Silicone lymphadenitis


Implant with associated seroma Implant with associated seroma

Implant with associated seroma

Silicone lymphadenitis Silicone lymphadenitis

Silicone lymphadenitis

Virtual slides

Images hosted on other servers:

Breast, silicone granuloma

Lymph node, silicone lymphadenopathy

Cytology description
Positive stains
Negative stains
Electron microscopy description
  • Calcifications are composed of hydroxyapatite crystals
Sample pathology report
  • Left breast, core needle biopsy:
    • Benign breast tissue with fibrous capsule with associated foreign body giant cell reaction to silicone, chronic inflammation and fat necrosis
Differential diagnosis
  • Sinus histiocytosis with massive lymphadenopathy:
    • Fever, leukocytosis, anemia
    • Usually no history of breast implant
    • Large histiocytes with emperipolesis, plasma cells
    • No foreign body giant cell reaction
    • No foreign material
  • Fat necrosis:
    • Usually secondary to injury or previous procedures
    • No history of breast implant
    • May have foreign material from prior procedure(s) but is morphologically different from silicone
  • Abscess / acute mastitis:
    • Associated with lactation in most cases
    • Neutrophils are predominant
    • Bacteria are usually present (gram positive)
    • No foreign material
  • Cystic neutrophic granulomatous mastitis:
    • Fever, leukocytosis, anemia
    • Granulomatous inflammation with cystic spaces rimmed by neutrophils
    • Coryneform bacteria is present in cystic spaces (gram positive, culture or molecular testing)
    • No foreign material
Board review style question #1

A 34 year old nulliparous female presented with a unilateral breast mass 8 years after bilateral breast augmentation with silicone implants. On examination, the patient was afebrile but her breast was tender with a focal deformity. Which of the following histomorphological features is associated with her condition?

  1. Caseating granulomas
  2. Cystically dilated ducts with inspissated material
  3. Gram positive bacteria
  4. Histiocytes with refractile material
Board review style answer #1
D. Histiocytes with refractile material

Comment Here

Reference: Silicone leak / lymphadenopathy
Board review style question #2
Which of the following features is seen in silicone lymphadenitis?

  1. Crystals
  2. Emperipolesis
  3. Fungal hyphae
  4. Langhans giant cells
Board review style answer #2
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