Rupture of an expander prosthesis mimics axillary cancer recurrence

Giant siliconoma mimicking locally advanced breast cancer: A case report and review of literature

INTRODUCTION

Silicone prosthetics are widely used for breast augmentation and reconstruction. These devices may extrude free silicone into surrounding tissue, stimulating a granulomatous foreign body reaction. The resulting mass can mimic breast cancer.

PRESENTATION OF CASE

71 year old female with a history of a ruptured silicone implant presents with an enlarging left breast mass. Exam demonstrated and ulcerated, fungating mass with active infection. CT scan demonstrated a 23 × 15 cm mass involving the breast and chest wall with axillary lymphadenopathy. Preoperative biopsies were inconclusive and the patient underwent a modified radical mastectomy. Pathology demonstrated a siliconoma.

DISCUSSION

While benign, silicone granulomas of the breast can present similarly to malignancy and are an important differential in the diagnosis of a breast or axillary mass for appropriate patients. MRI is the study of choice and core needle biopsies cannot always establish the diagnosis preoperatively. PET scans can be falsely positive and the diagnosis requires an extensive workup to rule out cancer.

CONCLUSION

Siliconomas develop as a result of implant rupture and present with many of the signs and symptoms of breast cancer. The majority of patients should undergo surgery for symptom relief or to rule out cancer.

Radiological pitfall: Siliconoma in internal mammary lymph node mimics breast cancer recurrence

Siliconomas are rarely found in internal mammary lymph nodes in the context of ruptured, ipsilateral, silicone breast implants. However, they can sometimes cause a diagnostic dilemma, as in the presented case. We discuss the diagnostic pitfalls that can arise from misinterpreting a siliconoma for a metastatic lymph node, review the literature, and suggest appropriate diagnostic approaches.