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Chandrasiri N, Taiwo O, Ahmed M, Malhorta A, El-Sheikh S. Undifferentiated Pleomorphic Sarcoma Mimicking Breast Implant-Associated Anaplastic Large Cell Lymphoma. J Breast Cancer 2024; 27:27.e18. [PMID: 38769688 DOI: 10.4048/jbc.2024.0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/14/2024] [Accepted: 04/28/2024] [Indexed: 05/22/2024] Open
Abstract
Breast implant augmentation is a low-risk procedure with few life-threatening complications, most commonly rupture or leakage and contraction of the capsule. Breast implant-associated (BIA) malignancies are rare. Anaplastic large cell lymphoma (ALCL) is the most well-known neoplastic condition associated with breast augmentation. Carcinomas arising in association with implants have been reported but are rarer than ALCL. BIA-mesenchymal tumors are extremely rare and most are locally aggressive fibromatosis. To date, only seven cases of BIA sarcomas have been reported. Herein, we describe a case of silicone BIA-undifferentiated pleomorphic sarcoma (UPS) that was initially mistaken for ALCL because of a significant clinical and radiological overlap in presentation and imaging. Here, we present the morphological and molecular features of this rare neoplasm. We reviewed the existing literature related to BIA sarcomas to highlight the importance of considering this diagnosis in cases of recurrent ALCL-negative BIA effusions.
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Affiliation(s)
- Nayana Chandrasiri
- Department of Cellular Pathology, Royal Free London Foundation Trust, London, UK
| | - Oluwatosin Taiwo
- The Centre for Molecular Pathology, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - Muneer Ahmed
- Division of Surgery and Interventional Science, University College London, London, UK
- Department of Breast Surgery, Royal Free London NHS Foundation Trust, London, UK
| | - Anmol Malhorta
- Department of Radiology, Royal Free London NHS Trust, London, UK
| | - Soha El-Sheikh
- Department of Cellular Pathology, Royal Free London Foundation Trust, London, UK
- Research Department of Pathology, University College London (UCL) Cancer Institute, London, UK.
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2
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Marques-Piubelli ML, Medeiros LJ, Stewart J, Miranda RN. Breast Implant-Associated Anaplastic Large Cell Lymphoma. Surg Pathol Clin 2023; 16:347-360. [PMID: 37149362 DOI: 10.1016/j.path.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
Abstract
Pathologic staging including assessment of margins is essential for the proper management of patients with breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL). As most patients present with effusion, cytologic examination with immunohistochemistry and/or flow cytometry immunophenotyping are essential for diagnosis. Upon a diagnosis of BIA-ALCL, en bloc resection is recommended. When a tumor mass is not identified, a systematic approach to fixation and sampling of the capsule, followed by pathologic staging and assessment of margins, is essential. Cure is likely when lymphoma is contained within the en bloc resection and margins are negative. Incomplete resection or positive margins require a multidisciplinary team assessment for adjuvant therapy.
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3
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Vorstenbosch J, Chu JJ, Ariyan CE, McCarthy CM, Disa JJ, Nelson JA. Clinical Implications and Management of Non-BIA-ALCL Breast Implant Capsular Pathology. Plast Reconstr Surg 2023; 151:20e-30e. [PMID: 36194076 PMCID: PMC9797444 DOI: 10.1097/prs.0000000000009780] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
SUMMARY The breast implant capsule is a dynamic structure that forms following the implantation of a device. Although normally benign, increased awareness of breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) highlights that disease may arise from the capsule. BIA-ALCL presents as a late seroma or mass but explains few of the late seromas found in breast implant patients. To date, many of these seromas lack a clear cause and are often described as "idiopathic." Several benign and malignant breast implant capsular diseases can cause a late seroma or mass, including breast implant-associated squamous cell carcinoma. Similar to early reports of BIA-ALCL, these conditions are rare and largely limited to case reports or series. The purpose of this special topic is to present a narrative review highlighting capsular abnormalities that contribute to the formation of late seroma or mass in an attempt to broaden the differential diagnosis and help plastic surgeons identify the cause. Specifically, we review the presentation and management of BIA-ALCL, synovial metaplasia, capsular epithelialization, late hematoma, double capsule, breast cancer, squamous cell carcinoma, mesenchymal tumor, and B-cell lymphoma. Although rare, plastic surgeons should consider these capsular conditions as causes of late seromas and masses. Usually, these conditions may be diagnosed by following the National Comprehensive Cancer Network screening guidelines for BIA-ALCL. Thorough evaluation and workup of late seromas and masses may lead to improved characterization of these rare breast implant capsular conditions and improve our understanding of their pathophysiology and management.
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Affiliation(s)
- Joshua Vorstenbosch
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jacqueline J. Chu
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Charlotte E. Ariyan
- Gastric and Mixed Tumor Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Colleen M. McCarthy
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Joseph J. Disa
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jonas A. Nelson
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
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Russell DH, Montgomery EA, Susnik B. Low to Intermediate (Borderline) Grade Breast Spindle Cell Lesions on Needle Biopsy: Diagnostic Approach and Clinical Management. Adv Anat Pathol 2022; 29:309-323. [PMID: 35838633 DOI: 10.1097/pap.0000000000000353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Spindle cell proliferations of the breast are a heterogeneous group of lesions ranging from benign or reactive lesions to aggressive malignant neoplasms. Diagnosis on core biopsy can be particularly challenging as lesions displaying different lineages associated with variable outcomes share overlapping morphologies (scar vs. fibromatosis-like metaplastic carcinoma) whereas individual entities can exhibit a large variety of appearances (myofibroblastoma). In this review, lesions are grouped into lineage, when possible, including those showing fibroblastic/myofibroblastic differentiation, ranging from entities that require no additional management, such as scar and nodular fasciitis, to those with unpredictable clinical outcomes such as fibromatosis and solitary fibrous tumor or locally aggressive behavior such as dermatofibrosarcoma protuberans. The review of low-grade vascular lesions includes atypical vascular lesion and low-grade angiosarcoma. Also discussed are various adipocytic lesions ranging from lipoma to liposarcoma, and rare smooth muscle and neural entities more commonly encountered in locations outside the breast, such as leiomyoma, neurofibroma, schwannoma, or granular cell tumor. Optimal histological evaluation of these entities merges clinical and radiologic data with morphology and ancillary testing. We present our approach to immunohistochemical and other ancillary testing and highlight issues in pathology correlation with imaging. Recent updates in the management of breast spindle cell lesions are addressed. In a well-sampled lesion with radiographic concordance, the core biopsy diagnosis reliably guides management and we advocate the inclusion of management recommendations in the pathology report. Precise characterization using up to date guidelines is important to identify a subset of patients who may safely avoid unnecessary surgical procedures. A multidisciplinary approach with close collaboration with our clinical colleagues is emphasized.
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Affiliation(s)
- Daniel H Russell
- Departments of Pathology University of Miami Hospital and Jackson Health Systems, Miami, FL
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5
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Costa PA, Marbin S, Costa BMLA, Espejo-Freire AP, Saul EE, Barreto-Coelho P, Allen A, Hakim MO, Goel N, D'Amato GZ, Subhawong T, Trent JC. A nonrandom association of breast implants and the formation of desmoid tumors. Breast J 2021; 27:768-775. [PMID: 34453383 DOI: 10.1111/tbj.14276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 07/10/2021] [Accepted: 07/20/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Studies suggest that surgical breast augmentation with implants is a risk factor for breast desmoid tumors. The statistical strength of this correlation is unknown, as evidence is limited to anecdotal reports. METHODS Patients with breast desmoid tumors and a history of breast implants seen at a single center between 2000 and 2021 were identified via radiology, breast, and sarcoma databases. The standardized incidence ratio (SIR) was calculated to assess the correlation between breast desmoid tumors and breast implants. The cases were pooled with published cases for analyses. Progression-free survival curves and hazard ratios were estimated using the Kaplan-Meier method and Cox proportional-hazards modeling. RESULTS Fourteen patients from one institution and 66 cases in the literature were identified. All patients were female, and the mean age was 38 years old (range 20-66). 63 patients (82%) underwent resection, 9 (12%) received chemotherapy, 3 (4%) received sorafenib, 11 (14%) received hormonal therapy, and 3 (4%) underwent active surveillance. After resection, the 2-year recurrence-free survival rate was 77% (95% CI 65%-89%). The recurrence risk was lower for resection with no residual tumor (R0) compared to microscopic (R1) or macroscopic (R2) residual tumor (HR: 0.15; 95% CI 0.02-0.8; p < 0.05). The SIR was 482 (95% CI 259-775) to 823 (95% CI 442-1322), suggesting a 482-823 times higher risk of developing a breast desmoid tumor after breast augmentation than the general population. CONCLUSION We present a nonrandom association between breast implants and desmoid tumors. Whether the tumors arise from the surgical trauma or the implant's biomaterial is unknown. When surgery is indicated, negative margins reduce the risk of recurrence.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Neha Goel
- University of Miami, Miami, Florida, USA
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6
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Al-Wiswasy M, Al-Balas M, Al-Saffar R, Al-Balas H. Primary stromal sarcoma of breast: A case report and literature review. Breast Dis 2021; 40:199-205. [PMID: 33720870 DOI: 10.3233/bd-201012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Primary breast sarcoma (PBS) was first described in 1887 as a rare heterogeneous neoplasm arising from the mesenchymal tissue of the mammary gland accounting for less than 5% of all body soft-tissue sarcomas and less than 0.1% of all malignant tumors of the breast. CASE PRESENTATION A 31-year old lady presented with left breast mass which she felt four years before during which the mass increased in size from 1 to 6 cm in the largest diameter, diagnosed clinically as a benign fibroadenoma without any further cytological or histopathological confirmation. Histopathological examination of the excised breast mass reveals undifferentiated, primary stromal sarcoma of the breast (PSSB), which was followed by mastectomy three weeks later with reconstructive breast surgery with a total duration of follow-up of 3 years thereafter. This is the first case of PSSB reported in Jordan. DISCUSSION/CONCLUSION PSSB is the generic term given to malignant breast tumors thought to arise from the specialized mesenchymal stroma of the breast but lacking an epithelial component with a phylloides pattern. PSSB is difficult to diagnose preoperatively due to its rarity and inadequate imaging methods to establish an exact diagnosis. The histology of the patient mass may be the leading factor for the management of these tumors. Even in very young patients, a progressively growing breast mass should alert the clinician to investigate for malignancy and verify the results by biopsy. Surgery with adequate resection margins represents the only potentially curative modality with prognostic significance. Adjuvant chemotherapy and radiotherapy are not very beneficial. The prognosis is dismal for patients with lymph node involvement and the size of the tumor has a lesser bearing on the outcome.
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Affiliation(s)
- Mohammad Al-Wiswasy
- Department of Basic Medical Sciences, Faculty of Medicine, Hashemite University, Zarqa, Jordan
| | - Mahmoud Al-Balas
- Department of General and Special Surgery, Faculty of Medicine, Hashemite University, Zarqa, Jordan
| | - Raith Al-Saffar
- Department of Basic Medical Sciences, Faculty of Medicine, Hashemite University, Zarqa, Jordan
| | - Hamzeh Al-Balas
- Department of General and Special Surgery, Faculty of Medicine, Hashemite University, Zarqa, Jordan
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7
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Jo VY, Schoen FJ. Tumorigenesis and Biomaterials. Biomater Sci 2020. [DOI: 10.1016/b978-0-12-816137-1.00053-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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8
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Silva S, Lage P, Cabral F, Alves R, Catarino A, Félix A, André S. Bilateral breast fibromatosis after silicone prosthetics in a patient with classic familial adenomatous polyposis: A case report. Oncol Lett 2018; 16:1449-1454. [PMID: 30008823 PMCID: PMC6036415 DOI: 10.3892/ol.2018.8853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Accepted: 03/16/2018] [Indexed: 11/07/2022] Open
Abstract
Breast fibromatosis is a benign fibroblastic proliferation accounting for less than 0.2% of breast tumors. It presents sporadically or as a manifestation of familial adenomatous polyposis (FAP). Fibromatosis in FAP may develop in patients with adenomatous polyposis coli (APC) gene mutations at any location through the gene. Notably, there is an increased risk if mutation is downstream codon 1400. The present case report described a 33-year-old woman with recurrent bilateral breast fibromatosis after breast implants in a context of classic FAP. APC mutation (codon-935) was detected at the age of 16. In the same year, a thyroidectomy for a cribriform-morular papillary thyroid carcinoma (pT1) was performed. Seven years later, a prophylactic total colectomy with >100 adenomas without invasive carcinoma was performed and the patient was kept under surveillance. At the age of 30 years old, she underwent breast silicone implantation for cosmetic reasons. One year later, bilateral breast tumors were diagnosed in core biopsy as fibromatosis (nuclear β-catenin+, estrogen receptors-). After no success with medical treatment with tamoxifen, bilateral mastectomy was performed. The patient relapsed one year later and a fibromatosis lesion in the right thoracic wall was excised again. The patient demonstrated no signs of relapse 24 months after the surgery. This rare case illustrates that the increased risk of developing fibromatosis in patients with FAP, even in the classic form, should be considered before deciding to place breast implants.
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Affiliation(s)
- Sara Silva
- NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, 1169-056 Lisbon, Portugal
| | - Pedro Lage
- Department of Gastroenterology, Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG), 1099-023 Lisbon, Portugal
| | - Francisco Cabral
- Department of Surgery, Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG), 1099-023 Lisbon, Portugal
| | - Rui Alves
- Department of Surgery, Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG), 1099-023 Lisbon, Portugal
| | - Ana Catarino
- NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, 1169-056 Lisbon, Portugal.,Department of Pathology, Serviço de Anatomia Patológica do Hospital da Luz, 1500-650 Lisbon, Portugal
| | - Ana Félix
- NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, 1169-056 Lisbon, Portugal.,Department of Pathology, Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG), 1099-023 Lisbon, Portugal
| | - Saudade André
- NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, 1169-056 Lisbon, Portugal.,Department of Pathology, Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG), 1099-023 Lisbon, Portugal
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9
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Buchanan PJ, Chopra VK, Walker KL, Rudolph R, Greco RJ. Primary Squamous Cell Carcinoma Arising From a Breast Implant Capsule: A Case Report and Review of the Literature. Aesthet Surg J 2018; 38:4962487. [PMID: 29659713 DOI: 10.1093/asj/sjy092] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
LEVEL OF EVIDENCE 5
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Affiliation(s)
- Patrick J Buchanan
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Florida Health, Gainesville, FL
| | - Vinod K Chopra
- Mercer University School of Medicine, Memorial University Medical Center, Savannah, GA
| | - Kristen L Walker
- Mercer University School of Medicine, Memorial University Medical Center, Savannah, GA
| | - Ray Rudolph
- Anderson Cancer Institute, Memorial University Medical Center, Savannah, GA
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10
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Morales RD, Mendoza AG, Luces C, Abreu EB, Romero G, Pérez G, Russo L. Aggressive breast fibromatosis following augmentation mastoplasty: a series of case reports. Ecancermedicalscience 2018; 12:833. [PMID: 29910830 PMCID: PMC5985752 DOI: 10.3332/ecancer.2018.833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Indexed: 11/06/2022] Open
Abstract
Aggressive fibromatosis comprises connective tissue tumours that represent 0.03% of all bodily neoplasms, occurring more often in the abdominal wall, mesentery, and extremities; its location in the breast constitutes a very infrequent type of lesion. Its pathogenesis is diverse and its relationship with augmentation mastoplasty is still unclear. Four cases of aggressive breast fibromatosis following augmentation mastoplasty are reported in this article.
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Affiliation(s)
- Rafael Delgado Morales
- Department of Digestive Pathology, Soft Tissue Tumors and Melanoma, Instituto de Oncología Luis Razetti (IOLR), Caracas, 1010, Venezuela
| | - Armando Gil Mendoza
- Department of Digestive Pathology, Soft Tissue Tumors and Melanoma, Instituto de Oncología Luis Razetti (IOLR), Caracas, 1010, Venezuela
| | - Carmen Luces
- Department of Digestive Pathology, Soft Tissue Tumors and Melanoma, Instituto de Oncología Luis Razetti (IOLR), Caracas, 1010, Venezuela
| | | | - Gabriel Romero
- Department of Mammary Pathology, Instituto de Oncología Luis Razetti (IOLR), Caracas, 1010, Venezuela
| | - Gabriel Pérez
- Department of Mammary Pathology, Instituto de Oncología Luis Razetti (IOLR), Caracas, 1010, Venezuela
| | - Leonardo Russo
- Department of Mammary Pathology, Instituto de Oncología Luis Razetti (IOLR), Caracas, 1010, Venezuela
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11
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Desmoid Tumor and Silicone Breast Implant Surgery: Is There Really a Connection? A Literature Review. Aesthetic Plast Surg 2018; 42:59-63. [PMID: 28842766 DOI: 10.1007/s00266-017-0948-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 07/17/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND Desmoid tumors are borderline tumors of the connective tissue, arising in the musculo-aponeurotic stromal elements. A desmoid tumor (DT) has an infiltrative and locally aggressive growth pattern and usually does not metastasize; however, it has a high recurrence and complication rate. DT located in the breast (BDT) represents a rare extra-abdominal form. Recently, the presence of breast silicone implants was suggested by several researchers as a risk factor for developing BDT. OBJECTIVES The goal of this review is to investigate the possible correlation between BDT and breast implant surgery. METHODS We conducted a literature review of BDT-reported cases, associated with breast implant surgery. RESULTS The search revealed 36 cases of BDT associated with silicone breast implants. CONCLUSIONS Based on the reviewed data, the incidence of BDT following breast implant surgery is lower than BDT in the general population. At the moment, a possible association between breast implants and the development of breast desmoid tumors cannot be unequivocally confirmed. A world registry with accurate documentation of each case of BDT associated with breast implant surgery should be performed for future investigation. LEVEL OF EVIDENCE II This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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12
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13
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Olsen DL, Keeney GL, Chen B, Visscher DW, Carter JM. Breast implant capsule-associated squamous cell carcinoma: a report of 2 cases. Hum Pathol 2017; 67:94-100. [PMID: 28739500 DOI: 10.1016/j.humpath.2017.07.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 06/16/2017] [Accepted: 07/05/2017] [Indexed: 11/30/2022]
Abstract
The use of prosthetic implants for breast augmentation has become commonplace. Although implants do not increase the risk of conventional mammary carcinoma, they are rarely associated with anaplastic large cell lymphoma. We report 2 cases of breast implant capsule-associated squamous cell carcinoma with poor clinical outcomes. Both patients (56-year-old woman and 81-year-old woman) had long-standing implants (>25 years) and presented with acute unilateral breast enlargement. In both cases, squamous cell carcinoma arose in (focally dysplastic) squamous epithelium-lined breast implant capsules and widely invaded surrounding breast parenchyma or chest wall. Neither patient had evidence of a primary mammary carcinoma or squamous cell carcinoma at any other anatomic site. Within 1 year, one patient developed extensive, treatment-refractory, locoregional soft tissue metastasis, and the second patient developed hepatic and soft tissue metastases and died of disease. There are 2 prior reported cases of implant-associated squamous cell carcinoma in the plastic surgery literature; one provides no pathologic staging or outcome information, and the second case was a capsule-confined squamous cell carcinoma. Together, all 4 cases share notable commonalities: the patients had long-standing breast implants and presented with acute unilateral breast pain and enlargement secondary to tumors arising on the posterior aspect of squamous epithelialized implant capsules. Because of both its rarity and its unusual clinical presentation, implant capsule-associated squamous cell carcinoma may be underrecognized. The aggressive behavior of the tumors in this series underscores the importance of excluding malignancy in patients with long-standing breast implants who present with acute unilateral breast pain and enlargement.
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Affiliation(s)
- Daniel L Olsen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905
| | - Gary L Keeney
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905
| | - Beiyun Chen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905
| | - Daniel W Visscher
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905
| | - Jodi M Carter
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905.
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14
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Radiologic images of an aggressive implant-associated fibromatosis of the breast and chest wall: case report and review of the literature. Radiol Case Rep 2017; 12:431-438. [PMID: 28828097 PMCID: PMC5551988 DOI: 10.1016/j.radcr.2017.04.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Revised: 04/25/2017] [Accepted: 04/26/2017] [Indexed: 01/19/2023] Open
Abstract
Fibromatosis of the breast is a rare benign disease compromising <0.2% of all primary breast tumors. Although the chest wall is a common location, occurrences of implant-associated fibromatosis of the breast are extremely rare; only 33 cases have been reported. We present a case of a 42-year-old female who underwent breast augmentation with silicone breast implants, and 2 years later developed an aggressive implant-associated fibromatosis of the breast and chest wall. On imaging studies, the tumor mimicked breast carcinoma, and despite chemotherapy, the fibromatosis rapidly enlarged and was locally invasive requiring wide surgical excision. Unlike previously reported imaging findings, magnetic resonance imaging revealed an oval circumscribed mass with fringe-like internal architecture. We provide a review of the literature and discuss the imaging features of implant-associated fibromatosis of the breast.
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15
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Sarcomas of the Breast with a Spotlight on Angiosarcoma and Cystosarcoma Phyllodes. Surg Oncol Clin N Am 2016; 25:713-20. [DOI: 10.1016/j.soc.2016.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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16
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Cheah AL, Billings SD, Rowe JJ. Mesenchymal tumours of the breast and their mimics: a review with approach to diagnosis. Pathology 2016; 48:406-24. [DOI: 10.1016/j.pathol.2016.05.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 05/20/2016] [Accepted: 05/23/2016] [Indexed: 12/16/2022]
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17
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Dinets A, Unukovych D, Khrapach V, Zakhartseva O, Sulik V, Kaminskyi E, Khrapach O, Meloyan A, Zakhartseva L, Mishalov V. An unusual case of a ruptured Poly Implant Prothèse breast implant associated with xanthoma. CASE REPORTS IN PLASTIC SURGERY AND HAND SURGERY 2016; 3:11-5. [PMID: 27583262 PMCID: PMC4996062 DOI: 10.3109/23320885.2016.1153974] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 02/10/2016] [Indexed: 11/13/2022]
Abstract
A suspicious breast mass was intra-operatively found in a female patient previously operated for breast augmentation with the Poly Implant Prothèse (PIP) implants. The neoplasm was verified as xanthoma and an asymptomatic microrupture of PIP was also detected. This report discusses possible association of breast xanthoma with PIP implant rupture.
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Affiliation(s)
- Andrii Dinets
- Department of Surgery #4, Bogomolets National Medical University, Kiev, Ukraine; Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Dmytro Unukovych
- Department of Surgery #4, Bogomolets National Medical University, Kiev, Ukraine; Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital, Uppsala, Sweden
| | - Vasyl Khrapach
- Department of Surgery #4, Bogomolets National Medical University , Kiev , Ukraine
| | - Olga Zakhartseva
- Department of Surgery #4, Bogomolets National Medical University , Kiev , Ukraine
| | - Volodymyr Sulik
- Department of Surgery #4, Bogomolets National Medical University , Kiev , Ukraine
| | - Edgar Kaminskyi
- Department of Plastic Surgery, Harmony Hospital , Kiev , Ukraine
| | - Olexandr Khrapach
- Department of Surgery #4, Bogomolets National Medical University , Kiev , Ukraine
| | - Ani Meloyan
- Department of Oncology-Pathology, Karolinska Institutet , Stockholm , Sweden
| | - Lubov Zakhartseva
- Department of Pathology, Kyiv City Teaching Oncology Center , Kiev , Ukraine
| | - Volodymyr Mishalov
- Department of Surgery #4, Bogomolets National Medical University , Kiev , Ukraine
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Iakovlev VV, Guelcher SA, Bendavid R. Degradation of polypropylene in vivo: A microscopic analysis of meshes explanted from patients. J Biomed Mater Res B Appl Biomater 2015; 105:237-248. [PMID: 26315946 DOI: 10.1002/jbm.b.33502] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 06/21/2015] [Accepted: 07/30/2015] [Indexed: 11/05/2022]
Abstract
Polypropylene meshes, originally introduced for hernia repair, are presently utilized in several anatomical sites. Several million are implanted annually worldwide. Depending on the device, up to 10% will be excised to treat complications. The excised meshes can provide material to study the complications, however, they have remained underutilized over the last decades and the mechanisms of complications continue to be incompletely understood. The fundamental question as to whether polypropylene degrades in vivo is still debated. We have examined 164 excised meshes using conventional microscopy to search for features of polypropylene degradation. Four specimens were also examined by transmission electron microscopy. The degraded material, detected by its ability to absorb dyes in the degradation nanopores, formed a continuous layer at the surface of the mesh fibers. It retained birefringence, inclusions of non-degraded polypropylene, and showed ability to meld with the non-degraded fiber core when heated by the surgical cautery. Several features indicated that the degradation layer formed in vivo: inflammatory cells trapped within fissures, melting caused by cautery of excision surgery, and gradual but progressive growth of the degradation layer while in the body. Cracking of the degraded material indicated a contribution to clinically important mesh stiffening and deformation. Chemical products of degradation need to be analyzed and studied for their role in the mesh-body interactions. The described methods can also be used to study degradation of other materials. © 2015 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 237-248, 2017.
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Affiliation(s)
- Vladimir V Iakovlev
- Laboratory Medicine and Pathobiology, Division of Pathology and Keenan Research Centre of the Li Ka Shing Knowledge Institute, University of Toronto, St. Michael's Hospital, Toronto, Canada
| | - Scott A Guelcher
- Department of Chemical and Biomolecular Engineering, School of Engineering, Vanderbilt University, Nashville, Tennessee
| | - Robert Bendavid
- Department of Surgery, Shouldice Hospital, Thornhill, Canada
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Shim HS, Kim SJ, Kim OH, Jung HK, Kim SJ, Kim W, Kim WW. Fibromatosis Associated with Silicone Breast Implant: Ultrasonography and MR Imaging Findings. Breast J 2014; 20:645-9. [DOI: 10.1111/tbj.12340] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Hyun Seok Shim
- Department of Radiology; Inje University College of Medicine; Haeundae Paik Hospital; Busan Korea
| | - Seon-Jeong Kim
- Department of Radiology; Inje University College of Medicine; Haeundae Paik Hospital; Busan Korea
| | - Ok Hwa Kim
- Department of Radiology; Inje University College of Medicine; Haeundae Paik Hospital; Busan Korea
| | - Hyun Kyung Jung
- Department of Radiology; Inje University College of Medicine; Haeundae Paik Hospital; Busan Korea
| | - Suk Jung Kim
- Department of Radiology; Inje University College of Medicine; Haeundae Paik Hospital; Busan Korea
| | - Woogyeong Kim
- Department of Pathology; Inje University College of Medicine; Haeundae Paik Hospital; Busan Korea
| | - Woon Won Kim
- Department of Surgery; Inje University College of Medicine; Haeundae Paik Hospital; Busan Korea
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Schoen FJ. Tumors Associated with Biomaterials and Implants. Biomater Sci 2013. [DOI: 10.1016/b978-0-08-087780-8.00049-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
Some inflammatory and reactive lesions of the breast present problems clinically but are treated without resort to biopsy. In others, biopsy is required to make the correct diagnosis and to distinguish the process from malignancy. Still others represent incidental microscopic findings that may create diagnostic problems. This article reviews a number of inflammatory and reactive conditions that are likely to be encountered in routine surgical pathology practice, as well as those that have been recently described.
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Affiliation(s)
- Jennifer S Kaplan
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Stuart J Schnitt
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA.
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Camacho D, Machan S, Pilesanski U, Revelles JM, Martín L, Requena L. Generalized Livedo Reticularis Induced by Silicone Implants for Soft Tissue Augmentation. Am J Dermatopathol 2012; 34:203-7. [DOI: 10.1097/dad.0b013e31821cb3c5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Dialani V, Lai KC, Slanetz PJ. MR imaging of the reconstructed breast: What the radiologist needs to know. Insights Imaging 2012; 3:201-13. [PMID: 22696083 PMCID: PMC3369124 DOI: 10.1007/s13244-012-0150-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2012] [Accepted: 01/23/2012] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE The objective is to review the different types of breast reconstruction following cancer surgery and describe expected imaging appearances and complications seen in the reconstructed breast. METHODS Surgical management of breast cancer often entails lumpectomy or mastectomy. When mastectomy is performed, patients often opt for breast reconstruction. Most facilities do not routinely image the reconstructed breast with mammography. RESULTS However, many of these women are imaged with screening breast MRI for evaluation of the contralateral breast, or they may develop a clinical problem that warrants a diagnostic evaluation with MRI. In this article, we will review the more commonly encountered types of breast reconstruction, which include implants, tranversus rectus abdomnis flap, latissimus dorsi flap, deep inferior epigastric perforator flap, and gluteal flaps. Each of these types of reconstruction has different appearances on MR. We will also discuss potential complications that can be seen in the reconstructed breasts, including fat necrosis and recurrence. CONCLUSION Radiologists will better understand the different types of breast reconstruction after mastectomy and their normal imaging appearance on MRI. Radiologists will be more aware of how to recognize complications related to surgery as well as how to determine whether recurrence is present. MAIN MESSAGES • The different surgical techniques used in breast reconstruction are discussed. • Describes the normal magnetic resonance imaging appearance of the breast after reconstruction. • Identify MR imaging features of benign sequelae and recurrence following breast reconstruction.
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Affiliation(s)
- Vandana Dialani
- Department of Radiology, Beth Israel Deaconess Medical Center, C/o Dr. Vandana Dialani, 330 Brookline Avenue, Boston, MA, 02215, USA,
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Gergelé F, Guy F, Collin F, Krausé D. A desmoid tumour associated with a breast prosthesis. Diagn Interv Imaging 2012; 93:e200-3. [DOI: 10.1016/j.diii.2011.12.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kotton DN, Muse VV, Nishino M. Case records of the Massachusetts General Hospital. Case 2-2012. A 63-year-old woman with dyspnea and rapidly progressive respiratory failure. N Engl J Med 2012; 366:259-69. [PMID: 22256809 DOI: 10.1056/nejmcpc1109274] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Voutsadakis IA, Zaman K, Leyvraz S. Breast sarcomas: current and future perspectives. Breast 2011; 20:199-204. [PMID: 21398126 DOI: 10.1016/j.breast.2011.02.016] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2010] [Revised: 02/04/2011] [Accepted: 02/14/2011] [Indexed: 12/16/2022] Open
Abstract
Breast sarcomas are rare neoplasms of the breast that need to be clearly distinguished from the very common breast carcinomas and treated in a multidisciplinary manner modelled after treatment paradigms in other sarcoma locations. An increasing need to differentiate sarcoma sub-types based on molecular characteristics that will also be depicted in differential treatment sensitivities and development of specifically targeted therapies are equally valid in sarcomas in general and in breast sarcomas in particular. Of special interest in breast are sarcomas developing after breast irradiation for a previous breast carcinoma, a scenario that is increasingly common, given the increasing trends of breast conservation in the surgical treatment of breast carcinoma that necessitates the adjuvant use of radiotherapy.
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Affiliation(s)
- Ioannis A Voutsadakis
- Centre Pluridisciplinaire d'Oncologie, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
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Adverse reactions to injectable soft tissue fillers. J Am Acad Dermatol 2011; 64:1-34; quiz 35-6. [DOI: 10.1016/j.jaad.2010.02.064] [Citation(s) in RCA: 210] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2009] [Revised: 01/29/2010] [Accepted: 02/02/2010] [Indexed: 11/23/2022]
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Stöblen F, Rezai M, Kümmel S. Imaging in patients with breast implants-results of the First International Breast (Implant) Conference 2009. Insights Imaging 2010; 1:93-97. [PMID: 22347910 PMCID: PMC3259348 DOI: 10.1007/s13244-010-0021-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Accepted: 04/08/2010] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND: The First International Breast (Implant) Conference was held by the EAoS® (European Academy of Senology) in cooperation with the German Society of Senology during its 29th annual meeting in Düsseldorf, Germany, on 13 June 2009. METHODS: It was performed as a whole-day interactive workshop in which the standards of implant surgery within reconstructive and aesthetic breast surgery were discussed and defined by telecommunication dialogue voting. RESULTS: This article describes the conference results concerning pre- and post-procedural imaging in patients with breast implants. Both before and after augmentation, imaging is mandatory and provides essential information concerning tissue and implant integrity. Whereas mammography is the first-line method before surgery, ultrasound is the mainstay of post-procedural imaging. Cancer screening in augmented breasts generally follows the same guidelines as for non-augmented breasts. CONCLUSION: Whereas agreement about the indications for mammographical and sonographical evaluations is largely unanimous, there was substantial disagreement as far as the application of magnetic resonance imaging is concerned. There is an obvious demand for an evidence-based evaluation of this modality and the implementation of appropriate guidelines.
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