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Marques-Piubelli ML, Lyapichev KA, Fnu A, Adrada B, Stewart J, Hunt KK, Clemens MW, Iyer S, Wu Y, El Hussein S, Xu J, Ok CY, Li S, Pierson DM, Ferrufino-Schmidt MC, Nahmod KA, Yoga A, Hunsicker L, Evans MG, Resetkova E, Qiu L, Khanlari M, Garces SA, Bueso-Ramos CE, Medeiros LJ, Miranda RN. The Spectrum of Non-neoplastic Changes Associated With Breast Implants: Histopathology, Imaging, and Clinical Significance. Am J Surg Pathol 2024; 48:e43-e64. [PMID: 38451836 DOI: 10.1097/pas.0000000000002198] [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: 03/09/2024]
Abstract
Breast implant-associated anaplastic large cell lymphoma has been recognized as a distinct entity in the World Health Organization classification of hematolymphoid neoplasms. These neoplasms are causally related to textured implants that were used worldwide until recently. Consequently, there is an increased demand for processing periprosthetic capsules, adding new challenges for surgeons, clinicians, and pathologists. In the literature, the focus has been on breast implant-associated anaplastic large cell lymphoma; however, benign complications related to the placement of breast implants occur in up to 20% to 30% of patients. Imaging studies are helpful in assessing patients with breast implants for evidence of implant rupture, changes in tissues surrounding the implants, or regional lymphadenopathy related to breast implants, but pathologic examination is often required. In this review, we couple our experience with a review of the literature to describe a range of benign lesions associated with breast implants that can be associated with different clinical presentations or pathogenesis and that may require different diagnostic approaches. We illustrate the spectrum of the most common of these benign disorders, highlighting their clinical, imaging, gross, and microscopic features. Finally, we propose a systematic approach for the diagnosis and handling of breast implant specimens in general.
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Affiliation(s)
| | - Kirill A Lyapichev
- Department of Pathology, University of Texas Medical Branch, Galveston, TX
| | | | | | | | | | | | - Swaminathan Iyer
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston
| | | | - Siba El Hussein
- Department of Pathology, The University of Vermont Larner College of Medicine, Burlington, VT
| | - Jie Xu
- Department of Hematopathology
| | | | | | - Diane M Pierson
- Department of Pathology, Kings Daughters Medical Center, Ashland, KY
| | | | | | - Arthy Yoga
- Houston Methodist, Breast Surgical Oncology, Houston, TX
| | - Lisa Hunsicker
- Revalla Plastic Surgery and Medical Esthetics, Denver, CO
| | | | | | - Lianqun Qiu
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA
| | - Mahsa Khanlari
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN
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Atkins DJ, Chau AL, Rosas JM, Chen YT, Chan ST, Urueña JM, Pitenis AA. Silicone Implant Surface Roughness, Friction, and Wear. SURFACE TOPOGRAPHY : METROLOGY AND PROPERTIES 2023; 11:014010. [PMID: 37193116 PMCID: PMC10181813 DOI: 10.1088/2051-672x/ac9f5a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Textured silicone breast implants with high average surface roughness ("macrotextured") have been associated with a rare cancer of the immune system, Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL). Silicone elastomer wear debris may lead to chronic inflammation, a key step in the development of this cancer. Here, we model the generation and release of silicone wear debris in the case of a folded implant-implant ("shell-shell") sliding interface for three different types of implants, characterized by their surface roughness. The "smooth" implant shell with the lowest average surface roughness tested (Ra = 2.7 ± 0.6 μm) resulted in average friction coefficients of μavg = 0.46 ± 0.11 across 1,000 mm of sliding distance and generated 1,304 particles with an average particle diameter of Davg = 8.3 ± 13.1 μm. The "microtextured" implant shell (Ra = 32 ± 7.0 μm) exhibited μavg = 1.20 ± 0.10 and generated 2,730 particles with Davg = 4.7 ± 9.1 μm. The "macrotextured" implant shell (Ra = 80 ± 10 μm) exhibited the highest friction coefficients, μavg = 2.82 ± 0.15 and the greatest number of wear debris particles, 11,699, with an average particle size of Davg = 5.3 ± 3.3 μm. Our data may provide guidance for the design of silicone breast implants with lower surface roughness, lower friction, and smaller quantities of wear debris.
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Affiliation(s)
- Dixon J Atkins
- Department of Biomolecular Science and Engineering, University of California, Santa Barbara
| | - Allison L Chau
- Materials Department, University of California, Santa Barbara
| | - Jonah M Rosas
- Department of Biomolecular Science and Engineering, University of California, Santa Barbara
| | - Yen-Tsung Chen
- Department of Chemical Engineering, University of California, Santa Barbara
| | - Samantha T Chan
- Molecular, Cellular, and Developmental Biology Department, University of California, Santa Barbara
| | - Juan Manuel Urueña
- NSF BioPACIFIC Materials Innovation Platform, University of California, Santa Barbara
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3
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Almuqbel MM, Palmer NJ, Jenkins A, Keenan RJ, Melzer TR. Magnetic resonance imaging of breast implants: Optimizing tissue contrast. J Med Imaging Radiat Sci 2023; 54:9-15. [PMID: 36646549 DOI: 10.1016/j.jmir.2022.12.001] [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: 08/11/2022] [Revised: 11/24/2022] [Accepted: 12/05/2022] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Patients with breast implants need to undergo regular screening MRI procedures. One of the key requirements of this screening scan is the ability to suppress one or more tissues (water, fat, or silicone) simultaneously. However, the presence of "foreign" implants within the breast biological space affects the MRI scanner's normal operating mode. Often, this requires operator's supervision to make sure the correct image contrast is achieved. METHODS We built a phantom that represents the commonly encountered tissues (water, fat, and silicone) in breast implant imaging. The phantom was used to optimise imaging parameters and highlight common challenges encountered while imaging breast implants. We scanned the phantom on seven different MRI scanners (including 1.5T and 3T) and produced vendor-specific cheat-sheets on how to image breast implants. Ethical approval was not required for this article type. CONCLUSION Performing a breast MRI procedure with implants in-situ can be challenging. Employing a purpose-built phantom, we provide easy-to-use cheat sheets, with examples, outlining steps that can be taken to ensure appropriate tissue suppression and image contrast in breast implant MRI. We hope these cheat-sheets will help MRI practitioners to confidently and efficiently achieve accurate image contrasts across a number of implant scenarios which will aid in improving diagnostic accuracy, treatment plans, and thus prognosis for the patient.
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Affiliation(s)
- Mustafa M Almuqbel
- Pacific Radiology Group, Christchurch, New Zealand; New Zealand Brain Research Institute, Christchurch, New Zealand; Department of Medicine, University of Otago, Christchurch, New Zealand.
| | | | | | - Ross J Keenan
- Pacific Radiology Group, Christchurch, New Zealand; New Zealand Brain Research Institute, Christchurch, New Zealand; Department of Radiology, Christchurch Hospital, Christchurch, New Zealand
| | - Tracy R Melzer
- New Zealand Brain Research Institute, Christchurch, New Zealand; Department of Medicine, University of Otago, Christchurch, New Zealand; School of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
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Antmen E, Muller CB, Calligaro C, Dupret-Bories A, Barthes J, Lavalle P, Vrana NE. In vitro two-step granuloma formation model for testing innate immune response to implants and coatings. BIOMATERIALS ADVANCES 2022; 138:212872. [PMID: 35913252 DOI: 10.1016/j.bioadv.2022.212872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 02/20/2022] [Accepted: 05/16/2022] [Indexed: 06/15/2023]
Abstract
The extensive innate immune response to implanted biomaterials contributes significantly to their sub-par performance and failure. Granuloma formation is one of such reactions which results in multi-cell type clusters in line with the immune reaction to implanted materials. However, currently no in vitro model of granuloma formation exists that takes into account the arrival of multiple cell types (immune cells and connective tissue cells) to the implant insertion site. In this study, we developed a two-step model based on stimulated macrophage seeding followed by fibroblast introduction after a physiologically relevant time period for mimicking initial steps of immune reaction to biomaterials and inducing granuloma like behavior. Both LPS and TNF-α induction resulted in granuloma like formations which persisted longer than the control conditions. Introduction of human fibroblasts resulted in the colonization of the surfaces where the cell numbers and the collagen secretion were dependent on the microenvironment. In order to demonstrate the capacity of our model system to monitor the reaction to a given coating, a validated antimicrobial coating (Polyarginine (PAR)/Hyaluronic acid (HA)) was used as a testing bed. The coating prevented the adhesion of macrophages while allowing the adhesion of the fibroblast at the time of their arrival. Similar to its antimicrobial activity, macrophage metabolic activity and M2 differentiation in the presence of PAR was dependent to its chain length. The incorporation of fibroblasts resulted in decreased TNF-α and increased IL-1RA secretion especially in stimulation conditions. The pro- and anti-inflammatory cytokine secretions were low for PAR/HA coatings in line with the decreased number of macrophage presence. In the presence of complex PBMC population, the coating resulted in slightly less cellular attachment, without any significant cytokine secretion; the absence of inflammatory reaction was also demonstrated in vivo in a mouse model. The described in vitro granuloma testing system can control the macrophage reaction as a function of stimulation. It can also be used for testing new biomaterials for the potential innate immune responses and also for validation of implant coatings beyond their primary function from the immune response point of view.
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Affiliation(s)
- Ezgi Antmen
- BIOMATEN, Middle East Technical University, Center of Excellence in Biomaterials and Tissue Engineering, Ankara, Turkey
| | - Celine B Muller
- SPARTHA Medical, 14B Rue de la Canardiere, Strasbourg Cedex 67100, France; INSERM Unité 1121 Biomaterials and Bioengineering, CRBS, 1 Rue Eugène Boeckel, Strasbourg Cedex 67000, France
| | - Cynthia Calligaro
- SPARTHA Medical, 14B Rue de la Canardiere, Strasbourg Cedex 67100, France; INSERM Unité 1121 Biomaterials and Bioengineering, CRBS, 1 Rue Eugène Boeckel, Strasbourg Cedex 67000, France
| | - Agnes Dupret-Bories
- Surgery Department, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse Oncopole, 1 avenue Irène Joliot Curie, Toulouse 31052, France
| | - Julien Barthes
- INSERM Unité 1121 Biomaterials and Bioengineering, CRBS, 1 Rue Eugène Boeckel, Strasbourg Cedex 67000, France
| | - Philippe Lavalle
- SPARTHA Medical, 14B Rue de la Canardiere, Strasbourg Cedex 67100, France; INSERM Unité 1121 Biomaterials and Bioengineering, CRBS, 1 Rue Eugène Boeckel, Strasbourg Cedex 67000, France
| | - Nihal Engin Vrana
- SPARTHA Medical, 14B Rue de la Canardiere, Strasbourg Cedex 67100, France; INSERM Unité 1121 Biomaterials and Bioengineering, CRBS, 1 Rue Eugène Boeckel, Strasbourg Cedex 67000, France.
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Characteristics and treatment of silicone granulomas: A retrospective multicenter cohort of 21 patients. JAAD Int 2021; 3:111-114. [PMID: 34409379 PMCID: PMC8362293 DOI: 10.1016/j.jdin.2021.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
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Breast Prosthesis Syndrome: Pathophysiology and Management Algorithm. Aesthetic Plast Surg 2020; 44:1423-1437. [PMID: 32152711 DOI: 10.1007/s00266-020-01663-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 02/23/2020] [Indexed: 02/05/2023]
Abstract
The cosmetic use of devices like prostheses to increase breast volume is nothing new. It is calculated that millions of people have been exposed to silicone in several ways, including breast implants, and since 1964 there has been uncertainty regarding their safety. We did not find in the literature any studies that reported the appearance of a specific immunological disease in patients with silicone breast implants. Furthermore, there are also neither case-control studies nor reports of patients proving that symptoms of autoimmune/inflammatory syndrome induced by adjuvants (ASIA) occurred after the placement of silicone implants nor that the patients had pre-existing symptoms. Several studies link silicone to allergic reactions and the development of systemic autoimmune diseases; however, other studies deny this association. There are currently several theories about the effect of silicone on the body. One theory with greater acceptance proposes an adjuvant effect of silicone on the development of autoimmune diseases in genetically predisposed patients. However, the variety of symptoms occurring in patients who develop these pathologies leads to doubts about the relationship between the adjuvant effects of a silicone prosthesis may have with a specific autoimmune disease or a mix of these diseases. The lack of consensus on this topic obliges a full review of what has already been reported in the literature to integrate the knowledge and propose a focus for new research on this matter. LEVEL OF EVIDENCE IV: 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 the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Cheng Z, Shurer CR, Schmidt S, Gupta VK, Chuang G, Su J, Watkins AR, Shetty A, Spector JA, Hui CY, Reesink HL, Paszek MJ. The surface stress of biomedical silicones is a stimulant of cellular response. SCIENCE ADVANCES 2020; 6:eaay0076. [PMID: 32300645 PMCID: PMC7148089 DOI: 10.1126/sciadv.aay0076] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 01/08/2020] [Indexed: 06/11/2023]
Abstract
Silicones are commonly used for lubrication of syringes, encapsulation of medical devices, and fabrication of surgical implants. While silicones are generally viewed as relatively inert to the cellular milieu, they can mediate a variety of inflammatory responses and other deleterious effects, but the mechanisms underlying the bioactivity of silicones remain unresolved. Here, we report that silicone liquids and gels have high surface stresses that can strongly resist deformation at cellular length scales. Biomedical silicones, including syringe lubricants and fillings from FDA-approved breast implants, readily adsorb matrix proteins and activate canonical rigidity sensing pathways through their surface stresses. In 3D culture models, liquid silicone droplets support robust cellular adhesion and the formation of multinucleated monocyte-derived cell masses that recapitulate phenotypic aspects of granuloma formation in the foreign body response. Together, our findings implicate surface stress as a cellular stimulant that should be considered in application of silicones for biomedical purposes.
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Affiliation(s)
- Zhu Cheng
- Robert Frederick Smith School of Chemical and Biomolecular Engineering, Cornell University, Ithaca, NY 14853, USA
| | - Carolyn R. Shurer
- Robert Frederick Smith School of Chemical and Biomolecular Engineering, Cornell University, Ithaca, NY 14853, USA
| | - Samuel Schmidt
- Robert Frederick Smith School of Chemical and Biomolecular Engineering, Cornell University, Ithaca, NY 14853, USA
- Kavli Institute at Cornell for Nanoscale Science, Ithaca, NY 14853, USA
| | - Vivek K. Gupta
- Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, NY 14853, USA
- Department of Mechanical Engineering, Stanford University, CA 94305, USA
| | - Grace Chuang
- Robert Frederick Smith School of Chemical and Biomolecular Engineering, Cornell University, Ithaca, NY 14853, USA
| | - Jin Su
- College of Veterinary Medicine, Cornell University, Ithaca, NY 14853, USA
| | - Amanda R. Watkins
- College of Veterinary Medicine, Cornell University, Ithaca, NY 14853, USA
| | - Abhishek Shetty
- Rheology Department, Anton Paar USA Inc., Ashland, VA 23005, USA
| | - Jason A. Spector
- Weill Cornell Medicine, Cornell University, New York, NY 10065, USA
| | - Chung-Yuen Hui
- Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, NY 14853, USA
- Field of Theoretical and Applied Mechanics, Cornell University, Ithaca, NY 14853, USA
| | - Heidi L. Reesink
- College of Veterinary Medicine, Cornell University, Ithaca, NY 14853, USA
| | - Matthew J. Paszek
- Robert Frederick Smith School of Chemical and Biomolecular Engineering, Cornell University, Ithaca, NY 14853, USA
- Kavli Institute at Cornell for Nanoscale Science, Ithaca, NY 14853, USA
- Field of Biophysics, Cornell University, Ithaca, NY 14853, USA
- Field of Biomedical Engineering, Cornell University, Ithaca, NY 14853, USA
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Ryu AJ, Glazebrook KN, Samreen N, Bauer PR, Yi ES, Ryu JH. Spectrum of Chronic Complications Related to Silicone Leakage and Migration. Am J Med 2018; 131:1383-1386. [PMID: 29680487 DOI: 10.1016/j.amjmed.2018.03.041] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 03/22/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Medical silicone is widely used as implants and free injections, but the spectrum of complications related to migration or embolization of silicone remains unclear. METHODS We retrospectively reviewed 79 patients with silicone migration as confirmed on pathology between January 1, 2001, and December 31, 2016. The presenting clinical and imaging features, diagnostic testing, treatment, and outcome were assessed. RESULTS Nearly all patients were women, and 43% had a history of breast cancer. Sixty-three cases (80%) consisted of localized silicone granulomas, including 1 patient who developed severe hypercalcemia related to the granulomatous reaction. The remaining 16 cases (20%) involved migration of silicone to regional lymph nodes or distant tissue and included 1 case of chronic silicone pneumonitis. These complications were detected many years (median, 22 years; range, 1-40 years) after initial silicone placement. Only magnetic resonance imaging, dual-energy computed tomography (CT), and ultrasonography demonstrated specificity for detection of silicone in lymph nodes and soft tissues. Other modalities including positron emission tomography, single-energy CT, and mammography detected only nonspecific abnormalities. Excisional biopsy of symptomatic lymphadenopathy or masses usually led to resolution of symptoms. The patient with silicone pneumonitis improved with corticosteroid therapy. CONCLUSIONS Chronic complications related to silicone extravasation and migration can present with local or distant manifestations, typically encountered many years after the original silicone placement. Magnetic resonance imaging, dual-energy CT, and ultrasonography are helpful for noninvasive diagnosis.
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Affiliation(s)
- Alexander J Ryu
- Mayo Clinic School of Graduate Medical Education, Rochester, Minn
| | | | | | - Philippe R Bauer
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minn
| | - Eunhee S Yi
- Division of Anatomic Pathology, Mayo Clinic, Rochester, Minn
| | - Jay H Ryu
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minn.
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Silicone Migration and Late Hematoma following Silicone Implant Rupture: Case Report and Literature Review. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1849. [PMID: 30254827 PMCID: PMC6143320 DOI: 10.1097/gox.0000000000001849] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 05/09/2018] [Indexed: 11/25/2022]
Abstract
Supplemental Digital Content is available in the text. Distant silicone migration and late postoperative hematoma are rare but serious complications following breast implant rupture. This study describes a case report of both these complications occurring in the same patient. After a review of pertinent literature, the authors found 19 other case reports (20 total patients) with distant silicone migration following breast implant rupture. Median age at the time of presentation was 48 years (range, 21–76), and median time between initial breast augmentation and presentation with silicone migration was 10 years (range, 1–30 years). Sites of migrated silicone included arm/forearm (n = 11), thoracic cavity (n = 4), abdominal wall (n = 3), legs (n = 2), and back (n = 1). A total of 67% of patients had documented trauma to the chest before presentation. Our study highlights the need to consider distant silicone migration in the differential diagnosis when extracapsular implant rupture is suspected.
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10
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Blasco A, Baixauli E. Granuloma formation associated with patellar tendon necrosis in response to Ethibond confirmed by histopathological examination. BMJ Case Rep 2018; 2018:bcr-2017-222854. [PMID: 29754129 DOI: 10.1136/bcr-2017-222854] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The aim of this study is to describe a case of delayed granuloma formation associated with tendon necrosis in response to Ethibond confirmed by histopathological examination and to review and discuss the related literature. A 40-year-old woman underwent a patellar tendon repair with Krakow-like #5 Ethibond sutures. Four years after the repair, she noticed progressive soreness with knee extension and swelling. An ultrasound examination revealed a proximal partial patellar tendon rupture. Based on these findings, the patient was advised to undergo surgical intervention due to a diagnosis of re-rupture. Tendinosis, fibrosis and necrosis scar tissue surrounding the previous suture were observed and excised, and samples were sent for histopathological and microbiological examination. Stripping of the patellar paratenon was performed. Surprisingly, a giant cell foreign body reaction surrounding the synthetic refringent material, as well as polymorphonuclear cells surrounding the necrotic tendon, was reported.
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Affiliation(s)
- Alejandro Blasco
- Orthopedic Surgery, Hospital Universitari i Politecnic La Fe, Valencia, Spain
| | - Emilio Baixauli
- Orthopedic Surgery, Hospital Universitari i Politecnic La Fe, Valencia, Spain
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Zambacos GJ, Molnar C, Mandrekas AD. Silicone lymphadenopathy after breast augmentation: case reports, review of the literature, and current thoughts. Aesthetic Plast Surg 2013; 37:278-89. [PMID: 23354761 DOI: 10.1007/s00266-012-0025-9] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Accepted: 11/05/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Silicone lymphadenopathy after implantation of silicone breast implants is a foreign body reaction due to the release or migration of silicone into the tissues surrounding the breast implant. METHODS For the study, 14 cases of silicone lymphadenopathy were identified from the authors' files. Four patients had been implanted before 2000 and had various types of implants. The remaining 10 patients all were implanted between 2006 and 2009, and all had Poly Implant Prothèse (PIP) implants. In addition to an analysis of the authors' own cases, a thorough bibliographic search was initiated to identify all reports of lymphadenopathy related to silicone breast implants. RESULTS The implant age of the four patients implanted before 2000 was 12-34 years (mean, 17.25 years). The implant age of the 10 patients implanted after 2000 was 2-6 years (mean 3.45 years). The literature search identified 29 papers with case reports of silicone lymphadenopathy published between 1978 and 2012, with a total of 175 cases. Usable data were extracted from 164 of the 175 cases. Of these patients, 159 were implanted before (and including) the year 2000 and had a mean age of 11 years at presentation or explantation, and 5 of these patients were implanted after the year 2000 and had a mean age of 4.6 years at presentation or explantation . After inclusion of the authors' own cases, the mean age of the implants at presentation or explantation was 10.56 years in a total of 178 cases. Of these patients, 163 were implanted before (and including) the year 2000 and had a mean age of 11.16 years at presentation or explantation, and 15 of these patients were implanted after the year 2000 and had a mean age of 4.06 years at presentation or explantation. CONCLUSIONS Current breast implant technology has minimized the release of silicone gel due to rupture or bleeding of silicone and its migration into the surrounding tissues, thus reducing the rate of silicone lymphadenopathy in the last 10 years. The PIP implant scandal highlights the fact that disregard for the implant manufacturing technologies and standards in favor of higher profits increased rupture rates and gel diffusion, leading to increased local complication rates. Silicone lymphadenopathy is a foreign body reaction that does not warrant treatment unless it is symptomatic or interferes with breast cancer detection. LEVEL OF EVIDENCE III 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 the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Fischer J, Solari M, Shestak K. Enlarging breast mass in a patient with a history of polyurethane implants. Plast Reconstr Surg 2010; 125:68e-70e. [PMID: 20124812 DOI: 10.1097/prs.0b013e3181c91bce] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- John Fischer
- State University of New York, Upstate University School of Medicine; Syracuse, N.Y. (Fischer) Plastic Surgery Service; Magee Women's Hospital; Division of Plastic Surgery; Department of Surgery; University of Pittsburgh School of Medicine; Pittsburgh, Pa. (Solari, Shestak)
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13
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Fong D, Lann MA, Finlayson C, Page DL, Singh M. Diabetic (lymphocytic) mastopathy with exuberant lymphohistiocytic and granulomatous response: a case report with review of the literature. Am J Surg Pathol 2006; 30:1330-6. [PMID: 17001167 DOI: 10.1097/01.pas.0000213284.27789.a8] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
We report a case of a 66-year-old woman who presented with multiple painless masses in both breasts. Prior bilateral biopsies were diagnosed as Rosai-Dorfman disease (Sinus Histiocytosis with Massive Lymphadenopathy). A recent lumpectomy specimen revealed a gray-white smooth cut surface with a discrete masslike lesion. The histopathology demonstrated a fibrotic breast parenchyma with foci of dense fibrosis and scattered inconspicuous breast epithelium surrounded by lymphocytes that formed aggregates and follicles with germinal centers. The inflammation was in a periductal, perilobular, and perivascular distribution. In addition, an exuberant inflammatory response with histiocytes and fibroblasts was present. This inflammatory response focally surrounded areas of fat necrosis and formed noncaseating granulomas with rare multinucleated giant cells. This process had infiltrative, ill-defined edges and involved the subcutaneous tissues. The overlying epidermis was normal. The final diagnosis was diabetic mastopathy with an exuberant lymphohistiocytic response. The differential diagnosis included Rosai-Dorfman disease, inflammatory myofibroblastic tumor, granulomatous mastitis, sclerosing lipogranulomatous response/sclerosing lipogranuloma, lupus panniculitis, and rheumatoid nodules. Immunohistochemical studies and flow cytometry confirmed the polyclonal nature of the lymphoid infiltrate. After the histologic evaluation, we inquired if the patient had a history of diabetes mellitus, and learned that she did have type 2 noninsulin-dependent diabetes mellitus. In conclusion, we report a case of diabetic mastopathy that presents with bilateral tumorlike masses and an unusual exuberant lymphohistiocytic response with granuloma formation. The pathologist may not be provided with a history of diabetes mellitus, but the characteristic fibrosis, lymphocytic ductitis/lobulitis, and sclerosing lobulitis with perilobular and perivascular lymphocytic infiltrates should provide clues for an accurate diagnosis, even when an exuberant and an unusual lymphohistiocytic response is present. A timely accurate diagnosis can help limit repeat surgeries in this vulnerable group of patients.
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Affiliation(s)
- Dean Fong
- Department of Pathology, University of Colorado at Denver Health Sciences Center, Denver, CO, USA
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Alam M, Danahey DG. Permanent injectables for soft tissue augmentation: avoiding misinformation and a reprise of the breast implant debacle. ARCHIVES OF FACIAL PLASTIC SURGERY 2005; 7:370-3. [PMID: 16301455 DOI: 10.1001/archfaci.7.6.370] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
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Christensen L, Breiting V, Janssen M, Vuust J, Hogdall E. Adverse reactions to injectable soft tissue permanent fillers. Aesthetic Plast Surg 2005; 29:34-48. [PMID: 15759096 DOI: 10.1007/s00266-004-0113-6] [Citation(s) in RCA: 200] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2004] [Accepted: 10/01/2004] [Indexed: 02/06/2023]
Abstract
BACKGROUND Synthetic injectable facial fillers with a permanent effect are widely atoxic and nonimmunogenic, but they differ with respect to composition and in chemical and biologic characteristics. Yet, they all act as foreign bodies in the tissues eliciting a host response that try to remove the gel. Inflammatory nodules may develop at the sites of injection-for some fillers, many years later, for others, not. Why is that? METHODS Biopsies were contributed by various plastic surgeons from Europe and Australia after requests were made at international congresses and workshops. The study was based on (a) 5 biopsies from unreactive tissue obtained at different times after injection of polyacrylamide hydrogel (Aquamid); (b) 28 biopsies from intermediate or late inflammatory nodules after injection of polyacrylamide hydrogel (Aquamid) (20 cases), a hyaluronic acid-polyhydroxyethylmethacrylate/ethylmethacrylate gel (Dermalive) (2 cases), and a gel consisting of polylactic acid in mannitol/carbomethoxycellulose (New-Fill) (6 cases); and (c) a review of the literature on adverse reactions after injection with permanent fillers. RESULTS Clinically unreactive tissues after injection with Aquamid showed modest or no host reaction. Inflammatory nodules showed an increased foreign body reaction and a bacterial infection after injection with Aquamid, and a combination of moderate foreign body reaction, fibrosis, and in some cases also bacterial infection after injection with Dermalive and New-Fill. According to the literature, inflammatory nodules occur no later than 1 year after injection with polyacrylamide hydrogel, but up to 6 years after injection of combination gels (Artecol), and up to 28 years after injection of silicone gel. CONCLUSIONS Inflammatory nodules are likely to be caused by a low-grade infection maintained within a biogfilm surrounding the hydrophobic silicone gel and the combination gels. Aquamid gel may prevent formation of a biofilm through its high water-binding capacity, explaining why late inflammatory nodules are not seen after injection of this polyacrylamide hydrogel product.
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Affiliation(s)
- Lise Christensen
- Department of Pathology, Rigshospitalet Fred., Copenhagen, Denmark.
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