Ann Surg Treat Res.  2017 Dec;93(6):331-335. 10.4174/astr.2017.93.6.331.

Extensive silicone lymphadenopathy after breast implant insertion mimicking malignant lymphadenopathy

• Lee Y
• Song SE
• Yoon ES
• Bae JW
• Jung SP

• KMID: 2396875
• DOI: http://doi.org/10.4174/astr.2017.93.6.331

Abstract

Silicone implants are widely used in aesthetic and reconstructive breast surgery. Silicone lymphadenopathy is a well-known rare complication of implant insertion. Silicone leakage from a rupture or silicone bleeding can accumulate in lymph nodes. Foreign body reactions in the affected lymph nodes may be misdiagnosed as metastasis or malignant lymphadeno pathy upon initial presentation if silicone lymphadenopathy is not considered in the initial diagnosis. We report a case of siliconoma with extensive involvement of multiple lymph nodes mimicking malignant features to emphasize that clinicians should carefully evaluate each patient's medical history and disease status during differential diagnosis.

Keyword

Breast; Lymphadenopathy; Silicones

MeSH Terms

Breast Implants*
Breast*
Diagnosis
Diagnosis, Differential
Foreign Bodies
Hemorrhage
Lymph Nodes
Lymphatic Diseases*
Neoplasm Metastasis
Rupture
Silicon*
Silicones*
Silicon
Silicones

Figure

• 

  Fig. 1 Ultrasonographic and computed tomographic findings of the lymph nodes. (A) Ultrasonographic images of axillary lymph nodes. Multiple hyperechoic lesions with diffuse posterior white noise (where silicone blocks sound transmission, white arrows) were observed. (B) Coronal view of computed tomography. Round, nonenhanced enlarged lymph nodes are located in the right axilla and neck (white arrows).

• 

  Fig. 2 Mammographic and MRI of the breast and axilla. (A) Mediola teral view of mam mo graphy im ages demon strating the right breast implant and an enlarged lymph node with the dense internal material in the right axilla (white arrow). (B) Axial nonfat sup pressed, T1-weighted MRI of the breast show tear drop sign within the right implant and a hypo dense thin line in the interior of the implant indicative of intracapsular rupture (white arrows). (C) Axial nonfat suppressed, T1-weighted MRI im ages of the breast show oval cir cumscribed lymph nodes with isosignal intensity (white arrows) in the right axilla compared to the implanted silicone bag in panel B.

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  Fig. 3 Macroscopic findings of the excised lymph node. (A) The exterior of the lymph node is round and reddish-brown in color. (B) The cut surface of the node.

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  Fig. 4 Microscopic findings of excised lymph node. (A) Silicone-containing histiocytes are scattered through the lymph node parenchyme (H&E, ×40). (B) Large clusters of silicone-filled, clear-appearing histiocytes have replaced lymphoid tissue (H&E, ×200).

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