SESSION TITLE: Lung Cancer Cases - Student/Resident
SESSION TYPE: Student/Resident Case Report Slide
PRESENTED ON: Sunday, October 25, 2015 at 03:15 PM - 04:15 PM
INTRODUCTION: Mastectomy with breast reconstruction is a common procedure for women with a personal or family history of breast cancer. A concerning complication of silicone breast implants is implant rupture and subsequent systemic extravasation of silicone from the implant. We describe a case of a ruptured silicone implant that mimicked malignancy causing a syndrome of inappropriate antidiuretic hormone (SIADH).
CASE PRESENTATION: A 64-year-old Caucasian woman with a history of silicone breast implants following prophylactic bilateral mastectomy at age 37 due to strong family history presents to her PCM with nausea, fatigue, and anorexia. Initial evaluation demonstrated fever to 100.5 and hyponatremia with serum sodium of 119mEq/L. On evaluation, she underwent a computed tomography (CT) which demonstrated bilateral axillary lymphadenopathy, enlarged internal mammary chain lymph nodes, and numerous sub-centimeter, ground glass and solid pulmonary nodules. Subsequent ultrasound guided biopsy of the axillary lymph nodes revealed granulomatous inflammation and vacuolization associated with refractile, non-polarizing material consistent with silicone reaction. She underwent successful surgical explantation of her implants. Following surgery, the hyponatremia resolved immediately. Repeat CT three months post-operative showed near complete resolution of the lymphadenopathy and resolution of the ground glass and solid pulmonary nodules. To our knowledge, this is the first reported case of SIADH and pulmonary nodules in association with ruptured silicone implants.
DISCUSSION: Ruptured silicone implants can lead to migration of silicone beyond the breast tissue, causing inflammation and subsequent silicone granuloma formation. The most common symptoms associated with silicone lymphadenopathy include breast pain/discomfort, palpable lymphadenopathy, and constitutional symptoms secondary to foreign body inflammation. Lymphadenopathy associated with silicone granulomas is often worrisome for malignancy, as it follows the same lymphatic drainage pattern of axillary, internal mammary and ultimately supraclavicular and mediastinal lymph nodes. Tissue sampling or spectrometry can identify the diagnosis, the confirmation of which should lead to removal of ruptured implant.
CONCLUSIONS: With the increasing frequency of silicone breast implants being used for augmentation or reconstruction, physicians must remain vigilant to the long term complications of their use. Silicone lymphadenopathy can be diagnosed with mass spectrometry or tissue sampling, and can be treated with removal of the implant which lead to complete resolution of the SIADH and lympadenopathy in our patient.
Reference #1: Bauer et al. Silicone breast implant-induced lymphadenopathy: 18 Cases. Respiratory Medicine CME 4 (2011) 126-130.
Reference #2: Zambacos et al. Silicone Lymphadenopathy After Breast Augmentation: Case Reports, Review of the Literature, and Current Thoughts. Aesth Plast Surg (2013) 37:278-289.
DISCLOSURE: The following authors have nothing to disclose: Joseph Zeman, Nicholas Fiacco, Barbara Cooper
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