Kamel M, Protzner K, Fornasier V, Peters W, Smith D, Ibanez D
Laboratory of Bone and Joint Pathology, Department of Anatomic Pathology & Cytology, Wellesley Central Site, St. Michael's Hospital, University of Toronto, Toronto, Canada.
J Biomed Mater Res. 2001;58(1):88-96. doi: 10.1002/1097-4636(2001)58:1<88::aid-jbm130>3.0.co;2-7.
Silicone-based breast implants continue to be the focus of many studies attempting to correlate implant failure to clinical and pathological factors. Routine pathology of peri-implant capsule is extensively described in the literature. The actual significance of the cellular events remains unconfirmed, particularly with reference to clinical outcome. This study reviews our experience with explanted capsules. The study makes specific reference to the immunohistochemistry of the cells participating in the capsule and the significance of the immunophenotypic characterization of these cells to clinical outcome. The use of a wide selection of immunomarkers for T and B lymphocytes and histiocytes provided no supporting evidence for local cell participation in the capsule, which may indicate the presence of an immunological reaction present in the capsule at the time of explantation. One was only able to confirm the presence of a low grade inflammatory process and progression to fibrosis and calcification over time. Statistical correlation was obtained only between Baker grade of capsular contracture and CD3/CD68 immunomarker positivity. CD45RO did show correlation with pain. No correlation was demonstrated with calcification. The results obtained in this study highlighted the need for further investigations into the mechanism of histiocyte and fibrocyte recruitment and activation in the capsule, a possible source of pain and contracture, which is a serious long-term clinical finding leading to the necessity for explantation.
硅基乳房植入物仍然是许多研究的重点，这些研究试图将植入物失败与临床和病理因素联系起来。植入物周围包膜的常规病理学在文献中有广泛描述。细胞事件的实际意义仍未得到证实，特别是在临床结果方面。本研究回顾了我们对取出包膜的经验。该研究特别提到了参与包膜形成的细胞的免疫组织化学，以及这些细胞的免疫表型特征对临床结果的意义。使用多种针对T淋巴细胞、B淋巴细胞和组织细胞的免疫标志物，没有提供局部细胞参与包膜形成的支持证据，这可能表明在取出时包膜中存在免疫反应。只能确认存在低度炎症过程，以及随着时间的推移发展为纤维化和钙化。仅在包膜挛缩的贝克分级与CD3/CD68免疫标志物阳性之间获得了统计学相关性。CD45RO确实与疼痛相关。未发现与钙化相关。本研究获得的结果凸显了有必要进一步研究包膜中组织细胞和成纤维细胞募集和激活的机制，这可能是疼痛和挛缩的一个来源，而疼痛和挛缩是导致必须取出植入物的严重长期临床发现。
