Varga J, Schumacher H R, Jimenez S A
Thomas Jefferson University, University of Pennsylvania School of Medicine, Philadelphia.
Ann Intern Med. 1989 Sep 1;111(5):377-83. doi: 10.7326/0003-4819-111-5-377.
We describe four women who presented with systemic sclerosis several years after cosmetic augmentation mammoplasty with silicone-gel implants. The interval between implantation mammoplasty and the onset of systemic sclerosis ranged from 6 to 15 years. All patients fulfilled the criteria established by the American Rheumatism Association for systemic sclerosis and had Raynaud phenomenon, arthralgia, and evidence of pulmonary or gastrointestinal involvement. Enlargement of lymph nodes draining the prostheses was noted in two patients. Antinuclear antibodies were detected in three patients and showed speckled or nucleolar patterns. Removal of the prostheses in two cases did not result in improvement of systemic sclerosis. Evidence of silicone leakage from the implants included the following. The observation by light microscopy of refractile particles in tissues distant from the prostheses, the observation by electron microscopy of electron-dense structures consistent with silica, and the definitive identification of the element silicon by energy-dispersive analysis in these electron-dense structures. A marked, chronic inflammatory infiltrate containing lymphocytes, "foamy" histiocytes, and larger numbers of multi-nucleated giant cells with vacuoles and asteroid bodies was found at the same sites. Our demonstration that silicone escapes from elastomer-silicone-gel breast implants and appears to be closely associated with a chronic inflammatory reaction suggests that silicone plays a role in the development of certain cases of systemic sclerosis.
我们描述了四名在接受硅胶凝胶乳房植入隆乳术后数年出现系统性硬化症的女性。植入隆乳术与系统性硬化症发病之间的间隔为6至15年。所有患者均符合美国风湿病协会制定的系统性硬化症标准，并有雷诺现象、关节痛以及肺部或胃肠道受累的证据。两名患者发现引流假体的淋巴结肿大。三名患者检测到抗核抗体，呈斑点状或核仁型。两例取出假体后系统性硬化症并未改善。植入物硅胶渗漏的证据如下：在远离假体的组织中通过光学显微镜观察到折射颗粒；通过电子显微镜观察到与二氧化硅一致的电子致密结构；通过能量色散分析在这些电子致密结构中明确鉴定出硅元素。在相同部位发现了明显的慢性炎性浸润，其中含有淋巴细胞、“泡沫状”组织细胞以及大量带有空泡和星状体的多核巨细胞。我们证明硅胶从弹性体 - 硅胶凝胶乳房植入物中逸出，并且似乎与慢性炎症反应密切相关，这表明硅胶在某些系统性硬化症病例的发展中起作用。
