Sylvester-Hvid Amalie, Avnstorp Magnus B, Wagenblast Lene, Lock-Andersen Jørgen, Matzen Steen H
Department of Plastic and Breast Surgery, Zealand University Hospital, Sygehusvej 10, DK-4000 Roskilde, Denmark.
Int J Surg Case Rep. 2017;40:73-76. doi: 10.1016/j.ijscr.2017.08.061. Epub 2017 Sep 4.
Introduction Breast seroma may be caused by a variety of factors including lymphatic disruption, continuous inflammation and foreign bodies such as breast implants. In cases of breast implants associated seroma the diagnosis of Anaplastic Large Cell Lymphoma (ALCL) should be investigated. Presentation of Case A 45-year-old Caucasian woman was referred with bilateral swelling of the breasts causing tension and pain. MRI showed accumulations compatible with bilateral silicone implants. Ultrasound-guided aspiration showed no malignancy or silicone. The patient had a history of both soy- and silicone implants. Three years prior her breast implants was removed due to capsule formation. To treat the pain and rule out potential malignancy we performed capsulectomy of only the right breast, on the wish of the patient. We found brown fluid, no breast implants and histology of fluid and tissue showed no malignancy.
Breast seroma usually develops weeks after surgery such as mastectomy or axillary lymph node dissection. This patient developed a seroma through months and years after her last surgery. In cases of late seroma malignancy should be ruled out. Diagnostic statements should not solely be based on radiology, but in conjunction with clinical findings.
We performed capsulectomy on a patient with breast seroma mimicking breast implants. We excluded the diagnosis of breast implant-associated ALCL. Radiology has limitations and should be considered in conjunction with the patient's statement and the clinical findings.
引言 乳腺血清肿可能由多种因素引起，包括淋巴系统破坏、持续炎症以及乳房植入物等异物。对于与乳房植入物相关的血清肿病例，应排查间变性大细胞淋巴瘤（ALCL）的诊断。病例介绍 一名45岁的白人女性因双侧乳房肿胀导致紧绷和疼痛前来就诊。磁共振成像（MRI）显示积液与双侧硅胶植入物相符。超声引导下穿刺未发现恶性肿瘤或硅胶。该患者有大豆和硅胶植入物植入史。三年前，由于包膜形成，她的乳房植入物被取出。为缓解疼痛并排除潜在恶性肿瘤，应患者要求，我们仅对右侧乳房进行了包膜切除术。我们发现了棕色液体，未发现乳房植入物，液体和组织的组织学检查未显示恶性肿瘤。
乳腺血清肿通常在乳房切除术或腋窝淋巴结清扫术等手术后数周出现。该患者在最后一次手术后数月乃至数年出现了血清肿。对于晚期血清肿病例，应排除恶性肿瘤。诊断不能仅基于影像学检查，而应结合临床发现。
我们对一名疑似乳房植入物的乳腺血清肿患者进行了包膜切除术。我们排除了乳房植入物相关ALCL的诊断。影像学检查有局限性，应结合患者陈述和临床发现进行综合考虑。
