Mayo Clinic School of Graduate Medical Education, Rochester, Minn.
Department of Radiology, Mayo Clinic, Rochester, Minn.
Am J Med. 2018 Nov;131(11):1383-1386. doi: 10.1016/j.amjmed.2018.03.041. Epub 2018 Apr 20.
Medical silicone is widely used as implants and free injections, but the spectrum of complications related to migration or embolization of silicone remains unclear.
We retrospectively reviewed 79 patients with silicone migration as confirmed on pathology between January 1, 2001, and December 31, 2016. The presenting clinical and imaging features, diagnostic testing, treatment, and outcome were assessed.
Nearly all patients were women, and 43% had a history of breast cancer. Sixty-three cases (80%) consisted of localized silicone granulomas, including 1 patient who developed severe hypercalcemia related to the granulomatous reaction. The remaining 16 cases (20%) involved migration of silicone to regional lymph nodes or distant tissue and included 1 case of chronic silicone pneumonitis. These complications were detected many years (median, 22 years; range, 1-40 years) after initial silicone placement. Only magnetic resonance imaging, dual-energy computed tomography (CT), and ultrasonography demonstrated specificity for detection of silicone in lymph nodes and soft tissues. Other modalities including positron emission tomography, single-energy CT, and mammography detected only nonspecific abnormalities. Excisional biopsy of symptomatic lymphadenopathy or masses usually led to resolution of symptoms. The patient with silicone pneumonitis improved with corticosteroid therapy.
Chronic complications related to silicone extravasation and migration can present with local or distant manifestations, typically encountered many years after the original silicone placement. Magnetic resonance imaging, dual-energy CT, and ultrasonography are helpful for noninvasive diagnosis.
医用硅酮被广泛用作植入物和游离注射剂，但与硅酮迁移或栓塞相关的并发症谱尚不清楚。
我们回顾性分析了 2001 年 1 月 1 日至 2016 年 12 月 31 日期间经病理证实的 79 例硅酮迁移患者。评估了其临床表现、影像学特征、诊断性检查、治疗和结局。
几乎所有患者均为女性，43%有乳腺癌病史。63 例（80%）为局限性硅酮肉芽肿，其中 1 例因肉芽肿反应导致严重高钙血症。其余 16 例（20%）涉及硅酮向区域性淋巴结或远处组织迁移，包括 1 例慢性硅酮性肺炎。这些并发症在初始硅酮植入后多年（中位数为 22 年；范围为 1-40 年）才被发现。只有磁共振成像、双能 CT 和超声检查显示出对淋巴结和软组织中硅酮的特异性。其他方式包括正电子发射断层扫描、单能 CT 和乳房 X 线摄影术仅能检测到非特异性异常。有症状的淋巴结病或肿块的切除活检通常可使症状缓解。硅酮性肺炎患者接受皮质类固醇治疗后病情改善。
与硅酮外渗和迁移相关的慢性并发症可表现为局部或远处表现，通常在最初的硅酮植入后多年才出现。磁共振成像、双能 CT 和超声检查有助于进行无创诊断。
