Goldberg Mytien Thi, Llaneras Jason, Willson Thomas D, Boyd John Brain, Venegas Rose J, Dauphine Christine, Kalantari Babak N
From the Division of Plastic and Reconstructive Surgery.
Department of Surgery.
Ann Plast Surg. 2021 Mar 1;86(3):268-272. doi: 10.1097/SAP.0000000000002524.
Breast augmentation and reconstruction utilizing implants are among the most common plastic surgery procedures performed in the United States. A small proportion of these implants are removed each year. We report 2 cases where routine pathologic evaluation of capsulectomy specimens revealed squamous cell carcinoma associated with the breast implant capsule and discuss the possible pathogenesis of this unusual entity. Both patients had long-standing implants (>10 years) and presented with acute unilateral breast erythema and swelling. Intraoperatively, the capsules for both cases appeared thickened and calcified, containing extensive granulomatosis and keratinaceous debris invading into the chest wall. Extensive workup failed to find an occult primary. One patient died from a malignant pleural effusion secondary to tumor invasion during chemotherapy, and the second patient obtained stabilization of the mass after 5 weeks of chemotherapy but subsequently declined further surgical intervention. A thorough literature review was performed, and 5 similar reports were identified, involving 6 patients. All patients presented with similar clinical presentations as ours and had poor outcomes. The mean reporting age at diagnosis was 60 years, and the average time from initial implant to diagnosis was 25 years. Due to the small numbers of squamous cell carcinomas associated with breast implant capsules, the true association between the 2 is unknown. It is postulated that chronic inflammation/irritation from the breast implant and epithelialization of the capsule play a significant role in the disease process. This may represent a new entity of "chronic inflammatory capsular malignancies." Increased awareness of this entity may allow for earlier suspicion, diagnosis, and management.
利用植入物进行隆胸和乳房重建是美国最常见的整形手术之一。每年都有一小部分此类植入物被取出。我们报告2例病例，在对包膜切除术标本进行常规病理评估时发现与乳房植入物包膜相关的鳞状细胞癌，并讨论这种罕见实体的可能发病机制。两名患者的植入物均已存在很长时间（>10年），表现为急性单侧乳房红斑和肿胀。术中，两例病例的包膜均增厚并钙化，含有广泛的肉芽肿和侵入胸壁的角质碎片。全面检查未发现隐匿性原发灶。一名患者在化疗期间因肿瘤侵犯继发恶性胸腔积液死亡，第二名患者在化疗5周后肿块稳定，但随后拒绝进一步手术干预。我们进行了全面的文献回顾，确定了5篇类似报告，涉及6名患者。所有患者的临床表现均与我们的病例相似，且预后不良。诊断时的平均报告年龄为60岁，从最初植入到诊断的平均时间为25年。由于与乳房植入物包膜相关的鳞状细胞癌数量较少，两者之间的真正关联尚不清楚。据推测，乳房植入物引起的慢性炎症/刺激以及包膜的上皮化生在疾病过程中起重要作用。这可能代表一种新的“慢性炎症性包膜恶性肿瘤”实体。提高对该实体的认识可能有助于更早地怀疑、诊断和处理。
