Breast Institute, Nottingham University Hospitals, Nottingham, UK.
Histopathology Department, Nottingham University Hospitals, Nottingham, UK.
Diagn Cytopathol. 2022 May;50(5):E119-E122. doi: 10.1002/dc.24919. Epub 2022 Jan 7.
A 40-year-old woman with silicone implants inserted 21 years before presented with sudden onset of painful right breast swelling. Clinical examination revealed a firm swollen breast with appearance of old bruising. Ultrasound showed fluid around the implant. Cytology of the fluid showed cells with large pleomorphic nuclei with prominent nucleoli including elongated forms and very occasional vacuoles. The cell block also contained small fragments with atypical spindle cells around slit-like spaces that were positive for CD31 and CD34. MRI showed a 25 mm serpiginous area of enhancement on the inner aspect of the fibrous capsule with haematoma between the capsule and the implant. The capsule and adjacent area were excised. Histology showed angiosarcoma extending from the inner aspect of the capsule into the cavity around the implant. The location of the tumour on the inner aspect of the capsule is the same site that breast implant associated anaplastic large cell lymphomas arise and suggests a possible causal link between the implant and the angiosarcoma. This case emphasises the value of cytological assessment of fluid around breast implants and the role of cell blocks and immunohistochemistry.
一位 40 岁女性，21 年前植入硅胶假体，现突发右侧乳房肿胀伴疼痛。临床检查发现乳房肿胀，质地坚硬，外观呈陈旧性瘀斑。超声显示假体周围有积液。积液的细胞学检查显示，细胞的细胞核大而多形性，核仁明显，包括长形和极偶尔的空泡。细胞块还包含小碎片，具有非典型梭形细胞，围绕缝隙样空间，CD31 和 CD34 阳性。MRI 显示纤维囊内面有 25mm 的蛇形强化区，囊与假体之间有血肿。切除囊和邻近区域。组织学显示血管肉瘤从囊内面延伸到假体周围的腔隙。肿瘤位于囊内面的位置与乳腺假体相关性间变性大细胞淋巴瘤的发生部位相同，提示假体与血管肉瘤之间可能存在因果关系。本病例强调了评估假体周围积液的细胞学检查、细胞块和免疫组织化学的价值。
