Intrapleural silicone granuloma mimicking pleural malignancy

Our plain-English summary of Intrapleural silicone granuloma mimicking pleural malignancy, by K. Vo, M. Kilgore, J. Scheel (Radiology Case Reports, 2021).

The study

• Authors: K. Vo, M. Kilgore, J. Scheel
• Journal: Radiology Case Reports
• Published: 2021;16(12):3824-3828
• Type of article: Case report
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

We describe a 78-year-old initially presenting with left breast cancer, status post mastectomy and bilateral dual-lumen breast implant placement, subsequently developed lung cancer years later status post lobectomy, who later developed FDG-avid pleural nodularity and thickening. The differential diagnosis of pleural thickening and nodularity can be broad, including metastatic cancer, asbestos-related pleural disease, loculated fluid (including simple pleural effusion, hemothorax, or chylothorax), and pleural infection. However, in the setting of two different primary malignancies, our patient's FGD-avid pleural thickening was concerning for metastatic disease. Further workup with a core-needle biopsy of the pleural nodule revealed "droplets of foreign material and foreign body giant cell reaction consistent with contents of ruptured medical device", without evidence of malignancy. Prior imaging did not indicate breast implant compromise. A subsequent mammogram suggested findings of bilateral implant rupture, however, no further clinical workup was performed. A screening mammogram a decade later indicated possible extracapsular silicone within the right breast and left mastectomy site and an MRI was recommended for further workup. Subsequent MRI showed bilateral extracapsular silicone implant rupture with a thick layer of silicone signal within the left pleura in a similar distribution to her pleural thickening and nodularity. Her breast MRI findings, in conjunction with her pleural biopsy result, are concordant with pleural silicone granulomas from extracapsular breast implant rupture via radio-occult tract from prior left lobectomy procedure.

© 2021 The Authors. Published by Elsevier Inc. on behalf of University of Washington.

In plain English

This case report described one 78-year-old woman whose pleural thickening and nodules on scans were at first concerning for cancer spread. She had earlier been treated for left breast cancer with mastectomy and reconstruction using dual-lumen saline and silicone implants. A decade later she had left lower lobe lung adenocarcinoma removed by lobectomy in 2008. Surveillance CT scans showed left pleural thickening and nodularity that had increased by February 2011, and a PET/CT scan in March 2011 showed hypermetabolic pleural nodules. A core needle biopsy of a pleural nodule found droplets of foreign material and a foreign body giant cell reaction consistent with contents of a ruptured medical device, without evidence of malignancy. The patient declined removal of the implants. A later breast MRI showed extracapsular rupture of both implants and silicone signal in the left pleura. The authors concluded that free silicone likely seeded the pleura through an unseen tract from the earlier lobectomy. The article listed asbestos-related pleural disease among possible causes of pleural thickening but did not report any asbestos exposure in this patient.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient)
• Who was studied: One 78-year-old woman with prior left breast cancer treated by mastectomy and dual-lumen saline and silicone implant reconstruction, and later left lower lobe lung adenocarcinoma treated by lobectomy in 2008; University of Washington, Seattle, USA
• Exposure: Free silicone from extracapsular rupture of breast implants. No asbestos exposure was reported; asbestos-related pleural disease was mentioned only as one possible cause of pleural thickening in the differential diagnosis.
• Main results:
  • Surveillance CT scans after the lobectomy showed left pleural thickening and nodularity that had increased by February 2011.
  • PET/CT in March 2011 showed multiple hypermetabolic (FDG-avid) left pleural nodules.
  • Core needle biopsy of the pleural nodule showed foreign material and a foreign body giant cell reaction consistent with a ruptured medical device, with no evidence of malignancy.
  • The patient declined removal of the breast implants.
  • A later breast MRI showed extracapsular rupture of both implants and a thick layer of silicone signal in the left pleura.
• The authors' conclusion: The authors concluded that the findings were consistent with pleural silicone granulomas from extracapsular breast implant rupture, with free silicone likely reaching the pleura through a tract from the prior left lobectomy that did not show on imaging.

Topics

Medical terms in this study, explained in our Lexicon: Granuloma, Bilateral, Lung Cancer, Differential Diagnosis, Pleural Thickening, Asbestos-Related Pleural Disease, Pleural Effusion, Hemothorax.

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