Diagnostic cytological features of polyacrylamide gel injection augmentation mammoplasty

To study the cytological features of breast lesions associated with hydrophilic polyacrylamide gel (PAAG) injection augmentation mammoplasty and to determine the specific diagnostic features.

Fine needle aspiration (FNA) cytology smears from 14 patients who presented with breast lump and a clinical history of PAAG injection were reviewed. The staining properties of the PAAG material in Papanicolaou (Pap), Haematoxylin and Eosin (H&E) and Diff-Quik stains, as well as the cellular background, were studied. Cell blocks were also studied with H&E, periodic acid-Schiff (PAS), periodic acid-Schiff with diastase digestion (PASD) and mucicarmine (MC) stains.

PAAG was stained consistently pinkish with a homogenous smooth texture on H&E (100%), polychromasia on Pap (100%) and magenta violet with bubbly vacuoles on Diff-Quik (100%). Half (7) of the cases showed sharp borders. The presence of foreign body type giant cells with histiocytes (5 cases, 36%) and scanty clusters of benign ductal cells (4 cases, 29%) were seen in the background of a minority of the cases. PAAG was represented by blocks of homogenous grey-purplish acellular material with a sharp border on cell block sections, which were negative for PAS, PASD and MC.

PAAG shows a consistent staining pattern in various common cytological staining preparations. Blocks of acellular gelatinous material, stained homogenous pinkish on H&E, polychromasia on Pap and magenta violet with bubbly vacuoles on Diff-Quik, are the reliable cytological features of PAAG.