Intrapleural silicone granuloma mimicking pleural malignancy

Area of Science:

• Radiology
• Pathology
• Oncology

Background:

• A 78-year-old female with a history of left breast cancer (post-mastectomy with bilateral implants) and lung cancer (post-lobectomy) presented with new FDG-avid pleural thickening.
• The differential diagnosis for pleural abnormalities is broad, including malignancy, infection, and asbestos-related disease.

Observation:

• FDG-avid pleural nodularity and thickening raised suspicion for metastatic disease, given the patient's history of two primary malignancies.
• Core-needle biopsy of a pleural nodule revealed foreign material and a foreign body giant cell reaction, inconsistent with malignancy.
• Subsequent imaging demonstrated bilateral extracapsular silicone breast implant rupture.

Findings:

• The pleural biopsy findings, combined with MRI evidence of extracapsular silicone, confirmed the presence of pleural silicone granulomas.
• The silicone likely migrated via a radio-occult tract related to the prior left lobectomy procedure.
• This case highlights a rare complication of breast implants presenting as FDG-avid pleural disease.

Implications:

• This case underscores the importance of considering breast implant complications in the differential diagnosis of FDG-avid pleural abnormalities, especially in patients with a history of breast cancer surgery.
• It emphasizes the utility of advanced imaging like MRI and tissue biopsy in diagnosing unusual conditions.
• Understanding this pathway of silicone migration is crucial for accurate diagnosis and patient management.