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Angiosarcoma arising in the capsule of a mammary silicone implant
Sreekumar Sundara Rajan1, Asma Haider2, Helen Burrell1
1Breast Institute, Nottingham University Hospitals, Nottingham, UK.
Insights
A rare angiosarcoma was diagnosed in fluid around a silicone breast implant. This highlights the importance of fluid cytology for detecting implant-associated cancers.
Area of Science:
- Oncology
- Pathology
- Radiology
Background:
- Silicone breast implants are widely used for augmentation and reconstruction.
- Complications can arise, including rare malignancies.
- Early detection of implant-associated complications is crucial.
Observation:
- A 40-year-old woman presented with painful swelling and bruising of the breast with silicone implants.
- Ultrasound revealed periprosthetic fluid; cytology showed atypical cells.
- MRI demonstrated a serpiginous enhancing area within the fibrous capsule.
Findings:
- Histology confirmed angiosarcoma invading the fibrous capsule and periprosthetic space.
- Tumor markers CD31 and CD34 were positive in spindle cells.
- The tumor location mirrored that of breast implant-associated anaplastic large cell lymphoma.
Implications:
- This case suggests a potential causal link between silicone implants and angiosarcoma.
- Cytological assessment of periprosthetic fluid is vital for diagnosing implant-associated malignancies.
- Cell blocks and immunohistochemistry are essential tools in diagnosis.
Abstract:
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.
