Alexander J Ryu1, Katrina N Glazebrook2, Naziya Samreen2, Philippe R Bauer3, Eunhee S Yi4, Jay H Ryu5. 1. Mayo Clinic School of Graduate Medical Education, Rochester, Minn. 2. Department of Radiology, Mayo Clinic, Rochester, Minn. 3. Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minn. 4. Division of Anatomic Pathology, Mayo Clinic, Rochester, Minn. 5. Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minn. Electronic address: ryu.jay@mayo.edu.
Abstract
BACKGROUND: Medical silicone is widely used as implants and free injections, but the spectrum of complications related to migration or embolization of silicone remains unclear. METHODS: We retrospectively reviewed 79 patients with silicone migration as confirmed on pathology between January 1, 2001, and December 31, 2016. The presenting clinical and imaging features, diagnostic testing, treatment, and outcome were assessed. RESULTS: Nearly all patients were women, and 43% had a history of breast cancer. Sixty-three cases (80%) consisted of localized silicone granulomas, including 1 patient who developed severe hypercalcemia related to the granulomatous reaction. The remaining 16 cases (20%) involved migration of silicone to regional lymph nodes or distant tissue and included 1 case of chronic silicone pneumonitis. These complications were detected many years (median, 22 years; range, 1-40 years) after initial silicone placement. Only magnetic resonance imaging, dual-energy computed tomography (CT), and ultrasonography demonstrated specificity for detection of silicone in lymph nodes and soft tissues. Other modalities including positron emission tomography, single-energy CT, and mammography detected only nonspecific abnormalities. Excisional biopsy of symptomatic lymphadenopathy or masses usually led to resolution of symptoms. The patient with silicone pneumonitis improved with corticosteroid therapy. CONCLUSIONS: Chronic complications related to silicone extravasation and migration can present with local or distant manifestations, typically encountered many years after the original silicone placement. Magnetic resonance imaging, dual-energy CT, and ultrasonography are helpful for noninvasive diagnosis.
BACKGROUND: Medical silicone is widely used as implants and free injections, but the spectrum of complications related to migration or embolization of silicone remains unclear. METHODS: We retrospectively reviewed 79 patients with silicone migration as confirmed on pathology between January 1, 2001, and December 31, 2016. The presenting clinical and imaging features, diagnostic testing, treatment, and outcome were assessed. RESULTS: Nearly all patients were women, and 43% had a history of breast cancer. Sixty-three cases (80%) consisted of localized siliconegranulomas, including 1 patient who developed severe hypercalcemia related to the granulomatous reaction. The remaining 16 cases (20%) involved migration of silicone to regional lymph nodes or distant tissue and included 1 case of chronic siliconepneumonitis. These complications were detected many years (median, 22 years; range, 1-40 years) after initial silicone placement. Only magnetic resonance imaging, dual-energy computed tomography (CT), and ultrasonography demonstrated specificity for detection of silicone in lymph nodes and soft tissues. Other modalities including positron emission tomography, single-energy CT, and mammography detected only nonspecific abnormalities. Excisional biopsy of symptomatic lymphadenopathy or masses usually led to resolution of symptoms. The patient with siliconepneumonitis improved with corticosteroid therapy. CONCLUSIONS: Chronic complications related to silicone extravasation and migration can present with local or distant manifestations, typically encountered many years after the original silicone placement. Magnetic resonance imaging, dual-energy CT, and ultrasonography are helpful for noninvasive diagnosis.