Breast-implant Related Silicone Lymphadenopathy: Asteroid Bodies do not Always Equal Sarcoidosis!

Abstract

Silicone breast implants are frequently used for breast augmentation for cosmetic purposes, as well as for breast reconstruction after prophylactic or therapeutic mastectomy. Silicone lymphadenopathy is a well-known complication of silicone breast implants. Silicone droplets are present in the breast tissue through ‘silicone bleeding’ of the implant or because of implant rupture. These silicone particles can migrate from the breast to the regional lymph nodes. Silicone lymphadenopathy is caused by a substantial foreign body reaction against these silicone particles, and is frequently associated with asteroid body-containing multinucleated giant cells. Similar multinucleated giant cells are often observed in the capsule surrounding the silicone breast implant, and the number of associated asteroid bodies is highly variable. Here, we discuss a series of twelve women with breast implant-related asteroid bodies in their lymph nodes and/or breast tissue. This pictorial essay illustrates that the presence of asteroid bodies in a lymph node does not necessarily suggests a diagnosis of sarcoidosis. Clinical information about the patient having (or having had) silicone breast implants is often lacking. The encounter of asteroid body-containing giant cells in lymph node cytology, biopsies or resections should therefore lead to reflex clinical-pathological correlation, before establishing a final diagnosis.

The Spectrum of Non-neoplastic Changes Associated With Breast Implants

“…91 It is more prominent in patients with ruptured implants but can be subtle as a result of gel "bleeding" of silicone implants. [91][92][93]…”

“…Lymphadenopathy (LAD) secondary to a silicone reaction is a well-known complication in patients with breast implants 91 . It is more prominent in patients with ruptured implants but can be subtle as a result of gel “bleeding” of silicone implants 91–93 …”

“…9B, C). More substantial amounts of silicone appear with implant rupture and appear as large empty spaces in the lymph node, frequently associated with sinus histiocytosis, as well as a foreign body giant cell reaction; asteroid bodies can be observed in histiocytes 93,97,100 . “Bleeding” of silicone appears as small vacuoles in histiocytes (Fig.…”

Silicone Cervical Lymphadenopathy: A Rare Complication After Breast Augmentation

“…Silicone particles can then migrate to regional lymph nodes via macrophages of the reticuloendothelial system, resulting in swelling, fibrosis, and a foreign body granulomatous reaction. The classic histopathology report describes the presence of giant cells, asteroid bodies, lymphoid infiltration, and clear cytoplasmic silicone vacuoles [17].…”