Breast Implant Capsule-Associated Squamous Cell Carcinoma: A Report of Two Cases

Publication date: Available online 22 July 2017
Source:Human Pathology
Author(s): Daniel L. Olsen, Gary L. Keeney, Beiyun Chen, Daniel W. Visscher, Jodi M. Carter
The use of prosthetic implants for breast augmentation has become commonplace. While implants do not increase the risk of conventional mammary carcinoma, they are rarely associated with anaplastic large cell lymphoma. We report two cases of breast implant capsule-associated squamous cell carcinoma with poor clinical outcomes. Both patients (56-year-old female and 81-year-old female) had long-standing implants (>25years) and presented with acute unilateral breast enlargement. In both cases, squamous cell carcinoma arose in (focally dysplastic) squamous epithelium-lined breast implant capsules, and widely invaded surrounding breast parenchyma or chest wall. Neither patient had evidence of a primary mammary carcinoma or squamous cell carcinoma at any other anatomic site. Within one year, one patient developed extensive, treatment-refractory, loco-regional soft tissue metastasis and the second patient developed hepatic and soft tissue metastases and died of disease.There are two prior reported cases of implant-associated squamous cell carcinoma in the plastic surgery literature; one provides no pathologic staging or outcome information and the second case was a capsule-confined squamous cell carcinoma. Together, all four cases share notable commonalities: the patients had long-standing breast implants, and presented with acute unilateral breast pain and enlargement secondary to tumors arising on the posterior aspect of squamous epithelialized implant capsules. Due both to its rarity and unusual clinical presentation, implant capsule-associated squamous cell carcinoma may be under-recognized. The aggressive behavior of the tumors in this series underscores the importance of excluding malignancy in patients with long-standing breast implants who present with acute unilateral breast pain and enlargement.



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