Clinical Image
Lung siliconoma, an etiology to consider
Siliconoma pulmonar, una etiología a tener en cuenta
Fernando Cózar Bernal
, Julia González Fernández, Juan Carlos Girón Arjona
Corresponding author
Servicio de Cirugía Torácica, Hospital Universitario Virgen Macarena, Sevilla, Spain
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A) nódulo pulmonar, subpleural, en segmento anterior del lóbulo superior derecho. B) nódulos pulmonares en lóbulo inferior izquierdo. (C-F) Imágenes histológicas del nódulo pulmonar resecado durante la cirugía. C) Se observa a la izquierda parénquima pulmonar y algún bronquiolo. A derecha un nódulo constituido por células de aspecto claro a este aumento con ribete linfocítico incompleto (variante de granuloma a cuerpo extraño). D) A mayor aumento se identifica que estas células son de hábito histiocítico y tienen un amplio citoplasma «blanco» esto es, vacío, porque en el procesamiento la silicona se disuelve, dejando el hueco. E) Granuloma a cuerpo extraño en el parénquima pulmonar cerca de una vena. 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A) Subpleural pulmonary nodule in the anterior segment of the right upper lobe. B) Left lower lobe pulmonary nodules. (C–F) Histologic images of the pulmonary nodule resected during surgery. C) Pulmonary parenchyma and bronchiole observed on the left, and on the right a nodule consisting of cells that appear light-colored at this magnification, with an incomplete lymphocytic rim (a foreign body granuloma variant). D) At higher magnification, these cells are seen to be histiocytic with a large “blank”, i.e. empty cytoplasm, because the silicone dissolves as it is processed, leaving a hollow space. E) Foreign body granuloma in the lung parenchyma near a vein. F) At higher magnification, the typical histiocytes and multinucleated giant cells are seen in more detail.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 52-year-old woman with stage IA infiltrating lobular breast cancer underwent right radical mastectomy with immediate reconstruction. In her oncological follow-up, a cannonball radiological pattern was observed (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>), so one of the nodules was biopsied for histologic typing.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Atypical right S3 segmentectomy was performed by video-assisted thoracoscopy and, surprisingly, an intra-pulmonary nodule was reported, consisting of intra-cytoplasmic oily material with a lymphocytic rim, with the presence of giant cell microgranulomas with intravascular oily material, consistent with a diagnosis of pulmonary siliconoma (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><p id="par0015" class="elsevierStylePara elsevierViewall">A conservative approach was taken with regard to the nodules (as resection would have required a lobectomy), with close follow-up and replacement of the silicone implant, which was assumed to have ruptured. No changes in the lung lesions were observed in successive follow-ups.</p><p id="par0020" class="elsevierStylePara elsevierViewall">In 1964, Winer first described siliconoma (foreign body granulomatous reaction caused by liquid silicones in the tissues and surrounding fibrosis). Late complications, such as local siliconomas or lymphadenopathies, are widely described, while peripheral spread to subcutaneous tissue and the existence of intrapulmonary siliconomas are extremely rare. We have only found reports by Muñiz et al.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> and Dragu et al.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>, which, unlike our case, were single lung lesions.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interests</span><p id="par0025" class="elsevierStylePara elsevierViewall">All authors declare no conflict of interests.</p><p id="par0030" class="elsevierStylePara elsevierViewall">This study received no specific grants from public sector agencies, the commercial sector, or from non-profit organizations.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflict of interests" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Cózar Bernal F, González Fernández J, Girón Arjona JC, Siliconoma pulmonar, una etiología a tener en cuenta. Arch Bronconeumol. 2022;58:83.</p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1134 "Ancho" => 2167 "Tamanyo" => 600149 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A–B<span class="elsevierStyleBold">)</span> Pre-operative CT image showing bilateral pulmonary nodules. A) Subpleural pulmonary nodule in the anterior segment of the right upper lobe. B) Left lower lobe pulmonary nodules. (C–F) Histologic images of the pulmonary nodule resected during surgery. C) Pulmonary parenchyma and bronchiole observed on the left, and on the right a nodule consisting of cells that appear light-colored at this magnification, with an incomplete lymphocytic rim (a foreign body granuloma variant). D) At higher magnification, these cells are seen to be histiocytic with a large “blank”, i.e. empty cytoplasm, because the silicone dissolves as it is processed, leaving a hollow space. E) Foreign body granuloma in the lung parenchyma near a vein. F) At higher magnification, the typical histiocytes and multinucleated giant cells are seen in more detail.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:2 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Siliconoma pulmonar, una rara complicación de rotura de prótesis de mamaria" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "F. Muñiz" 1 => "F. Hermoso" 2 => "M.P. Cano" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.arbres.2018.02.019" "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2018" "volumen" => "54" "paginaInicial" => "580" "paginaFinal" => "593" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29622364" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intrapulmonary and cutaneous siliconoma after silent silicone breast implant failure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Dragu" 1 => "D. Theegarten" 2 => "A.D. Bach" 3 => "E Polykandriotis" 4 => "A Arkudas" 5 => "U Kneser" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1524-4741.2009.00765.x" "Revista" => array:6 [ "tituloSerie" => "Breast J" "fecha" => "2009" "volumen" => "15" "paginaInicial" => "496" "paginaFinal" => "499" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19624416" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/03002896/0000005800000001/v1_202201130549/S0300289621004051/v1_202201130549/en/main.assets" "Apartado" => array:4 [ "identificador" => "21422" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Clinical Images / Imágenes clínicas" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/03002896/0000005800000001/v1_202201130549/S0300289621004051/v1_202201130549/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289621004051?idApp=UINPBA00003Z" ]
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