By Stuart J Schnitt
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Extra resources for Biopsy Interpretation of the Breast
Implant-associated lymphomas have also been described (see Chapter 14). Some capsules surrounding breast implants develop a cellular lining that histologically, immunohistochemically, and ultrastructurally resembles either normal synovium or synovium with papillary hyperplasia (proliferative synovitis) and has physiological properties similar to those of synovium (Fig. 13, e-Fig. , micromotion and friction) between the implant and the surrounding tissue. 12 Breast implant capsule. This fibrous capsule shows cystic spaces containing pale material consistent with silicone.
In this duct, the lumen is obliterated by fibrous tissue. The obliterated lumen is surrounded by a "garland" of epithelial-lined spaces. 15 In particular, smoking has been reported to be associated with periductal inflammation but not with duct dilatation. 16-18 Patients present with palpable or mammographically detected breast masses that may be multiple and bilateral. 18 These include dense, keloid-like fibrosis; periductal, perilobular, and perivascular lymphocytic infiltrates (primarily composed of B-lymphocytes); and epithelioid myofibroblasts in the stroma (Fig.
However, several issues merit particular comment. First, cysts may be confused with duct ectasia. The presence of elastic tissue can be demonstrated around ectatic ducts but not cysts, as discussed earlier. Second, several neoplastic lesions may be mistaken for cysts at scanning magnification, particularly flat epithelial atypia and cystic hypersecretory carcinoma (discussed in Chapters 4 and 3, respectively). Finally, CNB sampling of cysts may yield only portions of the cyst wall. These are characterized by areas of fibrosis with or without adjacent epithelium.
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