대한흉부영상의학회 Weekly Chest Cases

Case No : 1345 Date 2023-08-02

Courtesy of Jong Eun Lee, Jong Hyeon Kim, Won Gi Jeong, Yun-Hyeon Kim / Chonnam National University Hospital, Chonnam National University Hwasun Hospital
Age/Sex 57 / F
Chief ComplaintPreoperative staging workup of a subsolid nodule in the left upper lobe

Figure 1
Figure 2
Figure 3
Figure 4

Diagnosis With Brief Discussion

Diagnosis: Silicone granuloma
Radiologic Findings: Fig. 1. Axial lung-window CT image reveals a spiculated subsolid nodule with bubbly lucency in the left upper lobe.
Fig. 2A. Axial mediastinal-window CT image reveals a well-defined nodular lesion in the left internal thoracic chain. The patient has a history of underwent augmentation mammoplasty with retropectoral silicone implants in both breasts. The implant shows convoluted contour and heterogeneous lumen, which was suspicious for implant rupture.
Fig. 2B. Axial mediastinal-window CT image obtained at the same level reveals mild post-contrast enhancement of the nodular lesion in the left internal thoracic chain.
Fig. 2C. FDG PET-CT image obtained at the same level reveals focal hypermetabolism (max. SUV, 3.1) of the nodular lesion in the left internal thoracic chain.

The patient underwent LUL lobectomy with mediastinal lymph node dissection via VATS. Histopathologic analysis showed that the subsolid nodule of the left upper lobe is a papillary adenocarcinoma (T2N0M0) and the nodular lesion of the internal thoracic chain was a silicone granuloma (1).
Brief Review: Silicone granuloma (or siliconoma) is a rare, benign lesion occurring after augmentation mammoplasty performed for cosmetic or reconstructive purposes following breast cancer surgery. Silicone granuloma
primarily occurs in proximal areas, such as the chest wall, axillae, and upper extremities. However, it has been reported to occur in distal areas, such as the lower extremities, which is speculated to be due to silicone migration along hematogenous or lymphatic flow since silicone is lipid-soluble. Silicone granulomas are typically found on CT. Magnetic resonance imaging may additionally be performed to identify the presence or absence of implant rupture and the presence of silicone particles outside of an implant. If a malignancy is suspected, PET/CT is likely to be performed. The differential diagnosis is not easy because of hypermetabolic
uptake due to focal inflammation.
References: 1. Yun JS, Song SY, Na KJ, Lee CH, Jeon JB. Silicone Granuloma Mimicking a Lymphatic Metastasis in a Lung Cancer Patient: A Case Report. J Chest Surg 2023;56:53-55.
2. Carson B, Cox S, Ismael H. Giant siliconoma mimicking locally advanced breast cancer: a case report and review of literature. Int J Surg Case Rep 2018;48:54-60.
3. Oh JH, Song SY, Lew DH, Lee DW. Distant migration of multiple siliconomas in lower extremities following breast implant rupture: case report . Plast Reconstr Surg Glob Open 2016;4:e1011
4. Vo K, Kilgore M, Scheel J. Intrapleural silicone granuloma mimicking pleural malignancy . Radiol Case Rep 2021;16:3824-8.
5. Grubstein A, Cohen M, Steinmetz A, Cohen D. Siliconomas mimicking cancer . Clin Imaging 2011;35:228-31.
Keywords

No. of Applicants : 80

▶ Correct Answer : 42/80, 52.5%

- Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
- , Japan SUZUNE TSUKAMOTO
- , Japan HIROAKI ARAKAWA
- , Japan KYOKO NAGAI
- Kyoto City Hospital , Japan YUSUKE UTSUNOMIYA
- Chonnam National University Hospital , Korea (South) HYUNJIN KIM
- Healthy Longevity Medical Center , Japan SHIN-ICHI CHO
- Chonnam National University Hwasun Hospital , Korea (South) DONGHUN HAN
- Vita Hospital , Brazil DIOGO LAGO PINHEIRO
- Secomedic Hospital , Japan FUMINORI MIYOSHI
- Seoul Medical Center , Korea (South) HYUK GI HONG
- The University of Tokyo Hospital , Japan WATARU GONOI
- Osaka University , Japan AKINORI HATA
- Ajou University Hospital , Korea (South) HAEIN LEE
- Ajou University Hospital , Korea (South) HYUNSEUNG LEE
- OITA UNIVERSITY , Japan FUMIKA ISHITOBI
- , Japan YUKIKO USUI
- Ajou University Hospital , Korea (South) MINJI KIM
- Ajou University Hospital , Korea (South) JAYOUNG MOON
- Presbyterian Medical Center , Korea (South) SOOYEON JEONG
- Gifu University Hospital , Japan Yo Kaneko
- Asan Medical Center , Korea (South) JIEUN KIM
- Kyoto University Hospital , Japan YASUHISA KURATA
- , Japan SHUNJIRO NOGUCHI
- , Korea (South) HEONSEOK LEE
- Korea University Guro Hospital , Korea (South) LEE DAKYONG
- Osaka metropolitan university Hospital , Japan TATSUSHI OURA
- Seoul National University Hospital , Korea (South) SUNGHO HONG
- , Korea (South) KIM HYE IN
- Others , India PURUSHOTHAMA RAO TUMMALA
- Chonnam National University Hospital , Korea (South) GYERYEONG PARK
- Chonnam National University Hospital , Korea (South) KIM SANG GYUN
- Paras hospital, Panchkula , India SHALEEN RANA
- Kyoto University , Japan SHO KOYASU
- Seoul National University Bundang Hospital , Korea (South) YOONAH DO
- Fukuoka university , Japan KEISUKE SATO
- Kantou Rousai Hospital , Japan KAORU SUMIDA
- Ichinomiya Nishi Hospital , Japan Takao Kiguchi
- Nerimahikarigaoka hospital , Japan TAKANA HAYASHI
- Chonnam National University Hospital , Korea (South) SEUNG WAN KANG
- Toyota Kosei Hospital , Japan YUKI HAYASHI
- Juntendo University , Japan YUTAKA IKENOUCHI

▶ Correct Answer as Differential Diagnosis : 8/80, 10.0%

- , Korea (South) JIN YOUNG LEE
- , Japan KENTARO KOTANI
- Jichi Medical University, School of Medicine , Japan MITSURU MATSUKI
- Avrasya Hospital/ISTANBUL , Turkey MURAT ULUSOY
- Other , Korea (South) HYE SUN RYU
- Hyogo Prefectural Kobe Children , Japan SHUHEI NORIMOTO
- Diagnose.me (BV) / Royal Perth Hospital , Australia YURANGA WEERAKKODY
- Kyoto university , Japan AKIHIKO SAKATA

▶ Semi-Correct Answer : 4/80, 5.0%

- The University of Tokyo Hospital , Japan JUN KANZAWA
- Oita University, Faculty of Medicine , Japan FUMITO OKADA
- Dokkyo Medical University , Japan HIROAKI ARAKAWA
- The University of Tokyo Hospital , Japan HIROSHI TAKUMIDA

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 1345 Date 2023-08-02

Discussion

No. of Applicants : 80