Abstract

Squamous malignancies in the genital region are thought to occur along two main etiological pathways: the first is in the setting of chronic inflammation and the second is in the setting of human papilloma virus.  Squamous cell carcinoma arising from breast implants has been known to rarely occur and has been hypothesized to be related to chronic inflammation.  The histology of pre-cancerous lesions in the genital chronic inflammatory pathway exists on a spectrum from squamous hyperplasia without cytological atypia to frank differentiated intraepithelial neoplasm.  We recently encountered a case of a breast implant removal, which had been in the patient for over 10 years and had been removed secondary to rupture.  Histologically, there was extensive hyperplastic squamous epithelial metaplasia of the capsule surrounding the implant with lower epithelial keratinocytic cytological atypia in the form of increased nuclear size, nucleoli, and moderate cytological pleomorphism.  The cytoplasm of the squamous cells was abundantly eosinophilic.  In many areas, there was subepithelial edematous and densely eosinophilic material. These changes were histologically similar to the differentiated intraepithelial neoplasia seen in lichen sclerosus in the genital region.  We highlight this case as evidence suggesting that rare precancerous changes can exist at the site of a ruptured breast implant and to suggest that these changes may be histologically and conceptually analogous to the precancerous changes seen along the chronic inflammatory pathway of the genital region.  In our case clinical monitoring was pursued, as the presumed inciting agent (the implant) had been removed.