{"id":3765,"date":"2024-07-16T18:44:23","date_gmt":"2024-07-16T23:44:23","guid":{"rendered":"https:\/\/explantar.com\/?p=3765"},"modified":"2025-07-28T09:28:23","modified_gmt":"2025-07-28T14:28:23","slug":"los-casos-de-cancer-relacionado-con-implantes-mamarios-podrian-ser-mas-del-doble-segun-los-calculos-de-la-fda-2-5-2","status":"publish","type":"post","link":"https:\/\/explantar.com\/en\/los-casos-de-cancer-relacionado-con-implantes-mamarios-podrian-ser-mas-del-doble-segun-los-calculos-de-la-fda-2-5-2\/","title":{"rendered":"Syndrome ASIA: breast prostheses and Still's disease"},"content":{"rendered":"

Cristhian Armenteros1<\/sup>Andrea Odzak1<\/sup>, Florence Arcondo1<\/sup>Marcela Of God Soler2<\/sup>Tatiana Sinigier3<\/sup>, Marcelo Zylberman1<\/sup><\/strong><\/p>\n\n\n\n

1<\/sup> Division of Medical Clinic, Hospital General de Agudos Dr. Cosme Argerich,
2<\/sup> Pathological Anatomy service, Hospital Marie Curie,
3<\/sup> Plastic surgery, Hospital General de Agudos Dr. Cosme Argerich, Buenos Aires, Argentina<\/p>\n\n\n\n

\n\n\n\n

Summary<\/h2>\n\n\n\n

Connective tissue diseases linked to breast implants silicone have been a topic of discussion. In the last decade, the siliconosis has been included in the syndrome autoimmune\/inflammatory induced by adjuvant (ASIA) with the syndrome, Gulf war syndrome, miofascitis macrophagic and phenomena post-vaccine. The ASIA may manifest as lupus, rheumatoid arthritis, or more rarely as adult Still's disease. We present the case of a patient with prolonged fever and clinical criteria compatible with ASIA and Still's disease. We successfully resected the prosthesis and the anatomical pathology ruled out anaplastic lymphoma ALK (-) that is linked to a prosthesis. Physicians should be alert to the emergence of these new entities associated with breast implants silicone.<\/p>\n\n\n\n

Key words: <\/strong>Syndrome ASIA; Siliconosis; Still's Disease; Adjuvant; breast Implants.<\/p>\n\n\n\n

Abstract<\/h2>\n\n\n\n

ASIA syndrome: breast implant and Stills disease<\/em><\/strong>.<\/p>\n\n\n\n

Connective tissue diseases associated with silicone breast implants have been widely discussed. In the last decade, siliconosis has been included in the autoimmune\/inflammatory syndrome induced by adjuvants (ASIA) next to Gulf War syndrome, macrophage myofascitis and postvaccination phenomena. The ASIA syndrome may appear as lupus, rheumatoid arthritis, or more rarely, as adult Still''s disease. We discuss the case of a patient with prolonged fever and clinical criteria for ASIA and Still''s disease. The prostheses were resected and pathology showed absence of breast implant associated anaplastic lymphoma ALK (-). Physicians should be alert to these new entities linked to silicone breast implants.<\/p>\n\n\n\n

Key words: <\/strong>ASIA syndrome; Silicone; Stills disease; Adjuvant; Breast implants.<\/p>\n\n\n\n

\n\n\n\n

Since its adoption, the use of breast implants silicone (IMS) led to suspicion of association with connective tissue diseases (ETC)1<\/sup><\/a>. Despite meta\u00e1nalisis and recent reviews, these suspicions have not been able to be confirmed2<\/sup><\/a>. The siliconosis was one of the first diseases known as \u201cinduced by adjuvants\u201d and today is included next to the other, within the syndrome of Shoenfeld syndrome or autoimmune\/inflammatory induced by adjuvants (ASIA: for its acronym in English)3<\/sup><\/a>. We present the case of a patient with siliconosis, which is manifested as adult Still's disease (SA).<\/p>\n\n\n\n

Clinical case<\/h2>\n\n\n\n

Wife of 61 years, who was admitted for fever (39 \u00b0C), arthralgia, myalgia, and pain in the anterior aspect of the left hemithorax, seven days of evolution.
Had replacement of breast implant silicone gel-eight years ago by leaking prosthetic. There were two previous hospitalizations for febrile syndrome; the first nine months ago with spontaneous resolution and the second three months prior to this hospitalization where indicated corticosteroid treatment with normalization of the thermocline. Attached of these hospitalizations, the following additional tests: Hct. 33%, MCV 89, GOT, 84 IU\/l, GPT 144 IU\/l, ALP 115 IU\/l, CRP (C-reactive protein) 130 mg\/dl, LDH 1350 IU\/l. Serology of viral, HIV, ASTHMA (anti-smooth muscle), anti-LKM (anti-microsomes of liver and kidney), FAN (antinuclear antibodies) and anti-DNA negative. Snap, CPK and aldolase normal. Microbial cultures negative. TAC: adenomegalias axillary and bilateral supraclavicular left > 10 mm Splenomegaly (148 mm). Breast prosthesis bilateral thickening of the soft parts periprosthetic on the left breast. Breast ultrasound left: a collection of anechoic of 28 \u00d7 6 mm, compatible with seroma.
Biopsy of axillary lymph node left: expansion marked the T-zone and foci of necrosis. Stains (Ziehl-Neelsen, PAS and Giemsa negativaos.
Liver biopsy: liver disease, chronic active, mild. Video endoscopy high and low and transesophageal echocardiogram were normal.
Physical examination on admission: adenopathy axillary left 2 \u00d7 2.5 cm, non-painful; rash maculopapular in the lower limbs and trunk, which is exacerbated by the fever spikes. Splenomegaly.
Laboratory: Hct. 34%, GB 15800\/mm3, neutrophils 85%, LDH 1581 IU\/l, CRP 223 mg\/l, ESR 90 mm\/h, ferritin > 2000 ng\/ml, GOT 64 U\/l, GPT 13 U\/l. The rest, without particularities.
CT chest: breast prosthesis bilateral thickening and heterogeneity of tissues paraesternales left and liquid periprot\u00e9sico. Multiple adenomegalias cervical, axillary and chain breast left. Splenomegaly 140 mm
It was decided to removal of prosthetic bilateral. Flow cytometry of liquids of seroma: without evidence of clonality. Pathological anatomy: capsule breast with granulomas by silicones.
Treatment was started with prednisolone 1mg\/kg\/day for two weeks and gradual decrease. Remains afebrile and normal ferritin and CRP.<\/p>\n\n\n\n

Discussion<\/h2>\n\n\n\n

In the year 2000, a meta-analysis did not showed higher frequency of SLE, RA, scleroderma, Sj\u00f6gren's, or SO combined, in women with breast implants in general or IMS4 and the FDA developed in 2011, a security report concluding that there are no studies of the association between IMS and ETC5; despite this, recently Balk et al. they found an increased risk of RA, Sj\u00f6gren's syndrome and Raynaud in patients with IMS2<\/sup><\/a>.
In the last decade, it has been described syndromes defined by a response hi, in genetically susceptible individuals after exposure to environmental factors that act as adjuvants3<\/sup><\/a>. Silicone implants are biocompatible in the majority of patients, but are not immunologically inert. The leakage of silicone from the implants can cause with a certain frequency inflammation of the skin, regional lymphadenopathy and granulomatous reaction around the silicone (siliconoma), but the immune response with systemic symptoms defined as siliconosis is more rare3<\/sup><\/a>.
The diseases by adjuvants as siliconosis, syndrome, Gulf war syndrome, miofascitis macrophagic and phenomena post-vaccination, have been grouped by Shoenfeld and Agmon-Levine in 2010 as a syndrome autoimmune\/inflammatory induced by adjuvants (ASIA). Its symptoms include myalgia, arthralgia, myositis, fever, xerostomia, and neurological symptoms6<\/sup><\/a>. Its diagnostic criteria are described in the Table 1<\/a>. In our case, the history of leakage of the IMS, the presence of arthralgia, myalgia, fever, and the finding of siliconomas confirm syndrome of ASIA.<\/p>\n\n\n\n

Table 1<\/strong>. Syndrome ASIA: diagnostic criteria<\/p>\n\n\n

\n
\"\"<\/figure>\n<\/div>\n\n\n


The SA start in the adult is found next to the systemic lupus erythematosus (SLE), rheumatoid arthritis (RA) and fibromyalgia, within the clinical spectrum of syndromes associated with adjuvants. According to the diagnostic criteria of Yamaguchi, the presence of fever, joint pain, enlarged lymph nodes, splenomegaly, cutaneous rash, and leukocytosis in the absence of a FAN, and rheumatoid factor, lets you diagnose in our case, SA (Table 2<\/a>)7<\/sup><\/a>. We found in the literature, seven cases of SA side to the IMS. The time between implant placement and the onset of symptoms is variable. Patients with SA have typically a high fever, intermittent arthralgias, dark pink, lymph nodes cervical and elevation of ferritin and CRP8-13<\/sup><\/a>. The treatments used were mainly NSAIDS and steroids according to the severity. The removal of prosthetic was not necessary in all cases. In our patient, the presence of seroma pericapsular we bowed to the removal of the prosthesis to rule out lymphoma, anaplastic large-cell ALK ( -) - associated breast prosthesis. This entity, described by de Jong in 200814<\/sup><\/a>, prompted a warning from the FDA in the year 201115<\/sup><\/a>. The pathological anatomy of our patient to rule out this entity in the capsule and the cytometry of the content of the seroma showed no pathology clonal.<\/p>\n\n\n\n

Table 2<\/strong>. Criteria for the diagnosis of adult Still's disease*<\/p>\n\n\n

\n
\"\"<\/figure>\n<\/div>\n\n\n


<\/p>\n\n\n\n

This case can alert physicians to suspect, of new entities linked to the presence of mammary prosthesis, such as ASIA and anaplastic large cell lymphoma ALK (-).<\/p>\n\n\n\n

<\/p>\n\n\n\n

Christian Armenteros 1<\/sup> Andrea Odzak 1<\/sup> , Florence Arcondo 1<\/sup> Marcela Of God Soler 2<\/sup> Tatiana Sinigier 3<\/sup> , Marcelo Zylberman 1<\/sup><\/strong><\/p>\n\n\n\n

1<\/sup> Clinical Medicine Division, Dr. Cosme Argerich General Acute Hospital,
2<\/sup> Pathological Anatomy Service, Marie Curie Hospital,
3<\/sup> Plastic Surgery, Dr. Cosme Argerich General Acute Hospital, Buenos Aires, Argentina<\/p>\n\n\n\n

\n\n\n\n

Summary<\/h2>\n\n\n\n

Connective tissue diseases associated with silicone breast implants have been a topic of discussion. In the last decade, siliconosis has been included in the adjuvant-induced autoimmune\/inflammatory syndrome (ASIA) together with Gulf War syndrome, macrophagic myofasciitis syndrome and post-vaccination phenomena. ASIA can manifest as lupus, rheumatoid arthritis, or more rarely as adult-onset Still’s disease. We present the case of a patient with prolonged fever and clinical criteria compatible with ASIA and Still’s disease. The prostheses were resected and the pathology ruled out ALK (-) anaplastic lymphoma associated with prostheses. Physicians must be alert to the appearance of these new entities associated with silicone breast implants.<\/p>\n\n\n\n

Keywords:<\/strong> ASIA syndrome; Siliconosis; Still’s disease; Adjuvant; Breast implants.<\/p>\n\n\n\n

Abstract<\/h2>\n\n\n\n

ASIA syndrome: breast implant and Still’s disease<\/em><\/strong> .<\/p>\n\n\n\n

Connective tissue diseases associated with silicone breast implants have been widely discussed. In the last decade, siliconosis has been included in the autoimmune\/inflammatory syndrome induced by adjuvants (ASIA) next to Gulf War syndrome, macrophage myofascitis and postvaccination phenomena. The ASIA syndrome may appear as lupus, rheumatoid arthritis, or more rarely, as adult Still’s disease. We discuss the case of a patient with prolonged fever and clinical criteria for ASIA and Still’s disease. The prostheses were resected and pathology showed absence of breast implant associated anaplastic lymphoma ALK (-). Physicians should be alert to these new entities linked to silicone breast implants.<\/p>\n\n\n\n

Key words:<\/strong> ASIA syndrome; Silicone; Still’s disease; Adjuvant; Breast implants.<\/p>\n\n\n\n

\n\n\n\n

Since their approval, the use of silicone breast implants (SBI) has raised suspicions of an association with connective tissue diseases (CTD) 1<\/sup><\/a> . Despite recent meta-analyses and reviews, these suspicions have not been confirmed 2<\/sup><\/a> . Siliconosis was one of the first diseases recognized as \u201cadjuvant-induced\u201d and is now included, along with others, within the Shoenfeld syndrome or adjuvant-induced autoimmune\/inflammatory syndrome (ASIA) 3<\/sup><\/a> . We present the case of a patient with siliconosis that manifested as adult-onset Still\u2019s disease (AS).<\/p>\n\n\n\n

Clinical Case<\/h2>\n\n\n\n

A 61-year-old woman was admitted for fever (39 \u00b0C), arthralgia, myalgia and pain in the anterior aspect of the left hemithorax for seven days.
She had had a breast implant replaced with silicone gel eight years ago due to prosthetic leakage. She had been hospitalized twice previously for febrile syndrome; the first, nine months ago with spontaneous resolution and the second three months before this hospitalization, when corticosteroid treatment was prescribed with normalization of the thermal curve. The following complementary tests were attached from these hospitalizations: Hct. 33%, VMC 89, GOT 84 IU\/l, GPT 144 IU\/l, FAL 115 IU\/l, CRP (C-reactive protein) 130 mg\/dl, LDH 1350 IU\/l. Viral serologies, HIV, ASMA (anti-smooth muscle antibodies), anti LKM (anti-liver-kidney microsomes), FAN (antinuclear antibodies) and anti DNA negative. Complement, CPK and aldolase normal. Microbial cultures negative. CT: bilateral axillary and left supraclavicular adenomegaly > 10 mm. Splenomegaly (148 mm). Bilateral breast prosthesis with periprosthetic soft tissue thickening in the left breast. Left breast ultrasound: 28 \u00d7 6 mm anechoic collection compatible with seroma.
Left axillary lymph node biopsy: marked expansion of the T zone and foci of necrosis. Ziehl-Neelsen, PAS and Giemsa stains negative.
Liver biopsy: mild active chronic liver disease. Upper and lower video endoscopy and transesophageal echocardiogram normal.
Physical examination on admission: painless left axillary adenopathy 2 \u00d7 2.5 cm; maculopapular rash on lower limbs and trunk that worsened with fever peaks. Splenomegaly.
Laboratory: Hct. 34%, WBC 15,800\/mm3, neutrophils 85%, LDH 1,581 IU\/l, CRP 223 mg\/l, ESR 90 mm\/h, ferritin > 2,000 ng\/ml, GOT 64 U\/l, GPT 13 U\/l. The rest, without particularities.
Chest CT scan: bilateral breast prosthesis with thickening and heterogeneity of left parasternal tissues and periprosthetic fluid. Multiple cervical, axillary and left mammary chain adenomegalies. Splenomegaly 140 mm.
Bilateral prosthesis removal was decided. Flow cytometry of seroma fluids: no evidence of clonality. Pathology: breast capsule with silicone granulomas.
Treatment with meprednisone 1 mg\/kg\/day for two weeks and gradual tapering was started. The patient remains afebrile and ferritin and CRP have normalized.<\/p>\n\n\n\n

Discussion<\/h2>\n\n\n\n

In 2000, a meta-analysis found no increased incidence of SLE, RA, scleroderma, Sj\u00f6gren\u2019s, or combined CTE in women with breast implants in general or IMS4 and in 2011 the FDA issued a safety report concluding that there are no association studies between IMS and CTE5; however, Balk et al. recently found an increased risk of RA, Sj\u00f6gren\u2019s syndrome, and Raynaud\u2019s syndrome in patients with IMS 2<\/sup><\/a> .
In the last decade, syndromes defined by a hyperimmune response have been described in genetically susceptible individuals after exposure to environmental factors that act as adjuvants 3<\/sup><\/a> . Silicone implants are biocompatible in most patients but are not immunologically inert. Silicone leakage from the prosthesis can frequently cause skin inflammation, regional lymphadenopathy and granulomatous reaction around the silicone (siliconoma), but the immune response with systemic symptoms defined as siliconosis is rarer 3<\/sup><\/a> .
Adjuvant-induced diseases such as siliconosis, Gulf War syndrome, macrophagic myofascites syndrome and post-vaccination phenomena have been grouped by Shoenfeld and Agmon-Levine in 2010 as adjuvant-induced autoimmune\/inflammatory syndrome (ASIA). Its symptoms include myalgias, arthralgias, myositis, fever, xerostomia and neurological symptoms 6<\/sup><\/a> . Its diagnostic criteria are described in Table 1<\/a> . In our case, the history of IMS leakage, the presence of arthralgias, myalgias, fever and the finding of siliconomas confirm ASIA syndrome.<\/p>\n\n\n\n

Table 1.<\/strong> ASIA syndrome: diagnostic criteria<\/p>\n\n\n

\n
\"\"<\/figure>\n<\/div>\n\n\n


Adult-onset AS is, together with systemic lupus erythematosus (SLE), rheumatoid arthritis (RA) and fibromyalgia, within the clinical spectrum of adjuvant-associated syndromes. According to Yamaguchi’s diagnostic criteria, the presence of fever, arthralgia, adenopathy, splenomegaly, skin rash and leucocytosis in the absence of FAN and rheumatoid factor allows us to diagnose AS in our case ( Table 2<\/a> ) 7<\/sup><\/a> . We have found seven cases of AS secondary to MSI in the literature. The time between implant placement and the onset of symptoms is variable. Patients with AS typically present with intermittent high fever, arthralgia, pink macules, cervical adenopathy and elevated ferritin and CRP 8-13<\/sup><\/a> . The treatments used were mainly NSAIDs and steroids depending on the severity. Prosthetic removal was not necessary in all cases. In our patient, the presence of a pericapsular seroma led us to remove the prosthesis to rule out ALK(-) anaplastic large cell lymphoma associated with breast prostheses. This entity, described by de Jong in 2008 14<\/sup><\/a> , led to an FDA alert in 2011 15<\/sup><\/a> . The pathology of our patient ruled out this entity in the capsule, and cytometry of the seroma contents did not show clonal pathology.<\/p>\n\n\n\n

Table 2.<\/strong> Diagnostic criteria for adult Still’s disease*<\/p>\n\n\n

\n
\"\"<\/figure>\n<\/div>\n\n\n

This case may alert physicians to suspect new entities linked to the presence of breast implants, such as ASIA and ALK (-) anaplastic large cell lymphoma.<\/p>\n\n\n\n

Original Source: http:\/\/www.scielo.org.ar\/scielo.php?script=sci_arttext&pid=S0025-76802017000500013<\/a><\/p>","protected":false},"excerpt":{"rendered":"

Cristhian Armenteros1, Andrea Odzak1, Florencia Arcondo1, Marcela De Dios Soler2, Tatiana Sinigier3, Marcelo Zylberman1 1 Divisi\u00f3n Cl\u00ednica M\u00e9dica, Hospital General de Agudos Dr. Cosme Argerich,2 Servicio de Anatom\u00eda Patol\u00f3gica, Hospital Marie Curie,3 Cirug\u00eda Pl\u00e1stica, Hospital General de Agudos Dr. Cosme Argerich, Buenos Aires, Argentina Resumen Las enfermedades del tejido conectivo vinculadas a implantes mamarios de siliconas han sido tema de discusi\u00f3n. En la \u00faltima d\u00e9cada, la siliconosis ha sido incluida dentro del s\u00edndrome autoinmune\/inflamatorio inducido por adyuvante (ASIA) junto al s\u00edndrome de la guerra del Golfo, s\u00edndrome de miofascitis macrof\u00e1gica y fen\u00f3menos post vacunales. El ASIA puede manifestarse como lupus, artritis reumatoidea, o m\u00e1s raramente como enfermedad de Still del adulto. Presentamos el caso de una paciente con fiebre prolongada y criterios cl\u00ednicos compatibles con ASIA y enfermedad de Still. Se resecaron las pr\u00f3tesis y la anatom\u00eda patol\u00f3gica descart\u00f3 linfoma anapl\u00e1sico ALK (-) vinculado a pr\u00f3tesis. Los m\u00e9dicos debemos estar alertas ante la aparici\u00f3n de estas nuevas entidades asociadas a los implantes mamarios de siliconas. Palabras clave: S\u00edndrome ASIA; Siliconosis; Enfermedad de Still; Adyuvante; Implantes mamarios. Abstract ASIA syndrome: breast implant and Still\u00b4s disease. Connective tissue diseases associated with silicone breast implants have been widely discussed. In the last decade, siliconosis has been included in the autoimmune\/inflammatory syndrome induced by adjuvants (ASIA) next to Gulf War syndrome, macrophage myofascitis and postvaccination phenomena. The ASIA syndrome may appear as lupus, rheumatoid arthritis, or more rarely, as adult Still\u2019s disease. We discuss the case of a patient with prolonged fever and clinical criteria for ASIA and Still\u2019s disease. The prostheses were resected and pathology showed absence of breast implant associated anaplastic lymphoma ALK (-). Physicians should be alert to these new entities linked to silicone breast implants. Key words: ASIA syndrome; Silicone; Still\u00b4s disease; Adjuvant; Breast implants. Desde su aprobaci\u00f3n, la utilizaci\u00f3n de implantes mamarios de silicona (IMS) gener\u00f3 sospechas de asociaci\u00f3n con enfermedades del tejido conectivo (ETC)1. A pesar de meta\u00e1nalisis y revisiones recientes, estas sospechas no han logrado ser confirmadas2. La siliconosis fue una de las primeras enfermedades reconocida como \u201cinducida por adyuvantes\u201d y hoy se halla incluida junto a otras, dentro del s\u00edndrome de Shoenfeld o s\u00edndrome autoinmune\/inflamatorio inducido por adyuvantes (ASIA: por sus siglas en ingl\u00e9s)3. Presentamos el caso de una paciente con siliconosis que se manifest\u00f3 como enfermedad de Still del adulto (SA). Caso cl\u00ednico Mujer de 61 a\u00f1os que fue admitida por fiebre (39 \u00b0C), artralgias, mialgias y dolor en cara anterior de hemit\u00f3rax izquierdo de siete d\u00edas de evoluci\u00f3n.Tuvo recambio de implante mamario con gel de silicona ocho a\u00f1os atr\u00e1s por fuga prot\u00e9sica. Hubo dos internaciones previas por s\u00edndrome febril; la primera, nueve meses atr\u00e1s con resoluci\u00f3n espont\u00e1nea y la segunda tres meses antes de esta internaci\u00f3n donde se indic\u00f3 tratamiento corticoide con normalizaci\u00f3n de la curva t\u00e9rmica. Adjunta de esas internaciones los siguientes ex\u00e1menes complementarios: Hto. 33%, VMC 89, GOT 84 UI\/l, GPT 144 UI\/l, FAL 115 UI\/l, PCR (prote\u00edna C-reactiva) 130 mg\/dl, LDH 1350 UI\/l. Serolog\u00edas virales, HIV, ASMA (anticuerpos anti-m\u00fasculo liso), anti LKM (anti-microsomas de h\u00edgado-ri\u00f1\u00f3n), FAN (anticuerpos antinucleares) y anti DNA negativos. Complemento, CPK y aldolasa normales. Cultivos microbianos negativos. TAC: adenomegalias axilares bilaterales y supraclavicular izquierda > 10 mm. Esplenomegalia (148 mm). Pr\u00f3tesis mamaria bilateral con engrosamiento de partes blandas periprot\u00e9sica en la mama izquierda. Ecograf\u00eda mamaria izquierda: colecci\u00f3n anecoica de 28 \u00d7 6 mm compatible con seroma.Biopsia de ganglio axilar izquierdo: expansi\u00f3n marcada de la zona T y focos de necrosis. Tinciones de Ziehl-Neelsen, PAS y Giemsa negativaos.Biopsia hep\u00e1tica: hepatopat\u00eda cr\u00f3nica activa leve. Video endoscop\u00eda alta y baja y ecocardiograma transesof\u00e1gico normales.Examen f\u00edsico al ingreso: adenopat\u00eda axilar izquierda 2 \u00d7 2.5 cm no dolorosa; rash maculopapular en miembros inferiores y tronco que se exacerba con los picos febriles. Esplenomegalia.Laboratorio: Hto. 34%, GB 15800\/mm3, neutr\u00f3filos 85%, LDH 1581 UI\/l, PCR 223 mg\/l, VSG 90 mm\/h, ferritina > 2000 ng\/ml, GOT 64 U\/l, GPT 13 U\/l. El resto, sin particularidades.TAC t\u00f3rax: pr\u00f3tesis mamaria bilateral con engrosamiento y heterogeneidad de tejidos paraesternales izquierdos y l\u00edquido periprot\u00e9sico. M\u00faltiples adenomegalias cervicales, axilares y en cadena mamaria izquierda. Esplenomegalia 140 mm.Se decidi\u00f3 remoci\u00f3n prot\u00e9sica bilateral. Citometr\u00eda de flujo de l\u00edquidos de seroma: sin evidencia de clonalidad. Anatom\u00eda patol\u00f3gica: c\u00e1psula mamaria con granulomas por siliconas.Comenz\u00f3 tratamiento con meprednisona 1mg\/kg\/d\u00eda por dos semanas y descenso paulatino. Permanece afebril y normaliz\u00f3 la ferritina y PCR. Discusi\u00f3n En el a\u00f1o 2000, un metaan\u00e1lisis no evidenci\u00f3 mayor frecuencia de LES, AR, esclerodermia, Sj\u00f6gren o ETC combinadas en mujeres con implantes mamarios en general o IMS4 y la FDA elabor\u00f3 en 2011 un informe de seguridad concluyendo que no existen estudios de asociaci\u00f3n entre IMS y ETC5; a pesar de ello, recientemente Balk y col. hallaron un aumento del riesgo de AR, s\u00edndrome de Sj\u00f6gren y Raynaud en pacientes con IMS2.En la \u00faltima d\u00e9cada se han descripto s\u00edndromes definidos por una respuesta hiperinmune, en personas gen\u00e9ticamente susceptibles, luego de exposici\u00f3n a factores ambientales que act\u00faan como adyuvantes3. Los implantes de silicona son biocompatibles en la mayor\u00eda de los pacientes, pero no son inmunol\u00f3gicamente inertes. La fuga de silicona desde la pr\u00f3tesis puede ocasionar con cierta frecuencia inflamaci\u00f3n cut\u00e1nea, linfadenopat\u00eda regional y reacci\u00f3n granulomatosa alrededor de la silicona (siliconoma), pero la respuesta inmune con s\u00edntomas sist\u00e9micos definida como siliconosis es m\u00e1s rara3.Las enfermedades por adyuvantes como siliconosis, s\u00edndrome de la guerra del Golfo, s\u00edndrome de miofascitis macrof\u00e1gica y fen\u00f3menos post vacunaci\u00f3n, han sido agrupadas por Shoenfeld y Agmon-Levine en 2010 como s\u00edndrome autoinmune\/inflamatorio inducido por adyuvantes (ASIA). Sus s\u00edntomas incluyen mialgias, artralgias, miositis, fiebre, xerostom\u00eda y s\u00edntomas neurol\u00f3gicos6. Sus criterios diagn\u00f3sticos se describen en la Tabla 1. En nuestro caso el antecedente de fuga del IMS, la presencia de artralgias, mialgias, fiebre y el hallazgo de siliconomas confirman s\u00edndrome de ASIA. Tabla 1. S\u00edndrome ASIA: criterios diagn\u00f3sticos La SA de inicio en el adulto se halla, junto al lupus eritematoso sist\u00e9mico (LES), artritis reumatoide (AR) y fibromialgia, dentro del espectro cl\u00ednico de los s\u00edndromes asociados a adyuvantes. Seg\u00fan los criterios diagn\u00f3sticos de Yamaguchi, la presencia de fiebre, artralgias, adenopat\u00edas, esplenomegalia, rash<\/p>","protected":false},"author":1,"featured_media":3768,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"content-type":"","_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"categories":[1,58],"tags":[],"class_list":{"0":"post-3765","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-blog","8":"category-cancer"},"acf":[],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/explantar.com\/en\/wp-json\/wp\/v2\/posts\/3765","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/explantar.com\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/explantar.com\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/explantar.com\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/explantar.com\/en\/wp-json\/wp\/v2\/comments?post=3765"}],"version-history":[{"count":3,"href":"https:\/\/explantar.com\/en\/wp-json\/wp\/v2\/posts\/3765\/revisions"}],"predecessor-version":[{"id":3853,"href":"https:\/\/explantar.com\/en\/wp-json\/wp\/v2\/posts\/3765\/revisions\/3853"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/explantar.com\/en\/wp-json\/wp\/v2\/media\/3768"}],"wp:attachment":[{"href":"https:\/\/explantar.com\/en\/wp-json\/wp\/v2\/media?parent=3765"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/explantar.com\/en\/wp-json\/wp\/v2\/categories?post=3765"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/explantar.com\/en\/wp-json\/wp\/v2\/tags?post=3765"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}