Qap (Anatomical Pathology) 

QAP Peer Review

AP203
Case History: F/35 2 cm breast mass, prior FNA suggested mucocele-like lesion
Intended diagnosis: Foreign body reaction to PAAG. Contributed by:MST
Code Diagnosis Comment Score
anonymous Foreign body reaction consistent with breast implant material (100%) nil  95
anonymous foreign body with foreign body granuloma reaction nil  95
anonymous Foreign body granulomatous inflammation 100%. The foreign body material is morphologically compatible with polyacrylamide hydrogel. Polyacrylamide hydrogel has been used for breast augmentation, by direct injection into the breast tissue. Detail clinical history is of paramount importance. The differential diagnosis is mucinous carcinoma. Complete excision and processing of the whole 2 cm mass for thorough histologic examination is necessary. Special studies: Mucicarmine stain (to confirm the material is in fact not mucin), and a cytokeratin stain to confirm absence of any occult malignant epithelial cells.  100
anonymous Foreign body reaction to breast augmentation material, most likely PAAG nil  100
anonymous Favor FOREIGN BODY REACTION 70% vs MUCOCELE-LIKE TUMOR 30%. Definitive diagnosis can be established easily by correlation with any history of foreign body injection eg. breast augmentation. If that history is negative, the diagnosis is MUCOCELE-LIKE TUMOR, and throughout sampling should be done to exclude atypical hyperplasia, DCIS or mucinous carcinoma. Furthermore, the mucin nature of the extravasated material can be confirmed by mucin stains.  95
anonymous Foreign body reaction against amorphous purplish material. (100%) PAAG needs to be excluded.  100
anonymous Breast - foreign body giant cell reaction 100% PAAG is the likely foreign material introduced into the breast.  100
anonymous Mucinous lesion, consistent with mucocele-like lesion, complete excision with extensive sampling to rule out mucinous carcinoma Immunohistochemical study for epithelial cell marker (CK) to detect tiny epithelial island floating in the mucin pools.  50
anonymous Paraffinoma 100% nil  90
anonymous Foreign body granulomatous inflammatory process related to breast augmentation procedure. nil  95
anonymous Foreign body consistent with polyacrylamide hydrogel injection 100% nil  100
anonymous Foreign body reaction to gel mammoplasty, probably PAAG 100% nil  100
anonymous Foreign body reaction, likely to PAAG Need correlation with history  100
anonymous Foreign body granulomatous reaction--?silicone nil  90
anonymous Foreign body, suggestive of polyacrylamide hydrogel injection. 100% Probability nil  100
anonymous Foreign body giant cell reaction, likely reaction to implant material; no malignancy (100%). Correlation with clinical history.  95
anonymous Foreign body reaction. Need to exclude previous history of breast augmentation.  95