LIBRO DE OBSEQUIO SORPRESA 1 BREAST CANCER

6
Histological Diagnosis of Implant-Associated Pathologies
. . Fig. 3 SLIM type II. Neo-synovial membrane showing loss of lining cell layer, edema, reactive fibrovascular
tissue, and polymorphonuclear leukocyte infiltrate (H&E, ×200)
infection is suspected during surgery or for confirmation of its resolution in the two-stage
revision procedure. The main focus is on detecting and quantifying the presence of polymorphonuclear
leukocytes (PMN). Although direct microbial typing using special enzyme
histochemistry staining techniques may be possible in principle, it is generally limited to
fungal or mycobacterial infections. Polymerase chain reaction (PCR)-based techniques
with sequencing/hybridization of the amplifications enable definitive microbial typing
using formalin-fixed and paraffin-embedded (FFPE) tissue samples as well, although the
relatively low sensitivity must be taken into account [10].
Low-grade and high-grade purulent, abscess-forming types of inflammation must be
differentiated. The former can be difficult to diagnose with accuracy and it is characterized
by a predominant chronic inflammatory pattern featuring absence or a slight amount of
fibrinous exudate, loss of lining cell layer, edema, formation of granulation tissue with
activated fibroblasts, vascular proliferation, and a subtle inflammatory infiltrate of PMN,
often associated with plasma cells and small lymphocytic aggregates (. Fig. 3). The criteria
for the histological diagnosis of infection are detailed in section 2.10.
2.5 Mixed Synovitis/SLIM (Type III)
The histological diagnosis of type III synovitis/SLIM describes a combination of infection
and wear-induced synovitis as described for types I and II. A combination of periprosthetic
infection and wear-induced reaction is therefore associated with prosthesis failure. The