LIBRO DE OBSEQUIO SORPRESA 1 BREAST CANCER

10
Histological Diagnosis of Implant-Associated Pathologies
[20], [21]. Three histological patterns have been identified: (1) a predominantly macrophagic
pattern with absent or minimal lymphocytic response (. Fig. 7); (2) a mixed inflammatory
pattern, macrophagic and lymphocytic, with variable presence of plasma cells,
eosinophils, and mast cells (. Fig. 8, . Fig. 9); and (3) a granulomatous pattern, predominant
or associated with the mixed inflammatory pattern (. Fig. 10). In patterns 2 and 3 a
population of T cells or of mixed T and B cells has been described with T cells expressing
both CD4 + and CD8 + subsets [19], [20], [22], [23]. Of particular interest is the group of
cases exhibiting a high number of mast cells and eosinophils with or without formation of
perivascular lymphocytic germinal centers, which might represent a reaction to toxic wear
with allergic/hypersensitivity components, as recently reported [4].
The histological findings should always be interpreted in the context of all clinical,
radiological, microbiological, and allergological data. Valuable data for any class of implants
would also be obtained from biomechanical analysis of the corrosion patterns and
wear particle characterization by transmission/scanning electron microscopy of the periprosthetic
tissue. A multidisciplinary consensus conference with the participation of
experts from all specialties involved in the field could also be useful for assessing patient
management and treatment, a successful approach already in use for decades for neoplastic
diseases.
. . Fig. 7 SLIM type VI. Adverse local tissue reaction: macrophagic pattern with osteolysis. Perivascular macrophagic
infiltrate without lymphocytic component (H&E, ×200) and massive osteolysis in inset from metal-onmetal
implant in hip resurfacing arthroplasty (H&E, ×200)