Breast implant augmentation is a low-risk procedure with few life-threatening complications. Capsular contracture and rupture/leakage of the implant are the most common complications encountered. Malignant breast implant augmentation-associated lesions are rare, with anaplastic large cell lymphoma being the most common. Squamous cell carcinomas associated with breast implant augmentation are exceedingly rare, with only eight patients reported. Breast implant capsule-associated squamous cell carcinoma occurs in patients with long standing breast implant augmentations (>11 years). We report two additional patients with breast implant capsule-associated squamous cell carcinoma. Review of the literature reveals that invasion beyond the breast implant capsule into the adjacent tissue by the squamous cell carcinoma appears to have negative prognostic implications, and possibly warrants close clinical follow-up.

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Introduction/Objective Spindle cell lesions (SCL) are diagnostically challenging, especially on cytology specimens where entities have overlapping features. Neoplastic and non-neoplastic SCL are uncommonly encountered in the pancreas/peripancreatic tissue. The sensitivity and specificity of EUS-FNA of pancreatic lesions both approach 95%. In this study, we assess the frequency of SCL found in pancreas/peripancreatic tissue on cytology specimens, the frequency of performing IHC stains and the most useful IHC panels. We also evaluate histology-cytology discrepancies and pitfalls. Methods A retrospective analysis of all pancreas/peripancreatic cytology specimen results between January 2004 - August 2019 was conducted. A total of 5,132 cases were identified. The number of spindle cell lesions was 27 (0.52%), with surgical pathology results available for 15 cases (55%). IHC stains were performed on 18 cell blocks (66%) and 9 surgical pathology specimens (60%). Results Of the 27 SCL identified, 22 lesions were neoplastic (81%), and 5 lesions were non-neoplastic (19%). The Neoplastic cases were: 10 GISTs (37%), 4 spindle cell lesions, NOS (14.8%), 2 metastatic sarcomas (7.4%), 1 pheochromocytoma (3.7%), 1 leiomyoma (3.7%), 1 schwannoma (3.7%), 1 malignant fibrous histiocytoma (3.7%), 1 granular cell tumor (3.7%), and 1 neuroendocrine carcinoma (3.7%). Of the neoplastic cases, 10 were lesions originating in a different organ with direct extension/distant metastasis to the pancreas (71%), with the most common organ being the stomach, 6 cases (60%). The non-neoplastic cases were: 4 granulomas (14.8%), and 1 accessory spleen (3.7%). IHC stains were performed on 18 cell blocks (66%), and attempted unsuccessfully on 2 cell blocks. The most commonly utilized stains were: CD117, 15 cases (83%), SMA, 11 cases (61%), S-100, 9 cases (50%), CD34, 5 cases (27%) and Cytokeratin, 5 cases (27%). IHC stains assisted with proper classification in 9 cytology cases (50%). There was one interpretation error*, and the histology-cytology discrepancy rate was 6%. Conclusion Pancreatic and peripancreatic spindle cell lesions are uncommon (520/100,000), and are particularly challenging on cytology specimens. If neoplastic, the majority originate in an organ other than the pancreas. If non- neoplastic, the majority are granulomas. Immunohistochemical staining is required for proper classification. And in this small series, cytology is highly accurate for diagnosis (96%).