Mediastinal silicon-induced lymphadenopathy mimicking “N3” disease in resectable lung cancer

Silicone implant leakage can be associated with mediastinal silicon-induced lymphadenitis, representing a diagnostic challenge in case of previous history of malignant neoplasms or synchronous cancer. Silicone lymphadenopathy is due to the deposition, in one or more lymph nodes, of migrated silicone through tissues after clear damage of a silicone-containing membrane or through a continued slow bleed of gel through an intact surface. Here we report a case of a patient with a pathological diagnosis of primary lung cancer and clinical contralateral mediastinal involvement—a stage IIIB cN3 disease—potentially excluding from curative resection, in which thoracoscopic excision of the lymphadenopathy showed a silicon-induced lymphadenitis, thus offering the patients the best and most appropriate therapeutic option for lung cancer. Silicone lymphadenopathy should be considered within the differential diagnosis for patients with a proven diagnosis of cancer and mammary implants; lymph node biopsy is suggested and the assessment of leakage or rupture of the implant should be taken into consideration.