Expanding silicone granuloma

Complications of breast augmentation using silicone implants have been the subject of much discussion. We report a single case of a silicone granuloma, which has exhibited unusual behaviour in that it has grown rapidly and significantly. Whilst silicone granulomata have been reported on many occasions in the past, to our knowledge this is the first report of a rapidly growing example.

Differential effects of thalidomide on angiogenesis and tumor growth in mice

Thalidomide, clinically used as an antiinflammatory and antitumoral drug, inhibited sponge-induced angiogenesis when administered systemically (100 mg/kg(-1)) in mice. However, it failed to inhibit solid Ehrlich tumor in the same mouse strain. We have used functional, biochemical and histological parameters to assess neovascularization and fibrovascular tissue infiltration of the mice sponge granuloma. The neovascularization growth as detected by development of blood flow and hemoglobin content extracted from the implants showed that thalidomide inhibited fibrovascular tissue formation by 40%. The functional and biochemical parameters correlated well with the histological study. Thalidomide had no inhibitory effect in the development of Ehrlich tumor. The detection of this selective action using the same animal strain bearing two different processes, supports the hypothesis that rather than species specificity, thalidomide is tissue specific. This approach may be used to identify the specificity of other therapeutic agents against distinct angiogenesis-dependent diseases.

Gallstone granuloma: a rare complication of laparoscopic cholecystectomy

Gallstone spillage during laparoscopic cholecystectomy is a relatively common occurrence. These intraperitoneal stones rarely give rise to complications. We present the case of a 68 female who presented with a 5 cm diameter epigastric mass two years after a laparoscopic cholecystectomy for acute-on-chronic cholecystitis with gallbladder stones. CT abdomen demonstrated an inflammatory mass with central calcification. Laparotomy and excision of the mass revealed the diagnosis as a gallstone granuloma.

360 Degrees of epibulbar granulation tissue thirteen years after silicone circle buckle operation

To demonstrate a granulomatous reaction to silicone buckel thirteen years after retinal detachment surgery. We report on a 71-year-old man who developed a 360 degrees of epibulbar granulation tissue due to silicone circle buckel. The granulation tissue was demonstrated by a computer tomography and histologically. A granulomatous reaction to silicone circle buckel can be found many years from the first operation. Biopsy is always necessary to establish a definitive diagnosis. Treatment of 360 degrees of epibulbar granulation tissue causing ocular dysfunction is by surgical excision.

Adverse granulomatous reaction after cosmetic dermal silicone injection

BACKGROUND

Various alloplastic injectable implants have been developed for soft tissue augmentation without surgery, but different local or systemic adverse reactions have limited their use for cosmetic purposes.

OBJECTIVE

To examine the problems associated with silicone injection.

METHODS

Case report and literature review.

RESULTS

We describe an adverse granulomatous reaction after the injection of liquid silicone for lip augmentation, causing facial disfigurement. Although the initial response to steroids was poor, after 3 years of follow-up the nodules have almost disappeared spontaneously.

CONCLUSION

We advise that silicone injection be performed solely by trained physicians using medical-grade silicone or consider other injectable materials.

Human anti-hyaluronic acid antibodies: is it possible?

BACKGROUND

Although hyaluronan has been acknowledged as being free of species and organ specificity, for 4 years I have encountered a variety of adverse reactions to injectable hyaluronic acid as used in aesthetic medicine.

OBJECTIVE

I have tried to prove that some of those side effects may be allergic reactions to the commercial preparations of injectable hyaluronic acid.

METHODS

I began with intradermal tests to the reactive patients and to 2 witnesses; then lymphocyte transforming tests were performed at the University of Geneva (Switzerland). Histology was performed on the skin tests and on reactive treated areas of the face of different patients. A serum analysis was then done by Pr. Sainte Laudy of Laboratoire Pasteur--Cerba (France).

RESULTS

The skin tests were positive for one or the other or both of the injectable hyaluronic acid preparations used in aesthetic medicine. The different biopsies have shown for some a chronic inflammatory reaction, even 11 months after the treatment or a severe granulamatous reaction to foreign bodies. Serum analysis revealed positive antibodies against Restylane and/or Hylaform and even IgG and E anti-hyaluronic acid.

CONCLUSION

Since 1995, I have 8 patients with adverse reactions to injectable hyaluronic acid, which after several tests, may be allergic to those products. Isn't it time to introduce intradermal tests before any injection of this type, as done with injectable bovine collagen?

[A clinical analysis of cholesterol granuloma following chronic suppurative otitis media]

OBJECTIVE

To investigate the pathophysiological mechanism, clinical menifestation and radiographic diagnosis of cholesterol granuloma following chronic suppurative otitis media.

METHOD

Six cases of CG following chronic suppurative otitis media, confirmed by surgery and pathology, were reviewed and analyzed.

RESULT

CG frequently accompanied with other middle ear diseases, and was shown as a high signal intensity on both T1-and T2-weighted images in magnetic resonance imaging(MRI).

CONCLUSION

It was postulated that the obstruction of pneumatized temporal bone air cell, caused by other middle ear diseases such as cholesteatoma and tympanosclerosis, might be the pathophysiological mechanism of CG. The evaluations of computed tomography (CT) and clinical manifestation were limited to distinguish CG from cholesteatoma or other neoplasm, while the MRI can be of great value to characteristic diagnosis.

Foreign body granulomas of the breast presenting as bilateral spiculated masses

In Asia, mammography following the injection of foreign materials into the breasts for cosmetic augmentation is frequently seen and diagnosis based on the typical radiologic findings is straightforward. We report the unusual radiologic findings in two patients with foreign body granulomas caused by injected foreign materials and discovered incidentally during screening work up. The mammographic findings were bilateral, hyperdense, spiculated masses, with occasional microcalcification, and at sonography, markedly hypoechoic, spiculated solid masses, located near the pectoralis muscle and partly extending into it, were observed. These radiologic findings mimicked malignancy.

Association between hemosiderin deposition and blood vessel regression during involution of foreign-body granuloma. Histochemical and ultrastructural study

We have characterized the sequence of events resulting in vessel occlusion and stasis of blood flow during involution of a foreign-body granuloma using histochemistry and electron microscopy. In the microvascular bed of the granulation tissue accompanying the progressive resorption of an implanted collagen sponge, endothelial cells protruded into the vascular lumen, resulting in the occlusion of the lumens of venules and capillaries. Examination of sections stained by the TUNEL method showed brown-yellow stained structures in the vascular lumen during regression of blood vessels. However, the ultrastructural profiles of endothelial cells effectively involved in the vessel occlusion showed none of the cardinal morphological features of apoptosis. These endothelial cells which displayed remarkable indentations of their nuclei in the form of nuclear pinches and/or deep pockets bulged conspicuously into the lumen. Such endothelial cells served as effective valves by protruding into the lumens of small blood vessels, and eventually the vessels were completely plugged by red blood cells. However, protruding endothelial cells subsequently shed into the vascular lumen by deviating themselves from the constitution of the vessel wall. The endothelial cells undergoing apoptosis were removed by intraluminal macrophages. Between the 130 and 140 day, the occurrence of small vessels tightly packed with erythrocytes reached a peak value in the granulation tissue and was accompanied by hemosiderin deposits. The plugged vessels were frequently associated with erythrocyte extravasation, leading to openings between degenerated endothelial cells due to the disappearance of endothelial cytoplasmic projections. Extravasated erythrocytes were rapidly eliminated by phagocytic cells such as mononuclear macrophages and multinucleated giant cells, and ended as hemosiderin deposits in granulation and/or scar tissue at the end of the experimental period (130-140 days). The morphological analysis of this regression sequence suggests that the protrusion of endothelial cells with the nuclear deformation is a mechanism contributing to the occlusion of blood vessels and consequently leads to erythrocyte extravasation.

The post-cystectomy pseudotumour sign: MRI appearances of a modified chronic pelvic haematoma due to retained haemostatic gauze

The magnetic resonance imaging (MRI) findings of five men who had incidental similar pelvic masses identified after radical cystectomy are presented. In all patients the haemostatic agent Kaltostat had been used. In one patient, surgical resection of the mass was performed and histological evaluation showed a foreign body inflammatory reaction within a chronic haematoma. The differentiation between this lesion and other post-operative collections or tumours is discussed.

[Circumscribed choroidal granulomatous inflammation after perforating injury. A histopathological study of four eyes]

BACKGROUND

This study was performed to describe the clinicopathologic features of patients wo showed circumscribed choroidal granulomatous inflammation after trauma.

METHODS

We examined histologically 4 eyes which had been enucleated within 4 weeks after treatment for perforating trauma. The second eyes of the patients were not affected.

RESULTS

Four enucleated eyes with perforating injuries had focal uveal granulomatous inflammation of the posterior choroid. None of these eyes contained Dalen-Fuchs' nodules. One eye had a disrupted lens without lens-induced inflammation. All eyes exhibited choroidal ruptures. Foreign material could be detected in one of these eyes.

CONCLUSIONS

Focal choroidal granulomatous inflammation may occur as a result of penetrating ocular trauma. The origin of this condition is unknown, although a foreign body reaction and choroidal rupture may be involved in the pathogenesis of the granulomatous inflammation.

Aluminium-induced granulomas after inaccurate intradermal hyposensitization injections of aluminium-adsorbed depot preparations

BACKGROUND

The development of persistent subcutaneous nodules at the injection sites of aluminium-adsorbed hyposensitization solutions is rare. These nodules have been interpreted as a delayed, granulomatous hypersensitivity reaction to aluminium. We report for the first time a case of persistent intradermal granulomas that developed at the sites of inaccurate intradermal, instead of subcutaneous, hyposensitization injections.

METHODS

An intradermal nodule was excised and processed for histopathology, scanning electron microscopy, and X-ray microanalysis. Intradermal and patch tests with aluminium hydroxide were performed.

RESULTS

Histologically, the nodule presented a pattern of granulomatous inflammatory reaction surrounding foci of necrotic tissue. Scanning electron microscopy and X-ray microanalysis revealed deposits of aluminium within the granulomas. Patch tests with aluminium hydroxide were negative, and intradermal tests caused persistent intradermal granulomas. Subsequent hyposensitization therapy in our department with the usual subcutaneous injections of aluminium-adsorbed allergen extracts was well tolerated by the patient.

CONCLUSIONS

Local toxic effects of aluminium may be crucial in the development of persistent intradermal injection-site granulomas. Such intradermal nodules may develop even if the subcutaneous route is well tolerated. We conclude that inaccurate intradermal injections of aluminium-containing solutions have to be strictly avoided.

Are triglyceride breast implants really biocompatible?

A case of augmentation mammaplasty with triglyceride implants is presented. Histological examination of the capsules 3 years postimplantation showed retained, irregular, refractile yellow-brown fragments embedded in granulomatous tissue.

Petroleum jelly lipogranuloma of the penis treated with excision and native skin coverage

Penile augmentation by injection of petroleum jelly is still performed by nonmedical practitioners abroad and causes foreign body reactions with resultant scarring, deformity, and ulceration. Surgical treatment involves removal of the foreign material and granuloma, followed by scrotal flaps, inguinal flaps, free flaps, or split-thickness skin grafts. We present the use of native penile skin for coverage after resection of oleogranuloma in the first case of which we are aware. Local penile skin coverage allows for an excellent surgical result, with many potential advantages over flaps or skin grafts.

[A case of paravesical foreign body granuloma due to surgical sponge retained for 40 years]

A 67-year-old man complained of vague pain in the lower abdomen persisting over 10 years. A hard mass was palpable just under an operative scar (right Gibson incision for ureterolithotomy performed 40 years previously). In addition to the patient's history and physical examination, abdominal echography, computerized tomography and nuclear magnetic resonance imaging (MRI) were performed and resulted in a preoperative diagnosis of retroperitoneal gauzeoma. The paravesical mass, 7 x 6 x 6 cm in size, was surgically removed, which was an encapsulated granuloma surrounding a surgical sponge. The possibility of foreign body granulomas due to a retained surgical sponge (so-called gauzeomas) should be considered in patients who have a previous history of abdominal operations.

Silicone lymphadenopathy mimicking a lymphoma in a patient with a metatarsophalangeal joint prosthesis

With lymph node enlargement, the possibility of a malignant process such as metastatic carcinoma or lymphoma needs to be excluded. This report describes a 47 year old woman with inguinal lymph node enlargement initially suspicious for lymphoma. Fine needle aspiration findings favoured reactive hyperplasia, but a malignant process could not be excluded. The final histological diagnosis was a foreign body granulomatous inflammatory response as a result of regionally disseminated silicone particles from an over looked metatarsophalangeal joint prosthesis. Because of the large number of joint prostheses world wide, it should be kept in mind that migration of wear particles can create granulomatous inflammation and node enlargement.

Talc granulomatosis. A differential diagnosis of interstitial lung disease in HIV patients

Consumers of adulterated drugs may present with talc-induced interstitial lung disease. A transbronchial biopsy specimen showing granulomas with intracellular talc crystals is necessary to confirm this diagnosis. In patients infected with HIV, such a condition can be indistinguishable at first glance from opportunistic infections or other pulmonary diseases. A case is presented of a seropositive patient whose chest radiographs showed a diffuse interstitial pattern.

Cactus skin injuries

Cactus spine injuries to the skin are usually treated by removing the visible spines and applying a topical corticosteroid. With this approach, granulomatous inflammation usually resolves in 2 to 4 months. We describe a case of a 54-year-old Caucasian woman who presented for treatment of painful cactus spine granulomas on her right hand. Unroofing the granulomatous papules and removing the cactus spine fragments under a dissecting microscope, and subsequent soaking in an antibacterial solution, resulted in rapid resolution of the granulomatous lesions.

Cutaneous sinus tract from remaining tooth fragment of edentulous maxilla

Cutaneous sinus tract of dental origin usually arises from chronic dental infections. These tracts usually appear as suppurative lesions of the chin or neck. Because many patients with this lesion do not have any complaints of oral symptoms, these lesions are often diagnosed incorrectly and overlooked, and are also treated ineffectively. A case of an unusual presentation of a chronic suppurative granuloma on nasolabial fold, which originated from the remaining tooth fragment of edentulous maxilla, is reported. Treatment with removal of the tooth fragment as well as the sinus tract resulted in complete healing of the lesion. This report emphasizes the importance of awareness of the possible dental origin of facial sinuses, despite their unusual location.