[Chest granuloma secondary to methyl methacrylate. Case report]

We present the case of a patient with a history of a massive left hemithorax crushing injury in 1985; the exact management of the lesion is unknown. Twenty years later he had a thoracic fistula with a culture that was reported as positive for Enteroccocus faecalis and Staphyloccocus epidermidis. The patient was referred by the chest surgery service with the diagnosis of rib osteomyelitis once complementary imaging tests were performed (plain X-rays, CAT scan and MRI). The patient underwent surgery at our service; a granulomatous reaction secondary to a foreign body (methyl methacrylate and Ethibon) was reported. Chest reconstruction for massive lesions is possible with methyl methacrylate. Imaging studies involve the well-known difficulty to identify this material, given that it may produce signals and densities that are difficult to interpret by specialized physicians.

Foreign body granulomatous change from absorbable gelatin sponge and microcoil embolization after a guidewire-induced perforation in the distal coronary artery

We report an autopsy case of treatment by absorbable gelatin sponge and microcoil embolization after perforation of the distal coronary artery by guidewire. Histological examination revealed a foreign body granuloma in the coronary artery with embolization. Foreign body reaction to absorbable gelatin sponge seemed to be stronger than that to the microcoil.

Ultrasound features of suture granulomas in the thyroid bed after thyroidectomy for papillary thyroid carcinoma with an emphasis on their differentiation from locally recurrent thyroid carcinomas

The purpose of our study was to evaluate the ultrasound features of suture granulomas at the thyroid bed after thyroidectomy for papillary thyroid carcinoma with an emphasis on their differentiation from locally recurrent thyroid carcinomas. We enrolled 14 suture granulomas in 10 patients and 20 locally recurrent carcinomas in 18 patients after thyroidectomy, confirmed by surgery (15 out of 20 recurrent carcinomas), or ultrasound-guided fine needle aspiration cytology (14 suture granulomas and 5 recurrent carcinomas). The ultrasound findings, including presence of internal echogenic foci suggesting calcification or suture material, were compared between the two groups. In the cases with internal echogenic foci, the size, number, distribution pattern, and the presence of a paired appearance were also evaluated. In result, most of the suture granulomas were irregular (n=13) and heterogeneous (n=9) (p<0.05). The incidence of internal echogenic foci was higher in suture granulomas (n=12) than in recurrent carcinomas (n=7) (p<0.05). The internal echogenic foci in all suture granulomas were clustered centrally or paracentrally, unlike those in recurrent carcinomas (p<0.05). Most of the echogenic foci in suture granulomas were larger than 1 mm in diameter (p<0.05) and had a paired appearance (p<0.05). Shape, heterogeneity, and the presence of central or paracentral internal echogenic foci are helpful criteria for differentiating suture granulomas from locally recurrent tumors in the thyroid bed.

Clinical, pathological and radiological features of paraspinal textiloma: report of two cases and review of the literature

Textiloma is a term used for retained cottonoid or surgical sponge in the operation field. Although they occur mostly after thoracic or abdominal operation, they can also be encountered after surgery of extremities or the spine. There are few reports of spinal cases in which MR and CT imaging findings of textilomas have been described. In this report, two additional cases with MR, CT and pathological features of paraspinal textilomas are described. CT image demonstrated a paraspinal mass simulating a malignant tumour. While T1-weighted MR images showed the masses with low signal intensity, T2-weighted MR images showed heterogeneous masses with low and high signal intensities.

Bone wax can cause foreign body granuloma in the medulla oblongata

Bone wax is commonly used in neurosurgical practice as a haemostatic and sealing agent. It is a safe agent, but may lead to adverse effects such as infection, epistaxsis, allergic reaction or foreign body granuloma. There are very few reported cases of the neurological complications of remnant bone wax in the subdural or subarachnoid space. The authors report the case of a foreign body granuloma infiltration through the medulla oblongata due to remnant bone wax in the subarachnoid space after posterior fossa decompressive surgery.

Successful colchicine administration in facial granulomas caused by cosmetic implants: Report of a case

Injectable cutaneous microimplants may occasionally cause either persistent local irritation or late skin reactions in the form of foreign body granulomas at the injected areas. Permanent elimination of the latter is not easily achieved. The skin of a female patient developed nodules along the treated sites on her face a few months following the last session of intracutaneous injections. Intralesional steroids offered temporary and incomplete clearance. Colchicine was administered orally for better results.

Adverse reactions to dermal fillers: A review of European experiences

BACKGROUND

In Europe, numerous dermal fillers have been utilized for the past decade. A lot of drawbacks have been reported and sometimes, severe complications occurred.

OBJECTIVE

Our purpose is to report the clinical aspects of the adverse reactions following injections of some of the dermal fillers. Histological aspects of complications are also described.

RESULTS

Adverse reactions secondary to biodegradable products are usually time limited, but with the non-biodegradable products, we have observed severe, persistent, and recurrent complications. Histological examinations, in cases of non-biodegradable products, may show the presence and persistence of the filler.

CONCLUSION

For the moment, there is no ideal dermal filler. All fillers can lead to adverse events and we need to inform patients fully before injecting. Clinical studies with long-term follow-up before launching a new product on the market are recommended. We believe that in Europe, at present, the CE mark is not a guarantee of safety of dermal fillers.

[Spinal granuloma in a patient receiving a spinal infusion of morphine and clonidine]

Patients treated with long-term spinal infusion of high doses of morphine develop a granuloma at the location of the catheter tip. Diagnosis is based on a steady increase in intrathecal morphine dosage after a relatively prolonged period of stability, on the gradual development of neurologic signs and symptoms suggesting radicular or spinal cord compression, and on magnetic resonance images. We describe a man with central neuropathic pain after removal of a tumor. The presence of all 3 of the aforementioned diagnostic criteria led to suspicion of a spinal granuloma.

Injectable fillers: an American perspective

Since 1981, there has been a significant repertoire of United States Food and Drug Administrtion (FDA) approved fillers for both cosmetic rejuvenation and facial lipoatrophy. Currently available dermal fillers include bovine, human and porcine collagens, hyaluronic acids of animal and biosynthetic origin, poly-L-lactic acid, calcium hydroxylapatite, and polymethylmethacrylate. Many of these fillers were first available in Europe and Canada before their arrival in the United States (USA) and many of the complications known about these products have come from studies conducted both in the USA and abroad. Several of the fillers that are currently available abroad or are used in the USA off-label have been associated with significant complications. The authors review three of these fillers: liquid injectable silicone, DermaLive/DermaDeep, and Bio-Alcamid.

Sea urchin granuloma secondary to Strongylocentrotus purpuratus and Strongylocentrotus franciscanus

Sea urchin injuries have been associated with a variety of cutaneous lesions, ranging from acute, transient reactions, to more chronic inflammatory conditions that result in the formation of granulomas. Although diverse species of sea urchins have been reported to produce chronic cutaneous granulomas, the two most prevalent organisms found on the US West Coast, purple and red sea urchins (Strongylocentrotus purpuratus and Strongylocentrotus franciscanus), have not yet been reported to induce persistent granulomatosis in humans. We describe one case of a 35-year-old marine biologist with chronic cutaneous lesions produced after repeated exposures. The lesions were similar to the ones produced by other urchin species, consisting of small, firm, erythematous nodules on his palms, dorsum of the hands, elbows, and knees. Increased awareness of this condition, including its association with the two prevalent organisms on the West Coast, should lead to a more rapid diagnosis for those affected. This article reviews the types of injuries, clinical cutaneoous lesions, histopathological features, and pathogenesis of the chronic inflammatory process induced by sea urchins.

[Human adjuvant disease which developed after silicone augumentation mammoplasty]

A 73-year-old woman was admitted to our hospital to evaluate mediastinal lymphadenopathy found on a chest CT scan. She had undergone mammoplasty with silicone augmentation 50 years previously and had the implants removed 5 years previously. Biopsied specimens of a mediastinal lymph node under video-assisted thoracic surgery (VATS) revealed multiple hyalinized non-caseating epithelioid cell granulomas and multinucleated giant cells and foamy macrophages containing some vacuoles. According to these clinicopathological findings, we diagnosed human adjuvant disease which developed after mammoplasty with silicone augmentation. In cases of mammoplasty, we should pay attention to the complication of chronic thoracic disorder as a human adjuvant disease.

Foreign body aspiration in Hong Kong Chinese children

OBJECTIVES

To describe and compare the demographic, clinical, radiological, and bronchoscopy features and outcomes of children with foreign body aspiration in early- and late-diagnosis groups, to report the reasons for delay in diagnoses, and to determine what objects are commonly aspirated.

DESIGN

Retrospective study.

SETTING

Department of Paediatrics, Queen Elizabeth Hospital, Hong Kong.

PATIENTS

All children younger than the age of 18 years with foreign body aspiration admitted to the study hospital from 1 January 1993 to 31 May 2006.

RESULTS

Sixteen (59%) of the patients were categorised into the early-diagnosis group (correctly diagnosed foreign body aspiration<7 days of symptom onset) and 11 (41%) into the late-diagnosis group (correctly diagnosed>or=7 days after symptom onset). The common clinical manifestations of foreign body aspiration were persistent cough (100%) and history of choking (74%). Most children (82%) in the late-diagnosis group and 25% in early-diagnosis group (P=0.004) were misdiagnosed as respiratory infections and asthma. Intrabronchial granulation was more common in the late-diagnosis group (13% vs 55%, P=0.033). Peanuts and watermelon seeds accounted for 85% of the aspirations; 63% of the foreign body aspirations occurred around the Chinese New Year festival.

CONCLUSION

Foreign body aspiration is difficult to diagnose in children. Misdiagnosis as asthma and respiratory infection can delay treatment and result in intrabronchial granuloma. We therefore suggest early bronchoscopy in suspicious cases. Parents should be cautious when giving peanuts and watermelon seeds to their children.

An unusual presentation of Teflon granuloma: case report and discussion

For more than 25 years, Teflon was the most commonly used material for injection laryngoplasty. However, the incidence of Teflon granuloma and the consequent deterioration of glottic function ultimately led to the development of other injectable materials, and as a result, Teflon granulomas are no longer frequently encountered. We present a case of Teflon granuloma that was unusual in that (1) a long period of time had elapsed between the injection and the granuloma formation and (2) there was no change in the patient's glottic function.

[Pulmonary granuloma possibly caused by a fish bone material]

We herein describe an extremely rare case of pulmonary granuloma possibly caused by a fish bone material. A 60-year-old woman with hemosputum was found to have a right pulmonary nodule. Chest computed tomography showed a nodule with pleural retraction, vascular convergence and ground glass opacity, measuring 23 mm in diameter, located at the S2 Of right upper lobe. Based on these findings, this nodule was considered to be a primary lung cancer, and pulmonary resection was performed. Macroscopically, a foreign material was found in the lesion and the pathologic diagnosis of the nodule was foreign body granuloma possibly due to a fish bone material.

Intraosseous foreign-body granuloma in the mandible subsequent to a 20-year-old work-related accident

The purpose of this article was to describe the clinical and microscopic features of an intraosseous foreign-body granuloma in the mandible that developed after the traumatic implantation of metal fragments during a work-related accident. A 65-year-old male patient had a severe pain in the body of mandible. Clinical examination showed facial asymmetry and a scar, extending to the left mental region. Intraoral examination revealed a soft mass involving the left alveolar bone with normal appearance of the mucosa surface. Panoramic radiographs showed a radiolucent lesion along the mandible extending from the central incisive to the first molar. Computed tomography revealed an osteolytic mass in the same area. His medical history included a work-related accident twenty years prior to evaluation. During the biopsy an important amount of bright metal-like pieces surrounded by soft tissue were found. A microscopic examination showed a foreign body associated with an aggregation of multinucleated giant cells. The final diagnosis was a foreign body granuloma. Even though foreign-body granulomas in the mandible are rare lesions, dentists should be familiar with their features and include them in the differential diagnosis of tissue masses.

Talc granulomatosis mimicking sarcoidosis

Pulmonary disease due to talc, a group of hydrous magnesium silicates, is almost exclusively encountered secondary to occupational exposure or intravenous drug abuse. Talcosis or talc pneumoconiosis is one of the rarer forms of silicate-induced lung disease. It is seen in workers exposed during its production, and occasionally, in users of cosmetic talc and in intravenous drug addicts. Very often, the history of exposure is not recognised by the patient, and it is only the finding of granulomatous cellular interstitial lesions containing birefringent crystals which indicates considerable talc exposure. We report a 38-year-old woman who was initially diagnosed with sarcoidosis, until a bronchoscopic biopsy revealed the presence of numerous foreign body giant cells and birefringent particles forming non-caseating granulomas. There was no history of occupational exposure to talc or intravenous drug abuse. The patient responded to oral corticosteroid treatment. Talcosis is generally considered to be relatively benign.

[Pulmonary staple granuloma mimicking lung cancer; report of a case]

A 67-year-old man was referred to our hospital with chief complaints of bloody sputum and an abnormal chest shadow. He had a history of chronic renal failure and surgery for right pneumothorax. During dialysis treatment 2 years ago, an examination revealed a mass shadow with spiculation in the apex of the right lung. Subsequently, he noted bloody sputum, and the shadow became larger. Serum Progastrin-releasing-peptide (GRP) levels remained within the range of 70-80 pg/ml at the previous clinic, but were elevated to 109 pg/ml on admission to our hospital. These findings suggested lung cancer developing around the scar due to pneumothorax surgery, and we performed an operation. The resected tumor was a granuloma formed around a staple with a polytetra-fluoroethylene (PTFE) sheet, showing no evidence of malignancy. The patient's postoperative course was uneventful, and the serum Pro-GRP level fell to 60 pg/ml.

Chronic sinusitis associated with the use of unrecognized bone substitute: a case report

Bone grafts are used for bone augmentation to ensure optimal implant placement. However, this procedure may sometimes cause sinusitis. The case of a 44-year-old woman with the diagnosis of recurrent and chronic sinusitis of her right maxillary sinus with a history of dental implant surgery is presented. After several attempts with normal standard sinusitis therapy, unrecognized bone substitute was removed from the sinus cavity, which finally led to resolution of the sinusitis. This case reiterates the importance of a careful examination, consultation, and second opinion for the selection of optimal treatment.