Granuloma from liquid silicone

In recent years, the demand for cosmetic interventions to augment soft tissue by injecting different substances has increased, due to their apparent innocuity. However, these procedures are not free from adverse reactions, such as the formation of foreign body granulomas, a phenomenon described in literature with most of the materials used. We report the case of a female patient with inflammatory lesions of the face, whose diagnosis was made after the histopathological study, which revealed a granuloma caused by liquid silicone.     

Alopecia with foreign body granulomas induced by Radiesse injection: A case report

Radiesse is a soft tissue filler which has been widely used for cosmetic enhancement. The safety of Radiesse has been thoroughly investigated via numerous studies. A late-onset complication of Radiesse injection consists of foreign body granulomas, with only three case reports in over 10 years of clinical use. Herein, we describe the case of a patient who experienced alopecia with foreign body granulomas at the injection region one month after receiving a Radiesse injection. To our knowledge, this is the first report in the English literature of alopecia as an adverse event associated with Radiesse injection. The present case reminded physicians to evaluate more cautiously the necessity of injecting filler into hair-bearing area for lifting purpose. This procedure may cause foreign body granulomatous reaction, which may result in hair loss at the injection region.     

Simultaneous presentation of silicone and silica granuloma: a case report

We report a case of a 45-year-old woman who presented a simultaneous foreign-body granuloma reaction to silicone in her face and to silica in the elbow and knee. The patient had received silicone injections in her face 7 years earlier and had suffered a motorcycle accident when she was young. Changes suggestive of silicone were observed in the biopsy obtained from the face, and silica was detected in the biopsy taken from the elbow, confirmed by polarized light and X-ray microanalysis. The presence of polarizable foreign matter in cutaneous epithelioid granulomas should alert to the diagnosis of sarcoidosis.     

Foreign body post-varicella granulomas due to talc

Foreign body granulomas in the skin have been described frequently and may have various causes. Diagnosis is relatively easy in most cases, as most are related to foreign material penetrating into the skin due to different kinds of traumas. We present the case of a boy with multiple facial granulomas, persisting more than 6 months and related to the use of topical anti-pruriginous talc powder applied to papuloexudative lesions caused by varicella. Data gathered in the anamnesis, examination with polarized light and images seen through the electron microscope enabled us to identify the causal agent talc as the inducer of the granulomatous lesions that the patient presented, discarding other types of foreign body granulomas of exogenous origin.     

Penis swelling due to foreign body reaction after injection of silicone

A 19‐year‐old man presented with phimosis and painful swelling of the penis four weeks after augmentation with silicone in Thailand. Histology revealed a foreign body reaction to silicone. Infectious causes were ruled out. Granulomatous foreign body reactions to silicone are common, but there are few case reports on reactions following silicone injection for penis enlargement. Foreign body reactions should be included in the differential diagnosis of penis swelling.     

Pulse granuloma in a rectocutaneous fistula

Pulse granulomas are rare foreign body reactions to vegetable material characterized by hyaline rings or starch granules. Pulse granulomas have mainly been reported in association with lung aspirations, the oral cavity with a history of oral procedures and less frequently in intestinal fistulae, colonic diverticulae or stomach ulcers. Only one case involving the skin has been reported in a patient with jejunocutaneous and ileocutaneous fistulae. We report the second cutaneous pulse granuloma in a patient with a rectocutaneous fistula.     

Schwere Komplikationen nach glutealer Silikoninjektion

Silicone has a broad range of medical applications and plays an important role, for example, in plastic reconstruction. The use of silicone, however, may result in unpredictable consequences for the patient. These range from swelling and erythema at the site of injection and regional lymphadenopathy to the development of disseminated granulomas distant from the administration site. We report a woman who developed extensive distally-spreading ulcerations in both buttocks several years after gluteal silicone injection. Potential systemic reactions of silicone include intrapulmonary granulomas, embolism and related pneumonitis. Moreover, an association with the development of autoimmune diseases and neoplasias has been discussed. Therapeutic options include surgically removing the silicone and topical or systemic anti-inflammatory drug therapy. However, due to the diffuse dissemination of silicone, the former is often not completely possible and for the latter empirical data are limited and follow-up studies are missing. Liquid silicone is no longer authorized in Europe or in the U.S.A. When silicone implants are used, the decision should be weighed carefully and the patient adequately counseled. In addition, follow-up care on a regular basis is mandatory for both those with implants and those who obtained injections of liquid silicone in the past.     

Sarcoidal granulomas in a cosmetic tattoo in association with pulmonary sarcoidosis

Sarcoidosis is a granulomatous disease of unknown etiology, which may affect multiple organ systems. The skin is involved in up to one‐third of cases. The development of granulomatous lesions within tattoos is a well‐recognized phenomenon in patients with sarcoidosis. The characteristic histology shows non‐caseating granulomas; however similar findings may be seen in foreign body granulomas. We report on a patient, who developed sarcoidal granulomas within the black pigment of his tattoos. This subsequently led to the diagnosis of pulmonary sarcoidosis.     

A diagnostic trap for the dermatopathologist: granulomatous reactions from cutaneous microimplants for cosmetic purposes

We present a case of late granulomatous reactions from silicone that first appeared in a site different from that of the injection causing an incorrect diagnosis of liposarcoma in the beginning. The histological picture was a cystic-macrophagic granuloma in both the injection site (upper lip) and the migrating site (paranasal regions). We think that the foreign body has undergone an antigravity migration from the upper lip to the right paranasal region. To our knowledge, such a phenomenon has not been yet reported in literature.     

An uncommon zoonosis

In a patient with foreign‐body granulomas, dog hairs were identified as the causative agent by combing history, histopathology and highly sensitive detection of species‐specific canine mitochondrial DNA. Granulomas from human hair are well known in hairdressers. Animal hair granulomas have so far been only described in dog groomers, milkers, and shearers. To the best of our knowledge this patient represents the first described case of dog hair granulomas in a pet owner.     

Secondary lymphoedema of the lower leg as an unusual side-effect of a liquid silicone injection in the hips and buttocks

We report an unusual case of secondary lymphoedema of the lower extremities as a result of injections of liquid silicone. A 30-year-old transsexual had received large-volume injections of silicone in the hips and buttocks for cosmetic purposes in order to obtain a female body form. Painful silicone granulomas developed in both the treated areas and areas outside the original injection location, and a progressive lymphoedema of feet and legs developed during a period of 5 years.     

Cutaneous sarcoidosis presenting as leonine facies

Cutaneous sarcoidosis often masquerades as many other disease entities. We describe the case of a 56-year-old African American man with a 1-year history of progressively enlarging nodules and plaques of the face resulting in a leonine appearance and madarosis. The diagnosis of cutaneous sarcoidosis was made after skin biopsy results revealed noncaseating granulomas without evidence of foreign body, mycobacteria, or deep fungal infection. A thorough systemic workup was void of other comorbidities. The reports of tumoral sarcoidosis or sarcoidosis presenting with leonine facies are rare, and those cases that have been reported have been linked to other systemic findings.     

Adverse reactions to polylactic acid injections in the periorbital area

Background Correction of aging changes and contour deformities has been addressed largely by tissue augmentation agents whose volume is injected into tissues to achieve the required result. Polylactic acid (PLA) is an agent that is injected with the aim of enhancing the host's own collagen deposition. Objective We describe the development of multiple nodules and one case of a foreign‐body granuloma formation following the administration of PLA to the face for correction of rhytides and contour deformities. Methods Four case presentations, including clinical history, injection protocol, histopathology, individual treatment, and their outcomes, are discussed with pertinent literature review. Results Four patients who received injections of PLA developed nodules that were clinically similar in size, shape, and consistency. Histopathologic examination revealed the presence of a foreign‐body granulomatous inflammatory reaction in one of the patients. Conclusion Cosmetic treatment with PLA may be complicated by disfiguring nodules that may mask a granulomatous reaction. PLA‐induced nodules and foreign‐body granulomas have proven difficult to treat. Therefore, PLA should only be injected in the infraorbital area by experienced injectors who have had appropriate training. In addition to this, PLA should be injected in a “depot” method below the muscle at a significantly diluted volume. Due to the complications encountered after the use of PLA, we feel that a cautionary warning regarding the use of PLA in this area may be prudent regardless of the abovementioned precautions.     

Unusual histopathological features of cutaneous leishmaniasis identified by polymerase chain reaction specific for Leishmania on paraffin-embedded skin biopsies

BACKGROUND: Cutaneous leishmaniasis (CL) is rare in Northern Europe and may be overlooked because colleagues have little experience with it. OBJECTIVES: To identify manifestations of CL that may escape diagnosis. METHODS: Correlation of clinical diagnosis and histopathological findings in 28 biopsy specimens taken from 19 patients with CL confirmed by polymerase chain reaction (PCR) specific for Leishmania. RESULTS: In only one patient was the clinical diagnosis CL; other diagnoses included: malignant epithelial neoplasms (5), follicular cyst (2), atypical mycobacteriosis (1), sarcoidosis (2) and lymphoma (1). Lesions were single (15) or few (4) nodules predominantly situated on the extremities or face (16). Histopathological findings were diagnostic of CL in only 10 cases. In nine cases Leishmania was not identified microscopically; histopathological diagnoses were: granulomatous dermatitis (6), lupoid rosacea (1), foreign body granuloma (1) and granuloma annulare (1). Unaltered epidermis (9), nodular infiltrates (5), numerous multinucleated histiocytes (3), palisaded granulomas with fibrinoid centres (2), sarcoidal granulomas (4) and elastophagocytosis (1) misled the histopathologists in these cases. CONCLUSIONS: CL seems often to be misdiagnosed clinically in countries where it is not endemic. Histopathologically, CL may be misinterpreted as sarcoidosis, foreign body granuloma, lupoid rosacea and granuloma annulare, especially when Leishmania is not seen microscopically. We suggest that in Northern Europe, PCR for Leishmania-specific DNA should be performed routinely in any granulomatous dermatitis presenting as a single or few nodules on the extremities or face, even when a diagnosis of CL was not considered by the referring clinician.     

Cutaneous foreign body granulomas associated with lipolytic cocktail: Who is the enemy,mesotherapy or drugs injected?

Mesotherapy is widely used for its lipolytic effect as an alternative procedure to surgical methods. Although many benefits of lipolytic mesotherapy have been observed, numerous side effects have also been reported. Here, we report a case of cutaneous foreign body granulomas that occurred after lipolytic mesotherapy.     

Polishing-paste-induced silica granuloma of the gingiva

Polishing-paste-induced silica granuloma of the gingiva, an uncommon condition, may mimic various local or systemic pathological entities. A 33-year-old woman and a 42-year-old man were referred for a localised refractory gingival inflammation. Clinical diagnoses included allergy, lichen planus and herpes. Biopsy showed well-demarcated non-caseating granulomas, associating epithelioid and Langhans giant cells. Special bacterial and mycological stains were negative. Systemic examination and laboratory tests ruled out sarcoidosis and Crohn's disease. Polarised light revealed birefringent crystalline foreign material. A diagnosis of silica granuloma was made. Both patients had frequent dental hygiene treatment including polishing with abrasive paste, suggesting an iatrogenic implantation of the foreign bodies. Gingival damage can result from the use of some dental materials containing silica. Often asymptomatic, sometimes producing visible lesions, granulomatous gingivitis may mislead into wrong diagnosis and treatment. Old silica granulomas may become symptomatic if the patient contracts sarcoidosis.     

Immunohistochemical study of lysozyme in lupus miliaris disseminatus faciei

The lysozyme activity in tissue samples from patients with lupus miliaris disseminatus faciei (LMDF), sarcoidosis and foreign body granuloma was investigated using the immunoperoxidase technique. The majority of epithelioid cells and giant cells in LMDF and sarcoidosis showed strong lysozyme staining in their cytoplasm. However, most macrophages and giant cells in foreign body granulomas, including granulomatous reactions to epidermal cysts and other foreign materials, stained weakly for lysozyme or were negative. These results suggest that LMDF is different from the foreign body reaction to inert substances, and may be induced by an immunological mechanism associated with cell-mediated immunity.     

Paraffinoma

The subcutaneous infiltration of liquid paraffin is still used for penile enlargement. The procedure has many complications. A late problem is the development of foreign body granulomas known as paraffinomnas. They may be necrotic and ulcerated, requiring acute, radical surgical excision.     

Granuloma annulare: An immunohistochemical study

The monocyte/histiocytic response in granuloma annulare has not been extensively studied. We studied the immunohistochemical staining pattern in granuloma annulare by using a panel of markers for "histiocytic" cells including Ham 56, KP1, factor XIIIa, Mac 387, vimentin, and lysozyme. The infiltrate failed to stain with the histiocytic markers, except with antibodies against vimentin and lysozyme. Commonly used histiocytic markers for infectious, immunogenic, and foreign body granulomas fail to stain the infiltrate in granuloma annulare. We hypothesize that a locally derived, immunologically distinct population of histiocytes produces the reaction pattern of granuloma annulare.     

Sea urchin spines in the stratum corneum: an early finding related to trauma

Penetrating trauma from sea urchin (Echinoidea) spines has been shown to cause numerous cutaneous reactions, ranging from initial pain that rapidly dissipates and resolves to chronic inflammation and formation of characteristic sea urchin granulomas. Many of these skin‐colored or violaceous papules and nodules form weeks to months after injury, and may be surgically excised. Histopathologic examination commonly shows well‐defined granulomas, the majority of which represent sarcoidal‐type granulomas. Other microscopic patterns, such as foreign body reactions and chronic inflammation, have also been shown. Retained spine fragments are birefringent on polarized microscopic examination and are most likely found in the dermal layer. Herein, we describe a case of traumatic sea urchin cutaneous injury with a unique early cutaneous trauma reaction in a young male who lived in Hawaii. Histopathologic exam was significant for retained spines in the layer of the stratum corneum, but no signs of granulomatous inflammation were observed. This case report emphasizes the unique features of our case and reviews the common clinical and histopathologic features of sea urchin cutaneous reactions.