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SILICONE GRANULOMA IN ACRAL SKIN IN A PATIENT WITH SILICONE-GEL BREAST IMPLANTS AND SYSTEMIC SCLEROSIS |
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| Authors: | DAREN R ANDERSON BA JOSEPH SCHWARTZ MD CAROLYN M COTTRILL MD STEVE A McCLAIN MD JEFFREY S ROSS MD JORY G MAGIDSON MD ALBERT KLAINER MD EMIL BISACCIA MD |
| Institution: | From the Columbia University College of Physicians and Surgeons, New York, New York;the Dermatopathology Section, New York University, Now York, New York;the Department of internal Medicine, Morristown Memorial Hospital, Morristown, New Jersey;the Department of Pathology, Morris-town Memorial Hospital, Morristown, New Jersey;and the Department of Pathology, Albany Medical College, Albany, New York. |
| Abstract: | A 68-year-old white woman was referred to us by her rheumatologist for possible participation in a clinical study of photopheresis for scleroderma. In February 1993, she noticed edema of her distal phalanges, Raynaud's phenomenon in both hands, flu-like symptoms, fatigue, intermittent diarrhea, abdominal pain, tearing in both eyes, dyspnea on exertion, dysphagia, and odynophagia. Bilateral silicone-gel breast implants had been placed 12 years before; 2 months before her present evaluation, they were removed and found to be ruptured. Physical examination revealed edema, limited to the fingers and hands bilaterally, and slight induration of the skin on the dorsum of both hands and distal forearms. The remainder of the physical examination was normal. According to our study protocol, a skin biopsy specimen from the dorsum of the right hand was taken, but all other laboratory investigations were refused. Histopathologic examination revealed multiple clear spaces of varying sizes in the dermis and multinucleated macrophages containing small refractile particles, characteristic of silicone granuloma (Figs. 1 and 2); however, the specimen showed no evidence of scleroderma. X-ray energy dispersive analysis by scanning electron-microscopy confirmed the presence of elemental silicon in the small refractile particles. The patient did not receive any treatment after her diagnosis and shortly thereafter, she was lost to follow-up. |
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