Diagnosis and management of hypercalcemia associated with silicone-induced granuloma

SUMMARY Hypercalcemia associated with silicone-induced granuloma is a rare disease. Diagnosis can be tricky as it is established after ruling out other hypercalcemia-causing entities. In addition, management is customized depending on the patient's wishes and possible solutions. We present a male bodybuilder, in his thirties, with multiple silicone injections in his upper extremities, who developed hypercalcemia and urinary symptoms. Advanced laboratory tests ruled out various causes of hypercalcemia and CT imaging revealed nephrocalcinosis. A biopsy of the upper arm showed granulomatous tissue and inflammation. The patient necessitated two sessions of dialysis and corticosteroids were given to relieve symptoms and reverse laboratory abnormalities. Silicone-induced hypercalcemia should be on high alert because of the increasing trend of body contour enhancements with injections, implants and fillers. Treatment should be optimized depending on the patient's needs and condition.

RESUMO A hipercalcemia associada ao granuloma induzido por silicone é uma doença rara. O diagnóstico pode ser complicado, pois é estabelecido depois de eliminadas outras entidades que causam hipercalcemia. Além disso, o gerenciamento é personalizado, dependendo dos desejos do paciente e das possíveis soluções. Apresentamos um fisiculturista masculino, com trinta e poucos anos, múltiplas injeções de silicone nas extremidades superiores, que desenvolveu hipercalcemia e sintomas urinários. Testes laboratoriais avançados descartaram várias causas de hipercalcemia e a imagem da TC revelou nefrocalcinoses. Uma biópsia da parte superior mostrou tecido granulomatoso e inflamação. O paciente exigiu duas sessões de diálise e foram administrados corticosteroides para aliviar os sintomas e reverter as anormalidades laboratoriais. A hipercalcemia induzida por silicone deve estar em alerta elevado devido à crescente tendência de aprimoramentos do contorno corporal com injeções, implantes e enchimentos. O tratamento deve ser otimizado de acordo com as necessidades e condições do paciente.

Pencil-core granuloma

Abstract: Pencil core granulomas are still infrequently reported in the literature. A 67-year-old woman presented with a 4mm hard blue subcutaneous nodule on the forehead. She remembered being injured with a pencil tip about 60 years before. The subcutaneous nodule was excised, which microscopically revealed a foreign body reaction with histiocytes containing fragmented coarse black particles. We diagnosed pencil-core granuloma based on the patient's history of pencil tip injury and histological examination findings.

Complicação tardia de preenchimento cutâneo após facelift: relato de caso / Late complication of cutaneous filling after a facelift: a case report

Os autores apresentam o caso de uma paciente submetida 7 anos após aplicação de polimetilmetacrilato (PMMA) a um facelift com implante de prótese mentoniana, o qual evoluiu com granuloma por corpo estranho em região distante da aplicação do preenchimento. Após quase um ano de tratamento, a paciente evoluiu com resolução do caso.

The authors present the case of a patient who underwent a facelift with a chin implant 7 years after polymethylmethacrylate (PMMA) implantation, which evolved with foreign body granuloma in a region distant from the filling application. After nearly a year of treatment, the patient evolved with resolution of the granuloma.

Gestation and breastfeeding in schistosomotic mothers differently modulate the immune response of adult offspring to postnatal Schistosoma mansoni infection

Schistosoma mansoni antigens in the early life alter homologous and heterologous immunity during postnatal infections. We evaluate the immunity to parasite antigens and ovalbumin (OA) in adult mice born/suckled by schistosomotic mothers. Newborns were divided into: born (BIM), suckled (SIM) or born/suckled (BSIM) in schistosomotic mothers, and animals from noninfected mothers (control). When adults, the mice were infected and compared the hepatic granuloma size and cellularity. Some animals were OA + adjuvant immunised. We evaluated hypersensitivity reactions (HR), antibodies levels (IgG1/IgG2a) anti-soluble egg antigen and anti-soluble worm antigen preparation, and anti-OA, cytokine production, and CD4+FoxP3+T-cells by splenocytes. Compared to control group, BIM mice showed a greater quantity of granulomas and collagen deposition, whereas SIM and BSIM presented smaller granulomas. BSIM group exhibited the lowest levels of anti-parasite antibodies. For anti-OA immunity, immediate HR was suppressed in all groups, with greater intensity in SIM mice accompanied of the remarkable level of basal CD4+FoxP3+T-cells. BIM and SIM groups produced less interleukin (IL)-4 and interferon (IFN)-g. In BSIM, there was higher production of IL-10 and IFN-g, but lower levels of IL-4 and CD4+FoxP3+T-cells. Thus, pregnancy in schistosomotic mothers intensified hepatic fibrosis, whereas breastfeeding diminished granulomas in descendants. Separately, pregnancy and breastfeeding could suppress heterologous immunity; however, when combined, the responses could be partially restored in infected descendants.

Suture granuloma after orchiectomy: sonography, doppler and elastography features

ABSTRACTSuture granuloma is a mass forming benign lesion that develops at the site of surgery as a foreign body reaction to non-absorbable suture material. We present a case of suture granuloma that developed at the inguinal region after orchiectomy, and define the sonography, color Doppler sonography and real-time ultrasound elastography findings in correlation with the histopathological findings.

Rat subcutaneous tissue response to macrogranular porous anorganic bovine bone graft

The ideal bone graft must present biocompatibility, osteoconductive and osteoinductive properties, resistance and plasticity. Xenogenic grafts of bovine cancellous bone origin are particularly interesting due to their biologically designed porous structure that enhance both cellular and vascular invasion. The purpose of this study was to evaluate the tissue response induced by bovine macrogranular porous anorganic bone implanted in rat subcutaneous tissue. Forty rats were assigned to 2 groups, as follows: the control group received empty collagen capsules and the test group received subcutaneous implants of the test material. Samples were collected after 10, 20, 30 and 60 days and processed histologically. Histological analysis showed at 10 days a granulomatous inflammatory infiltrate, rich in multinucleated giant cells and free of lymphocytes or plasma cells, similarly to mineralized allograft implanted in rat subcutaneous. In later periods, there was a significant decrease in the inflammatory infiltrate and an increase in fibrosis around graft particles. In conclusion, the test material induced a foreign body-type granuloma with subsequent fibrosis around the graft particles implanted in rat subcutaneous and did not elicit any immune response, thus being considered biocompatible.

O enxerto ósseo ideal deve possuir características como biocompatibilidade, capacidade osteocondutora, osteoindutora, resistência e plasticidade. Dentre os implantes xenogênicos de origem bovina, os produzidos com o osso esponjoso revestem-se de particular interesse devido a sua arquitetura constituída de poros biologicamente desenhados que favorecem a invasão celular e vascular até o centro do defeito. O objetivo deste estudo foi avaliar a resposta tecidual ao material de osso inorgânico medular bovino macrogranular. Quarenta ratos foram divididos em 2 grupos (n=20): o grupo controle recebeu cápsulas de colágeno vazias, e o grupo experimental recebeu implante subcutâneo do material teste. As amostras foram coletadas após 10, 20, 30 e 60 dias de implantação e processadas histotecnicamente. A análise histológica mostrou aos 10 dias pós-cirúrgicos que o infiltrado inflamatório era do tipo granulomatoso rico em células gigantes multinucleadas, mas livre de linfócitos ou plasmócitos, quadro similar ao observado para aloenxertos mineralizados implantados em subcutâneo de ratos. Com o avançar do tempo experimental houve significante diminuição do infiltrado inflamatório inicial concomitantemente ao aumento no grau de fibrosamento ao redor das partículas implantadas. Concluiu-se que o material de enxerto testado em tecido conjuntivo subcutâneo de ratos induziu um granuloma tipo corpo estranho e fibrose ao redor das partículas implantadas, resposta semelhante do mesmo tecido aos aloenxertos mineralizados, e não desencadeou nenhuma resposta imune, sendo portanto biocompatível.

Correlaçäo anátomo-clínica: granulomatose sistêmica por talco em drogadicto HIV negativo / Systemic talc granulomatosis in a HIV-negative intravenous drug addict

É descrita a correlação anatomopatológica de um paciente usuário de drogas injetáveis com talcose sistêmica acometendo pulmões, pleuras, fígado, baço e linfonodos e que desenvolveu hipertensão arterial pulmonar e cor pulmonale. Destaca-se o fato de que apesar do uso crônico de drogas injetáveis e outros comportamentos de alto risco para infecção pelo retrovírus, o paciente era HIV negativo, não apresentava linfocitopenia, nem alterações histopatológicas compatíveis com AIDS à necropsia.

Tumor hepático por reacción a cuerpo extraño / Hepatic tumor by foreign body reaction

Entre los tumores hepáticos benignos se encuentra el granuloma hepático secundario a reacción por cuerpo extraño que puede ser provocado por agentes como el talco, almidón y materiales de sutura entre otros. Se presenta el,caso de un paciente de 34 años con antecedentes de traumatismo toracoabdominal que presenta, a los 5 años de evolución, dolor abdominal y baja de peso, evidenciándose en estudio por imágenes un tumor hepático sólido único. Se reseca quirúrgicamente, encontrándose en el examen histopatológico una lesión inflamatoria extensa con granulomas de tipo cuerpo extraño

Aspectos radiológico e ecográfico do silicone líquido injetado nas mamas / Radiologic and echographic aspects of liquid silicone injected in the breast

É relatado um caso de paciente de 45 anos de idade com silicone líquido injetado nas mamas. Säo descritos os aspectos radiológico, ecográfico e anatomopatológico do quadro, e comentam-se as complicaçöes clínicas e dificuldades desses exames na detecçäo de lesöes malignas

Granuloma de colesterol: enfoque diagnóstico y terapéutico actual / Cholesterol granuloma: present diagnostic and therapeutic approach

El granuloma de colesterol es una patología benigna poco frecuente, esta puede presentar comportamiento bastante agresivo si no es diagnosticada y tratada a tiempo. El diagnóstico es más precoz en las lesiones intratimpánicas ya que presentan cambios precoces a la otoscopia y audiometría, por compromiso de la cadena. A diferencia de la anterior la lesión en mastoides tiende a diagnosticarse más tardíamente, con cuadros clínicos muy polimorfos y normalmente se confunden con síntomas de otras patología concominantes. Para realizar un buen diagnóstico es esencial un TC que mostrará la lesión, para poder diferenciarlo de otras patologías de oído medio se recomienda el uso de RNM ya que estas lesiones tienen características especiales a la RNM. La audiometría si bien no es útil en el diagnóstico, sirve al momento de la decisión terapéutica y al decidir el abordaje quirúrgico a utilizar. En este trabajo además se presentan 2 casos clínicos que ejemplifican lo polimorfo que pueden ser estos cuadros y diferentes evoluciones que pueden presentar

Petrous apex region. Surgical anatomy, lesions, and operative techniques

The author describes the anatomy of the region of the petrous apex giving emphasis to the limits of surgical resection. The cochlea, located at the apex of the angle formed by the intersection of a line along the sphenopetrosal groove and a line from the facial hiatus to the internal auditory canal, has to be protected to preserve hearing. Surgical approaches can be divided in the posterior presigmoid approach that provides exposure to the posterior petrous bone and upper two thirds of the clivus, and the anterior subtemporal approach that provides exposure to the trigeminal ganglion, petrous carotid artery, Meckel's cave, and posterior cavernous sinus. Opening of Meckel's cave provides additional space for medial and inferior resection of the petrous apex. Two illustrative cases of primary petrous apex lesions are presented to demonstrate the surgical exposure obtained with each approach