The "autoimmune/inflammatory syndrome induced by adjuvants" (ASIA) after COVID-19 infection: A case report.

The term "autoimmune/inflammatory syndrome induced by adjuvants" (ASIA) describes a variety of autoimmune conditions triggered by exposure to substances with adjuvant activity. We present the case of a patient with a history of biopolymer infiltration in both glutes, who years later experienced progressive weakness and pain in the lower limbs, myalgias, cramps, and progressive functional impotence following a mild COVID-19 infection. Laboratory test results were not consistent with any autoimmune disease. Physical examination revealed diffuse bilateral subcutaneous nodules. After an extensive etiological study, a gluteal biopsy was performed, which showed findings compatible with sclerosing lipogranuloma. Our patient required treatment with high-dose glucocorticoids and showed significant improvement in symptoms during long-term follow-up. We suggest the role of COVID-19 infection as a possible trigger for ASIA, as it has already been described as a trigger for several other autoimmune diseases.

Ultrasonographic features of intestinal lipogranulomatous lymphangitis in 10 dogs.

Intestinal lipogranulomatous lymphangitis (ILL) is a granulomatous inflammation of the lymphatic vessels of the intestinal wall and mesentery characterized by lipogranulomas. The purpose of this retrospective, multi-center, case series study is to report the ultrasonographic features of canine ILL. Ten dogs with a histologically confirmed ILL undergoing preoperative abdominal ultrasound were retrospectively included. Additional CT was available in two cases. Lesion distribution was focal in eight dogs and multifocal in two. All dogs presented with intestinal wall thickening and two had a concomitant mesenteric mass adjacent to the intestinal lesion. All lesions were in the small intestine. Ultrasonographic features were altered wall layering with predominantly muscular and to a lesser extent submucosal layer thickening. Other findings included hyperechoic nodular tissue within the muscular, serosa/subserosal, and mucosal layers, hyperechoic perilesional mesentery, enlarged submucosal blood/lymphatic vessels, mild peritoneal effusion, intestinal corrugation, and mild lymphadenomegaly. The two intestinal to mesenteric masses presented heterogeneous echostructure, predominantly hyperechoic with multiple hypo/anechoic cavitations filled with mixed fluid and fat attenuation content on CT. Histopathological findings included lymphangiectasia, granulomatous inflammation, and structured lipogranulomas affecting mainly submucosa, muscularis, and serosa. The intestinal to mesenteric cavitary masses revealed severe granulomatous peritonitis with steatonecrosis. In conclusion, ILL should be considered as a differential diagnosis for dogs with this combination of ultrasonographic features.

Focal Lipogranuloma Inflammation: A Case Report of the Lung Origin.

INTRODUCTION: Limited experience exists regarding the clinical features of focal lipogranuloma inflammation of the lung, and there are no supporting guidelines for the diagnostic approach. CASE DESCRIPTION: We present the case of a 20-year-old man who was found to have a pulmonary nodule with a smooth margin during a health examination. He underwent wedge resection of the left lower lung to achieve a tissue diagnosis; this showed focal lipogranuloma inflammation of the lung. CONCLUSION: In this report, we combined imaging and pathological findings to reach the diagnosis, with a view to assisting clinicians in navigating this challenging clinical situation.

Liquid vitamin E injection for cosmetic facial rejuvenation: A disaster report of lipogranuloma.

BACKGROUND: The use of vitamin E for Facial rejuvenation is a dangerous practice and is associated with potential local, and sometimes systemic and life-threatening complications. Clinicians should be aware of complications induced by the injection of illegal products for tissue augmentation. Also, regulatory organizations should monitor illegal beauty centers and enact restrictive laws. CASE PRESENTATION: Herein, we report a case of liquid vitamin E injection for cosmetic facial rejuvenation and development of facial persistent erythema and induration, treated with oral prednisolone, azathioprine, and minocycline. Also, we review the reported cases of vitamin E injection for cosmetic facial rejuvenation. CONCLUSION: Lipogranuloma is one of those complications of vitamin E injection for cosmetic rejuvenation. It mostly represents inflammation, edema, erythema, and tenderness. Since there was no standard treatment for this complication, the management of these patients is challenging. Patients who have undergone cosmetic interventions in illegal institutions are more likely to develop such complications including medical and psychological problems. Clinicians should be aware of these complications for the best diagnosis and treatment.

Penile paraffinoma: a case report.

Penile paraffinoma or sclerosing lipogranuloma is a disease occurring uncommonly in Czechia; a pathologist meets this only rarely. Microscopically, we deal with chronic fibroproductive inflammation localised usually in subcutaneous tissue of the penis. It is caused by previous voluntary injection of liquid paraffin / mineral oil for the purpose of penis circumference augmentation, usually performed by a non-healthcare person or by the patient himself. Human tissues do not have enzymes that can break down synthetic lipids. The application leads, with a variable time lag, to a foreign body giant-cell reaction lasting for years, and often to annoying complications frequently associated with a genital mutilation and sexual dysfunction. The lesion often requires surgical treatment to remove the paraffin substance from the subcutaneous tissue. The surgery does not always lead to satisfying results and the paraffinoma tends to recur. In this article, we describe a case of a man with relapsing paraffinoma, which required excision of subcutis with subsequent plastic surgery with skin graft. During histological examination, lipid droplets were found in dermis and in subcutis, along with xantogranulomatous inflammation. The lipid nature of the material was proven by oil red and Sudan stain. The paper includes clinical and histopathological differential diagnostic consideration, summary of treatment options and relevant literature review.

Idiopathic Lipogranulomatous Orbital Inflammation: A Case Report and Literature Review.

A 57-year old woman presented with a 6-month history of a left red eye associated with diplopia. Examination was remarkable for 2 mm left-sided axial proptosis and restriction on left upgaze and abduction associated with diplopia. She had no previous history of trauma or surgery to the face. Magnetic resonance imaging revealed an enhancing infiltrative mass in the left intraconal space. Biopsy of the anterior orbital fat revealed extensive lipogranulomatous inflammation with no abnormalities noted on flow cytometry, culture, or special stains. The patient was managed with a tapering course of oral prednisolone and two 40 mg intraorbital triamcinolone injections resulting in complete resolution of her presenting symptoms. This represents a rare case of idiopathic lipogranulomatous orbital inflammation.

Relevance of animal studies in the toxicological assessment of oil and wax hydrocarbons. Solving the puzzle for a new outlook in risk assessment.

Paraffin waxes and white mineral oils are distinct petroleum products separated from a common feedstock by crystallization, where only n-alkanes, iso- and cyclo-alkanes with a linear backbone of ∼ 20 carbon atoms long, selectively crystalize out from the oil to form the wax, which is solid at room temperature, whereas oils remain liquid. Up until the 90's, these differences were reflected in separated regulatory assessments. A paradigm shift occurred when Fischer 344 rats (F-344) developed liver epithelioid granuloma following exposure to low and medium viscosity oils or waxes. This lesion was used as common denominator between these products to be jointly assessed under the common term "mineral hydrocarbons - MHC", obviating compositional differences. This regulatory paradigm dominated for the next 30 years, exacerbated by the EFSA 2012 evaluation using the analytical term "MOSH" (mineral oil saturated hydrocarbons) which encompassed these products under single chromatography fraction. The reconstruction of historical developments, together with recent EFSA-sponsored studies of toxicity and accumulation and supporting literature, has allowed us to understand the etiology of the F-344 rat hepatic epithelioid granuloma, which is presented in an adverse outcome pathway (AOP). Considering chemical composition, it clearly demonstrates that the hepatic effects in F-344 rats caused by linear alkanes of waxes are irrelevant for humans. Waxes are thus not MOSH and should thus be evaluated on their own merit. The term MOSH should not include n-alkanes and be exclusively used to mineral oil fractions when considering their chemical makeup for a relevant human hazard assessment.

Staged penile skin reconstruction for sclerosing lipogranuloma / A hímvesszo borének helyreállítása szklerotizáló lipogranuloma okozta deformitás miatt.

Összefoglaló. Bevezetés: A hímtag körméretének növelése érdekében, az annak bore alá bejuttatott zsírnemu anyag szklerotizáló lipogranulomát okoz. Hazánkban a szklerotizáló lipogranuloma okozta hímvesszo-deformitások kezelésének legelterjedtebb módszere a két ülésben végzett borpótlás. Ennek ellenére a magyar nyelvu szakirodalomban kevés adat áll rendelkezésre a kétüléses mutét eredményességérol és várható szövodményeirol. Célkituzés: Tanulmányunkban a szklerotizáló lipogranuloma okozta deformitások miatti - két ülésben végzett - hímvesszobor-helyreállítással szerzett tapasztalatainkról, a mutét után kialakuló szövodményekrol számolunk be retrospektív adatgyujtés alapján. Módszer: 2008. március 1. és 2020. március 1. között a Debreceni Egyetem Urológiai Klinikáján 17 betegen végeztünk kétüléses hímvesszobor-helyreállító mutétet. A szklerotizáló lipogranuloma által érintett bort teljes mértékben eltávolítottuk, majd a lecsupaszított hímtagot a herezacskó elülso felszínén kialakított subcutan csatornába helyeztük. A második ülés során a herezacskó bore alá ültetett hímvesszot felszabadítottuk. Eredmények: A Clavien-Dindo-beosztás szerint az elso ülés után három, a második ülés után egy I. gradusú szövodmény alakult ki; II-V. gradusú szövodményt nem figyeltünk meg. Azon 9 beteg közül, akik mindkét ülésen átestek, 7 beteg elégedett volt a beavatkozás eredményével, 2 beteg korrekciós mutéten esett át fél és 9 évvel a második ülés után. A 8 beteg közül, akik csak ez elso ülést vállalták, egy korrekciós mutét történt 4 hónappal a mutét után. Következtetés: A hímvesszo szklerotizáló lipogranulomája esetén az érintett borterület kimetszése után hímvesszobor-helyreállítás szükséges. A herezacskó-borlebeny alkalmazásának elonye, hogy a herezacskó színe és elaszticitása a hímvesszoboréhez hasonló, a tapintás- és erogén érzet megmarad. A kétüléses hímvesszobor-helyreállítás kevés szövodménnyel, plasztikai sebészeti jártasság nélkül elvégezheto. Orv Hetil. 2021; 162(35): 1413-1417. INTRODUCTION: Subcutaneous injection of liquid fatty materials to enhance penile girth induce sclerosing lipogranuloma of the penis. In spite of its well known severe consequences there has been a persistent use of this practice in non-medical circumstances. OBJECTIVE: The aim of this paper is to present our observations with staged penile skin reconstruction for sclerosing lipogranuloma and to evaluate postoperative complications in a retrospective manner. METHOD: Between 2008 and 2020, 17 patients underwent surgery to treat sclerosing lipogranuloma of the penis by staged penile skin reconstruction at our department. Complete exscision of the involved tissue was performed, then the denuded penile shaft was inserted into a subcutaneous channel on the anterior side of the scrotum during the first stage. The second stage of reconstruction consisted of releasing the penile shaft from the scrotum. The second stage was performed merely on 9 in 17 patients. RESULTS: According to the Clavien-Dindo classification system, 3 grade I and 1 grade I complications occurred in the postoperative period after the first and second stage, respectively. Grade II-V complications were not observed. 7 of 9 patients who underwent both stages were satisfied with the final result, 2 patients had minor correction surgery 6 months and 9 years following the second stage. 1 of 8 patients who underwent only the first stage had minor correction surgery 4 months following the operation. CONCLUSION: In case of sclerosing lipogranuloma of the penis, excision of the affected tissue and reconstruction of the penile skin are indicated. Advantages of using scrotal skin flaps are that colour and elasticity of the scrotal skin are similar to penile skin, erogenous sensation of the scrotal flap remains intact. Applying staged penile skin reconstruction with scrotal skin flap has the advantage of few postoperative complications and it is easy to perform. Orv Hetil. 2021; 162(35): 1413-1417.

Lipogranuloma Esclerosante Escrotal Primario. Reporte de caso y revisión de la literatura / Primary Scrotal Sclerosing Lipogranuloma. Case report and literature review

RESUMEN El lipogranuloma esclerosante es una condición extraña y benigna que puede afectar cualquier órgano, especialmente los genitales externos masculinos. Se suele presentar como masas subcutáneas en escroto, periné y pene. Aunque la mayoría de los casos son secundarios a aplicación de cuerpos extraños como parafina, vaselina o silicona con propósitos estéticos para aumentar el tamaño del pene, también puede deberse a degeneración lipídica endógena, secundaria a trauma, infecciones o reacciones alérgicas. No existe consenso en cuanto a su manejo ni datos sobre su prevalencia al ser una entidad poco reportada; se ha descrito el manejo con ciclos cortos de corticoides sistémicos, y cirugía en los casos recidivantes. El objetivo de este trabajo es reportar el caso de un paciente que acudió con induración y eritema en pene y escroto, quien negaba la aplicación de sustancias exógenas y que fue llevado a biopsia de la lesión, con diagnóstico de lipogranuloma esclerosante. MÉD.UIS.2021;34(2): 97-102.

ABSTRACT Sclerosing lipogranuloma is a noncommon and benign disease that could affect any system in the body, especially the male external genitalia. It is usually presented as a subcutaneous mass in scrotum, perineum and penis. Although, most cases are secondary to the injection of foreign bodies such as paraffin, petrolatum or silicone for cosmetic purposes to increase penis size, it could also be due to endogenous lipid degeneration, secondary to trauma, infections or allergic reactions. There is no unanimity regarding its management or data on its prevalence as it is a poorly reported entity. Management with short cycles of systemic corticosteroids and surgery in relapsing cases have been described. The purpose of this article is to present a case of a patient with induration and erythema in penis and scrotum, who denied the application of exogenous substances and has a reported biopsy of the lesion with diagnosis of sclerosing lipogranuloma. MÉD.UIS.2021;34(2): 97-102.

Carbol fuchsin stain enhances detection of poly-(d, l-lactide-co-glycolide) microspheres in exenatide extended-release cutaneous injection-site foreign body reaction.

Injection of high-viscosity fluids into subcutaneous tissues may lead to a granulomatous reaction called sclerosing lipogranuloma (SL). Poly-(d,l-lactide-co-glycolide) (PLG or PLGA) microspheres are used as vehicles for extended-release drugs. Here we describe the histopathologic features of a case of SL induced by exenatide extended-release injections, and the staining pattern of PLG microspheres and microsphere remnants with carbol fuchsin.

Sclerosing lipogranuloma of the penis: a narrative review of complications and treatment.

OBJECTIVE: Sclerosing lipogranuloma of the penis is a relatively rare disorder associated with injection of illicit foreign materials for penile augmentation. We aim to report the clinical presentation, diagnosis, treatment, and outcomes of patients with this condition, and to review the most relevant literature currently available. BACKGROUND: Injection of mineral oil into the subcutaneous tissues of the penis for augmentation has been practiced since ancient times. The potential for complications has long been known, and most doctors have abandoned the procedure. However, it is still practiced in some parts of the world. The complications may be devastating including death from embolism or sepsis. The affected area may not be restricted to the injection site, potentially involving the scrotal and suprapubic areas. Surgery with complete removal of the involved tissue followed by covering the denuded area with a graft or skin flap is the best therapeutic option. METHODS: The literature search involved keywords such as penis, augmentation, enlargement, sclerosing, lipogranuloma, penile injection, paraffinoma, and was obtained from computerized search of databases such as PubMed, Google Search and Scopus. Personal experience of the lead author (BS) is also described. We tried arbitrarily to limit our search to articles including ≥5 patients pertaining to the subject of our review and, therefore, excluded single case reports. However, a single systematic search of PubMed and Scopus was also found and included. CONCLUSIONS: The treatment of choice is radical excision of all the lesions followed by skin grafting. Bearing in mind that prospective, randomized, controlled studies are considered difficult to carry out, further work will continue apparently to be based on case series by individual surgeons. It is critical to advise patients to separate the myths from the facts and use preventive measures through awareness and education to best minimize the downsides of this problem.

Obstructive lower urinary tract symptoms (LUTS) as the initial presentation of penile paraffinoma: a case report and literature review.

Penile paraffinoma is a rare condition after penile injection of liquid paraffin or other mineral oils, with well-documented debilitating complications. Nevertheless, such injections are still performed by people of Eastern European and Asian descent for cosmetic penile augmentation. We report a case of penile paraffinoma in an otherwise healthy, 30-year-old male, with obstructive lower urinary tract symptoms (LUTS) as the sole complaint at presentation in the emergency department and a conservative approach. This case report describes an unusual presentation of penile paraffinoma in a young man and aims to raise public and physician awareness regarding disease manifestation to prevent high morbidity from delayed diagnosis and treatment.

Cytologic Features of Lipogranulomatous Reaction in an Axillary Sentinel Lymph Node.

INTRODUCTION: Multinucleated giant cells (MGC) are a rare finding when evaluating axillary sentinel lymph nodes. Some are described as foreign body-type MGC accompanied by foamy macrophages. They have been rarely reported in nodes from patients in which a previous breast biopsy was performed. The tissue damage induced by biopsy results in secondary changes including fat necrosis and hemorrhage that can migrate to axillary nodes. In this report, we illustrate a lipogranulomatous reaction in cytologic samples obtained during a sentinel lymph node examination of a woman previously biopsied because of breast carcinoma. We have found no previous cytologic descriptions and consider it an interesting finding that should be known to avoid diagnostic misinterpretations. CASE: A 51-year-old woman underwent mastectomy of the right breast with a sentinel lymph node biopsy at our medical center. One month before, a control mammography revealed suspicious microcalcifications and a vacuum-assisted breast biopsy resulted in a diagnosis of high-grade intraductal carcinoma with comedonecrosis. Surgery with a sentinel lymph node biopsy was performed. The sentinel node was processed as an intraoperative consultation. Frozen sections and air-dried Diff-Quik stained samples were obtained. They showed abundant lymphocytes with MGC and tumoral cells. MGC showed ample cytoplasm with evident vacuoles of variable size. Occasional hemosiderin-laden macrophages were also present. The complete histologic analysis and immunohistochemical studies revealed no malignant cells. Histologic analysis showed, in subcapsular location, occasional MGC phagocyting lipid droplets. Hemosiderin-laden macrophages were a common finding. CONCLUSION: Lipogranulomas may appear at axillary sentinel lymph nodes because of fat necrosis induced by previous breast biopsy. The most important consideration is not confounding MGC with epithelial cell clusters. This can occur with not well-processed samples, especially if unmounted.

The bilateral scrotal flap: Anatomical study and it's use for the management of inflammatory granulomas following custom-made injections.

INTRODUCTION: The management of 10 cases of penile inflammatory granulomas following a subcutaneous injection of non-absorbable substance for the purpose of penile augmentation is presented. We subsequently used the bilateral scrotal flaps to cover the post-excision skin defect. A simple decision aid chart outlining the management of penile foreign body injections is proposed. METHODS: A total of 10 patients were included in this study. All required surgical management by penile degloving, followed by complete excision of the inflammatory granuloma and overlying skin. The dissection of 14 cadavers was carried out to study the blood supply to the anterior scrotal flap. Penile reconstruction was then performed using a bilateral scrotal flap in all but two cases. Post-operatively, the patients were followed up for a 1 year period. RESULTS: We obtained good results in terms of the aesthetic outcome with all of our ten patients with the area covered having similar color to penile skin. There were no major post-operative complications. There were two minor complications involving wound healing. Sensory function was maintained and no penile shortening or curvatures were noted, in addition all patients were satisfied with both the shape and function of the penis. CONCLUSION: Although much rarer, penile augmentation related complications are still seen in western countries. The treating doctor should be aware of its management. We had achieved acceptable outcomes in our experience with the bilateral scrotal flap. We believe it is a good and simple option for soft tissue coverage of the penis in cases following the complete inflammatory granuloma excision. It can achieve satisfactory aesthetic and functional results for this group of patients.

Periorbital lipogranuloma after facial injection of autologous fat: A retrospective study of 18 cases.

OBJECTIVE: To investigate the clinical features of patients who develop periorbital lipogranuloma after injection of autologous fat. METHODS: This retrospective case series included 18 patients who developed a periorbital mass or swelling after undergoing injection of autologous fat for facial augmentation. The patients' medical records were reviewed for clinical history, radiologic findings, and treatment outcomes. RESULTS: All patients were women aged 24 to 50 years (mean, 31.6 years). Five patients (27.8%) involved both orbits. Presenting eye symptoms were a palpable mass (61.1%), eyelid swelling (44.4%), and ptosis (16.7%). The interval between the final injection and onset of eye symptoms ranged from 1 to 36 months (mean, 11.5 months). Thirteen patients underwent radiologic imaging. Fifteen patients received only one injection of autologous fat and three received two injections with the cryopreserved fat used in the second injection. Surgical excision was performed in 12 patients to remove the mass and identify the pathologic abnormalities. No recurrence was found during 1 year of follow-up. Two of the six patients who had refused treatment showed spontaneous resolution at the 6-month visit. CONCLUSION: Periorbital lipogranuloma after facial injection of autologous fat should be considered as a specific orbital disease entity for which MRI is an effective examination method. Surgery is warranted for this condition when conservative treatment is ineffective.

[Penile paraffinoma-Treatment strategies]. / Penile Paraffinome ­ therapeutische Strategien.

BACKGROUND: Penile paraffinomas are a consequence of an injection of mineral oils for augmentation. As an result of the foreign body reaction local complications regularly occur, which require a plastic reconstructive intervention. So far 8 cases have been treated in our clinic over the last 20 years. OBJECTIVE: Presentation of the operative treatment techniques for penile paraffinoma as well as the indications and complications. MATERIAL AND METHODS: After reviewing the relevant literature, we analyzed the data of our own patient cohort. Since 1999 a total of 8 patients with lipogranuloma underwent surgical treatment at the St. Antonius Hospital in Eschweiler. RESULTS: The choice of a plastic reconstructive treatment depends on the extent of the paraffinoma. If it is limited to the foreskin, a radical circumcision is sufficient but if it extends to the skin of the penile shaft, a plastic defect coverage with a mesh graft, a full skin graft or a scrotal skin flap is required. In cases with additional pathologies, such as urethral fistulas, auxiliary reconstructive procedures should be performed. CONCLUSION: For optimal cosmetic and functional results, the surgeon must master a broad spectrum of plastic reconstructive techniques. In selected complex cases an interdisciplinary approach consisting of urologists and plastic surgeons can be necessary.

An uncommon lymphoma mimic: lipogranulomas.

A lipogranuloma is a complication of injecting exogenous oily composites, forming a nodule composed of foreign body histiocytes. These may be seen in the setting of use of anabolic steroids. We present a case of a 52-year-old male with rapidly growing intramuscular masses with accompanying lymphadenopathy and constitutional symptoms. A diagnosis of lymphoma was initially made in view of the multifocal nature of his disease. CT and PET/CT scans were used to profile the extent of disease. However, US-guided biopsy samples demonstrated acute-on-chronic fibro-inflammatory connective tissue, but no evidence of malignancy. A follow-up CT scan showed resolution of most of these masses. Subsequently, a history of self-injected anabolic steroids was obtained. Familiarity of imaging characteristics of lipogranuloma may be helpful in avoiding the pitfall of misdiagnosis in this clinical setting.

Complications Associated with Fat Grafting to the Lower Eyelid.

Fat grafting is effectively used in the lower eyelid and periorbital area for rejuvenation of the aging face. Several complications may occur with fat grafting, including volume undercorrection or overcorrection, contour irregularities, prolonged bruising and swelling, infection, granulomas and inflammation, and vascular embolization with visual loss or stroke. In many cases, complications can be effectively treated, although permanent and serious injury can occur. Appropriate surgical techniques help to prevent most of these complications. An understanding of how and why complications of fat grafting of the lower eyelid occur aids in the avoidance and treatment of these complications.

Retroperitoneal lipogranuloma mimicking recurrence of renal cell carcinoma after laparoscopic partial nephrectomy.

Lipogranuloma is a rare inflammatory reactive process often reported to occur in the dermis and subcutis in the cosmetic surgery field.1 It very rarely occurs in the retroperitoneum. We present a case of retroperitoneal lipogranuloma mimicking metastases of renal cell carcinoma (RCC) after laparoscopic partial nephrectomy. A 63-year-old man who underwent laparoscopic left partial nephrectomy for RCC one year earlier had developed a left retroperitoneal tumor during postoperative surveillance. The tumor looked identical to an implant or recurrence of RCC on contrast-enhanced computed tomography (CT) and 18F-fluorodeoxyglucose positron emission tomography/CT. We resected the tumor, and pathology showed a lipogranuloma.