Cerebral foreign body granulomas after mechanical thrombectomy: Two case reports and a review of the literature.

OBJECTIVES: A foreign body granuloma after an endovascular intervention is a rare complication. Some cases of foreign body granulomas, especially after coil embolization, have been reported. However, only four cases of foreign body granulomas after mechanical thrombectomy (MT) have previously been reported. The current study reports two cases of post-MT foreign body granulomas, including a biopsy-proven case. MATERIAL AND METHODS: Case 1: A 73-year-old woman presented with complete occlusion of the right middle cerebral artery. Cerebral angiography and MT were successfully performed with improvement in clinical symptoms. Left hemiparesis and a disturbance in attention appeared after discharge and progressed slowly. She was re-admitted to our hospital 120 days after cerebral infarction owing to foreign body granulomas diagnosed on biopsy. Case 2: A 78-year-old man presented with occlusion of the left cervical internal carotid artery and the left middle cerebral artery. Cerebral angiography, percutaneous transluminal angioplasty, and MT were successfully performed. On the 34th day, he experienced progressive consciousness disorder because of foreign body granulomas. Both cases were successfully treated with steroid therapy. RESULTS: MRI after steroid treatment showed the disappearance of most nodular lesions and improvement of the encephalopathy. CONCLUSIONS: The cause of the granuloma may be an allergic reaction to the hydrophilic polymers that peel from endovascular devices. Steroid therapy is an effective treatment; therefore, neurologists should consider this complication when neurological symptoms or signs on image appears or worsens. A reliable diagnosis is important for prompt treatment.

Novel management of granuloma formation secondary to dermal filler: A multi-modality approach.

BACKGROUND: Dermal fillers for soft tissue augmentation have become increasingly popular among patients of all ages and ethnicities. With more widespread use, there has been an increased incidence of adverse reactions, one of which is the granulomatous foreign body reaction (GFBR). MATERIALS & METHODS: We present a three patient case series in which GFBR secondary to dermal filler was successfully treated with a multi-leveled approach. The first modality involves intralesional injection of a mixture containing 1 cc of 5-fluorouracil (5-FU), 0.5 cc of dexamethasone sodium phosphate, and 0.1 cc of triamcinolone 10. The lesion is injected intradermally in small aliquots, similar to scar treatment. The patient then takes colchicine 1.2 mg loading dose on day 1, then 0.6 mg twice per day for 4 days concurrently with naproxen 500 mg orally once daily for 5-7 days. This process may be repeated in 6 weeks if the lesions have not resolved and PDL laser may be employed for residual post-inflammatory erythema. RESULTS: All three patients presented in this case series had significant aesthetic improvement in their dermal filler-derived foreign body granulomatous reactions. CONCLUSION: GFBR provides both a medical and aesthetic issue for these patients including mental distress, pain, and dysfunction, therefore having an effective treatment for GFBR will affect medical management of these patients, improving patient outcomes and satisfaction. Our proposed regimen for GFBR has been shown to be highly efficacious and safe for these patients, providing a significant improvement in both function and cosmesis of the area.

Fine-Needle Aspiration Cytology in the Diagnosis of Breast Paraffinoma.

INTRODUCTION: Paraffin injections for breast augmentation once a popular form of mammoplasty are now considered obsolete. It had been abandoned by clinicians because of its associated serious complications. The practice is however still available and is being practiced by nonmedically qualified people. Paraffin injection results in the formation of multiple foreign-body granulomas known as breast paraffinoma. The clinical features of breast paraffinoma can mimic and be mistaken for breast carcinoma or inflammatory breast carcinoma. The use of fine-needle aspiration cytology (FNAC) in the evaluation of patients with breast paraffinoma has not been fully evaluated. METHODS: Retrospective review was performed on 30 patients who presented with breast paraffinoma between June 1, 2010, and June 30, 2020, who also had FNAC as part of their breast lump evaluation. RESULTS: FNAC of 73.3% patients showed multinucleated giant cells and macrophages or histiocytes containing engulfed clear, empty intracytoplasmic vacuoles of varying sizes. In 13.3% of the patients, macrophages or histiocytes with engulfed clear intracytoplasmic vacuoles of varying sizes were seen. In 6.7% of patients, multinucleated giant cells containing engulfed vacuoles of varying sizes were seen, and in 6.7% of patients, hypocellular smears with large amount of clear spaces were seen. Oily droplets were seen in the background of all the smears, and there were no malignant cells seen. These features were compatible with breast paraffinoma. CONCLUSION: Most patients with breast paraffinoma can be managed conservatively and they do not require further treatment; FNAC with its characteristic features can provide the reliable diagnosis of breast paraffinoma and therefore sparing these patients from more invasive diagnostic procedures.

Foreign body granuloma around implantable pulse generator for deep brain stimulation: Two case reports.

We report two cases of granuloma that occurred around an implantable pulse generator (IPG) for deep brain stimulation. Both cases showed no signs of infection and disappeared after moving the IPG and removing the granulation. If a noninfectious mass is formed, the relocation of IPG may improve it.

Delayed-onset granulomatous reaction presenting as chronic facial edema: a review of the diagnostic and therapeutic challenges.

Injection of soft tissue fillers for esthetic purposes is considered a relatively simple, minimally invasive procedure. Although rare, significant complications exist and may occur in the setting of both non-medical grade and medical-grade silicone fillers, administered by untrained or trained providers. We report a case of a 61 y/o male with an unusual case of foreign body granulomas arising on his forehead and periorbital region for the past 3 years. He had no drug allergies or history of trauma. He only recalled administration of "Botox" near the affected area 20 years ago, although he acknowledged being unsure of the nature of the substance. Examination showed bilateral, periorbital, edematous plaques, with subcutaneous nodules on the forehead. Punch biopsy showed multiple vacuoles surrounded by collagen bundles in the dermis, a histiocytic infiltrate, and multinucleated giant cells. Based on clinicopathological correlation, a diagnosis of foreign body granuloma related to silicone filler injections was made. He was treated with intralesional steroids and doxycycline 100 mg twice daily with complete resolution. Physicians should acknowledge this potential complication of silicone fillers and should inquire about their use with close-ended questions. We also review the diagnostic and therapeutic challenges faced by physicians when encountering this diagnosis.

Delayed Acute Granulomatous Anterior Uveitis after Inadvertent Intraocular Injection of Tattoo Ink from a Scleral Tattoo Procedure.

Purpose: To improve awareness of delayed onset uveitis in patients with a history of intraocular tattoo ink injection.Results: A 47-year-old man underwent a scleral tattoo procedure during which there was inadvertent intraocular injection of tattoo ink into his right eye. He subsequently developed endophthalmitis, retinal detachment, and retinal necrosis. He was treated with intravitreal and oral antibiotics and underwent vitreoretinal surgical intervention. A vitreous specimen was obtained and demonstrated significantly elevated levels of several heavy metals. One month later, he developed an acute granulomatous anterior uveitis in the same eye that was managed with a combination of topical and perioperative intravitreal, intravenous, and oral corticosteroids.Conclusion: This case highlights the importance of monitoring patients with a history of intraocular tattoo ink injection for delayed onset uveitis in addition to retinal toxicity.

Foreign body granuloma treatment with 22-MHz ultrasound-guided corticoid infiltration.

Intralesional corticoid infiltration guided by 22-MHz ultrasound is a new, noninvasive, and safe dermatological method for the treatment of foreign body granuloma. The great advantage of the procedure is that the medication is delivered straight to the desired target, preventing adverse treatment effects in noninjured areas.

Differentiating Nonpermanent Injectable Fillers: Prevention and Treatment of Filler Complications.

Though the incidence of complications and adverse events with dermatological fillers is inherently low, practitioners should be well versed in both prevention of filler complications and the treatment algorithms for addressing "granulomas," nodules, infection, and vascular compromise. Appropriate preventative measures, coupled with timely and effective treatment, are critically important for patient safety and satisfaction. In addition to the preventive measures and treatment algorithms outlined here, the authors emphasize that the broad classification and treatment of nodules as "granulomas" is likely to lead to ineffective treatment, or worse, unnecessary exposure to incorrect treatment. In practice, nodules are classified and treated based on clinical manifestation (eg, late vs early or noninflammatory vs inflammatory) rather than on histology. Indeed, classification of a nodule as a granuloma requires a histological examination, rarely available (or necessary) in clinical practice to guide treatment. Thus, the apparent inflammatory nature of the nodule and the time of onset should drive treatment approach. The treatment algorithms presented here are based on these clinically meaningful parameters.

Ghost cell odontogenic carcinoma with suspected cholesterol granuloma of the maxillary sinus in a patient treated with combined modality therapy: A case report and the review of literature.

RATIONALE: Ghost cell odontogenic carcinoma (GCOC) is a rare malignant odontogenic tumor with aggressive growth characteristics. PATIENT CONCERNS: A 41-year-old Chinese male visited our hospital in 2013, with a 4-month history of bloody purulent rhinorrhea with a peculiar smell in the right nasal cavity. DIAGNOSES: The patient suffered from recurrent GCOC with suspected cholesterol granuloma of the maxillary sinus. The patient was incorrectly diagnosed with a calcifying epithelial odontogenic tumor at his first recurrence. Physical examination, radiological examination, and histopathology were used to identify GCOC. INTERVENTIONS: Considering the recurrence of GCOC and poor effects of single surgery, postoperative adjuvant chemotherapy and concurrent chemoradiotherapy were performed after radical surgical excision. OUTCOMES: So far, no significant evidence has suggested recurrence or metastasis after a long-term follow-up. LESSONS: We advocate wide surgery with clean margins at the first accurate diagnosis. Combined modality therapy could be taken for the recurrent GCOC. We expect to provide a new treatment strategy to prevent the growth of this neoplasm.

Filler migration and extensive lesions after lip augmentation: Adverse effects of polydimethylsiloxane filler.

Polydimethylsiloxane (PDMS), also called liquid silicone, belongs to a group of polymeric compounds that are commonly referred to as silicones. These filling agents have been used as injectable filler for soft tissue augmentation. There are limited experiences about management of the severe complications related to filler migration associated with PDMS injection. We present a 35-year-old female with severe erythema, edema over her cheeks and neck, and multiple irregularities following cosmetic lip augmentation with PDMS. Further studies are required for management of this complicated case of PDMS injection.

A Hairy Affair: Ophthalmia nodosa Due to Caterpillar Hairs.

PURPOSE: To study different clinical presentations, course, and final outcomes of ophthalmia nodosa, a rare disease caused by hairs of the caterpillar. METHODS: A total of 29 eyes of 17 patients with the disease presenting to our institute in 2013 were included. RESULTS: Patients presented with foreign body sensation (94%), photophobia (88%), lacrimation (82%), redness (94%), and eyelid edema (82%). Hairs were found in the conjunctiva (89.6%), cornea (65.5%), and even anterior chamber (3.4%). There was a conjunctival nodule in two eyes (6.8%). Resolution of symptoms occurred in 3-21 days. Treatment included topical steroids, cycloplegia, and removal of hairs with forceps. More than one sitting was required in 17 eyes (62.9%) due to reactional inflammation, precluding visualization of all the hairs. CONCLUSIONS: Ophthalmia nodosa is a relatively rare condition with subtle findings, which can be missed, causing considerable discomfort to the patient if the hairs are not removed.

Biocompatible chitosan based hydrogels for potential application in local tumour therapy.

A series of hydrogels based on chitosan polyamine and nitrosalicylaldehyde were prepared via dynamic covalent chemistry (DCC), by imination and transimination reactions towards ordered clusters which play the role of crosslinking nodes of the chitosan network. The hydrogelation mechanism has been proved through NMR and FTIR spectroscopy, X-ray diffraction and polarized light microscopy. The successful preparation of the hydrogels and their mechanical properties were further investigated using rheological measurements. By electron scanning microscopy, the hydrogels exhibited a channels microstructure morphology which critically influenced their fast swelling by capillarity. The hydrogels cytotoxicity was explored in vitro on HeLa cancer cells and their biocompatibility was monitored in vivo by subcutaneous implantation on rats. The novel hydrogels proved good in vitro cytotoxicity on the HeLa cells and also in vivo biocompatibility in rats. Thus, these novel biomaterials promise to be suitable for local cancer therapy.

Surgical Management of Penile Lesions Secondary to Foreign Body Reaction: A Case Report and Systematic Review.

BACKGROUND: To improve the penile contour, some men choose to undergo implantation or injection of nonbiological materials. Foreign body reactions in penile tissue may produce scarring, deformity, ulceration, necrosis, and even gangrene. Consensus is lacking regarding the most effective surgical procedure for reconstruction of these penile lesions. OBJECTIVES: The authors describe one case study and the first systematic review focusing on reconstructive surgical management for penile lesions secondary to foreign body reaction. METHODS: PubMed, Medline, and Cochrane databases were queried for publications written in English, French, Portuguese, and Spanish from 1951 to May 2017. Multiple search terms were applied. RESULTS: Of the 3304 articles identified, 51 were included in the systematic review. All were retrospective studies, case series, or case reports. A total of 260 patients underwent surgical procedures, and the complication rate was 37.3%. The scrotal flap technique was performed most frequently (43.4%) and resulted in 65.6% of the total complications observed. One Brazilian case study was also described with an extensive and circumferential ulcer after six mineral oil bolls implant in the penile subcutaneous tissue. CONCLUSIONS: Restoration of the penile shape preserving the functionality and maintaining a good physician-patient relationship may be a challenge. The scrotal pouch may be advantageous for patch grafting of penile soft-tissue lesions, owing to its skin laxity and good blood supply. A less aggressive surgical approach has the benefits of shorter healing time and fewer early complications. Penile injuries are best treated by experienced surgeons on a case-by-case basis with care given to identify the most appropriate treatment.

Foreign Body Reaction to Dialysis Chatheter and Peritoneal Fluid Eosinophilia in a Child on Continuous Ambulatory Peritoneal Dialysis.

Foreign body reaction is a tissue response against implanted materials. We described for the first time the eosinophilic peritonitis and foreign body giant cell reaction to dialysis catheter in a nonatopic child on continuous ambulatory peritoneal dialysis. We found tenderness, redness, and swelling without purulent discharge around the peritoneal catheter; increased eosinophil count in cloudy dialysis fluid; and blood and hyperechoic granulomatous formation appearance surrounding the peritoneal catheter on ultrasonography and foreign body giant cell reaction to dialysis catheter in pathologic examination of granulomatous lesionin in our patient. The peritoneal dialysis catheter was removed due to resistance to antibiotic and antihistamine treatments for suspected peritonitis and tunnel infection. Foreign body reaction and eosinophilic peritonitis with eosinophilic cloudy dialysis effluent can exist simultaneously. Foreign body reaction should be considered in the differential diagnosis of exit site and/or tunnel infection. Ultrasonography helps distinguish between foreign body reaction and exit-site or tunnel infection.

B Cell Lymphoma Underlying Paraffinoma of Glabella.

Soft tissue reactions to paraffin include inflammation, fibrosis, disfigurement, and granulomatous inflammation with foreign body giant cell reaction. The authors report the case of a 77-year-old woman with cutaneous marginal zone B cell lymphoma located on glabella, arising in association with underlying paraffinoma. While it is unclear whether the implant directly contributed to the development of lymphoma, this association has not been previously documented, prompting this report.

Granulomatous reaction to Belotero Balance: A case study.

OBJECTIVE: The most commonly used dermal fillers are hyaluronic acids (HAs), and in general, are well tolerated with mild to moderate risk of adverse events. The most frequently reported side effects are injection site erythema and bruising. We present the first case of a patient who developed a severe granulomatous foreign body reaction to the HA filler, Belotero Balance. In our review of the literature, a granulomatous reaction has never before been reported as a side effect of this particular HA filler (1). CASE: On exam, the patient had firm erythematous, granulomatous plaques on her bilateral cheeks, with a tender, fluctuant nodule on her right cheek. Complete resolution of this delayed reaction was achieved after several injections of intralesional Kenalog (IL-K) 2.5 mg/cc, and further fine-tuning was achieved through laser resurfacing. CONCLUSION: Granulomatous reactions can occur with any HAs, though such incidents are not commonly reported. These delayed reactions are generally localized immunological reactions, though biofilm infections should be excluded where appropriate. It is only with long-term (5-year) longitudinal studies that accurate numbers of such reactions will be known.

Streptococcus sanguinis isolated from filler granuloma: Successful treatment with incision and drainage.

Filler granuloma is considered to be the result of delayed immune responses; growing evidence suggests that they may be secondary to biofilm formation. Dermal filler is technically a foreign body, and as the development of newer generations of dermal fillers lengthens their duration, it is possible that there is also an increased risk of biofilm formation. Here, we present a case report of a patient with Streptococcus sanguinis isolated from a filler granuloma, suggestive of biofilm formation. This case demonstrates the effective use of antibiotics after incision and drainage on antibiotic resistant biofilm.