Clinical improvement after removal of hypercalcemia-causing granulomas.

In this report, we present the case of a woman with clinical characteristics of hypercalcemia due to ectopic production of 1,25(OH)2D. She reported a history of aesthetic surgery with gluteal fillers. The formation of granulomas after these interventions were previously described. In this case, surgical removal of the foreign formations was attempted with clinical stability during 3 years.

Presentamos el caso de una mujer con características clínicas de hipercalcemia secundaria a la producción ectópica de 1,25(OH)2D. La paciente informó una historia de rellenos glúteos con fines estéticos. La formación de granulomas posterior a este tipo de intervenciones fue previamente descrita por otros autores. En este caso se intentó la extirpación quirúrgica de las formaciones extrañas con estabilidad clínica durante 3 años.

[A Resected Case of Intraperitoneal Foreign Body Granuloma Mimicking Peritoneal Dissemination].

Foreign body granuloma(FBG)is a granuloma that occurs due to chronic inflammation caused by various residual foreign objects. In the field of gastrointestinal surgery, intraperitoneal foreign body granulomas(IPFBGs)are often caused by sutures materials or residual gauzes, but those caused by food residue are extremely rare. We present an IPFBG case of food residue caused by anastomotic leakage, which was difficult to be distinguished from peritoneal dissemination. The patient is a 74- year-old male. Anastomotic leakage occurred following low anterior resection for rectal cancer, peritoneal drainage and ileostomy were performed. 1.5 years after rectal resection, liver metastasis was diagnosed by CT and peritoneal dissemination was diagnosed by PET-CT. Both lesions were resected at the same time. The pathological findings were liver metastasis and FBG. It was presumed to be an FBG formed by food residue left behind after anastomotic leakage. It has reported that FBG caused by residual gauzes were shown a ring-shaped uptake by PET-CT, but that was not observed in our case. In addition, since a nodule suspected of liver metastasis was observed simultaneously, we considered no differential diagnosis other than peritoneal dissemination. IPFBG resembling peritoneal dissemination, occurred after anastomotic leakage. A food residue can cause IPFBG, it is necessary to consider IPFBG in decision making treatment strategy for peritoneal nodule.

Spontaneous resolution of a wooden foreign-body granuloma in the conjunctiva of a child.

A conjunctival foreign-body (FB) granuloma may result following trauma with synthetic and non-synthetic materials including organic and non-organic objects. Children usually manifest with FB granulomas that develop due to inoculation of FBs from soft toys, blankets or woollen clothes. Encapsu- lation of these FBs following a granulomatous inflammatory response results in a nodular swelling in the conjunctiva. Reports of a wooden FB granuloma in the conjunctiva in children are anecdotal. A 5-year-old boy suffered an un- witnessed direct ocular trauma to his left eye (OS) with a wooden arrow while playing. He developed redness and nodular swelling at the inferotemporal aspect of the OS without any visual complaints. The diagnosis of a wooden FB granuloma is a challenge to ophthalmologists and may go undetected in children who neglect their symptoms. It characteristically presents as a unilateral conjunctival nodule. Surgical excision is the definitive management. However, spontaneous extrusion of the FB might be observed due to protective blinking and tearing mechanisms in the eye.

Complicación por inyección de silicona en estética facial: migración a tejido adenoideo / Silicone injection complication in facial aesthetics: Migration to adenoids

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Injerto dermo-epidérmico como tratamiento del siliconoma de extremidad inferior / Dermoepidermal graft as treatment of lower extremity siliconoma

Resumen Introducción A pesar de la evidencia sobre los malos resultados y riesgos del uso de inyecciones subcutáneas de silicona para mejorar el contorno corporal, esta técnica sigue siendo utilizada por personas no calificadas. Caso clínico Paciente de 56 años quien consultó por cuadro de celulitis en pierna izquierda. Se obtuvo el antecedente de intervención con silicona en cara, dorso de las manos, glúteos y piernas el año 2000. El cuadro progresó con múltiples abscesos en la totalidad de la pierna y sepsis. Se realizaron aseos quirúrgicos exponiendo planos fascial y muscular, se utilizó terapia local con sistemas de presión negativa y posterior injerto dermo-epidérmico (IDE). El manejo multidisciplinario se realizó en unidades críticas. Los resultados del manejo fueron satisfactorios, salvando la extremidad con cobertura total, logrando el alta luego de 4 meses. Conclusión A pesar de conocerse los peligros de la inyección de silicona, este sigue siendo un procedimiento frecuente. En nuestra paciente se manifestó como fascitis de la pierna, requiriendo tratamiento quirúrgico agresivo. Conocer esta entidad, su diagnóstico y tratamiento es fundamental para tratar pacientes con complicaciones graves.

Introduction Despite the evidence of poor performance and risks of using silicone subcutaneous injections to improve body contour, this technique is still used by untrained people, generating an iatrogenic entity with serious complications. Case report 56 year old female presented left lower extremity cellulitis. A history of previous intervention with silicone injections in face, back of hands, buttocks and legs in year 2000 was obtained. An inflammatory process progressed locally and systemically with multiple abscesses, subcutaneous thickness in the entire leg and sepsis, requiring multiple surgical procedures, reaching fascial and muscle planes exposition of the left leg. The patient underwent local therapy with negative pressure systems and subsequent dermoepidermal graft. Multidisciplinary management was performed on a critical unit. The results were satisfactory, preserving the limb with full coverage. She was discharged after four months of inpatient management. Conclusion Despite knowing the risks of silicone injection (industrial or medical) it remains a common procedure. In our patient she presented as leg fasciitis, requiring aggressive surgical treatment. Knowing this entity, its diagnosis and treatment is essential to treat patients with serious complications.

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.

Reação tipo corpo estranho a preenchimento facial com poliamida / Foreign body reaction to polyamide filling in the face

O uso de substâncias para preenchimento dérmico é crescente, e o número de complicações devido à sua utilização, significativo. Neste trabalho, relatamos um caso de granulomas de corpo estranho após preenchimento facial com gel de poliamida, chamado AqualiftTM, produto não encontrável nas bases de dados da literatura científica. São discutidos aspectos clínicos, terapêuticos e histopatológicos. Faz-se uma advertência relativa ao uso desta substância.

Dermal fillers are increasingly used, and the number of complications due to their use is significant. In this work, we report the case of foreign body granulomas due to the facial injection of a polyamide gel, named AqualiftTM, a product not found in scientific literature databases. Clinical, therapeutic and hystopathological aspects are discussed. A warning is made, concerning the use of this substance.

Granuloma mercurial en mano. A propósito de un caso / Mercury granuloma of the hand. Report of a case

Se presenta un caso de granuloma mercurial en dorso de la primera falange del tercer dedo mano izquierda tras rotura accidental de un termómetro convencional de mercurio. La paciente fue tratada durante 6 meses con crioterapia sin conseguir resolver el problema. Se practicó resección amplia en bloque de la lesión con cobertura del aparato extensor con injerto libre de piel total del pliegue de la muñeca. En la actualidad el resultado es satisfactorio no presentado recidiva al año de la intervención (AU)

A case is presented of mercury granuloma on the dorsal surface of the first phalanx of the middle finger of the left hand, secondary to accidental rupture of a conventional mercury thermometer. Six months of cryotherapy proved unable to solve the problem. Wide en bloc resection of the lesion was performed, covering the extensor unit with a full-thickness skin graft harvested from the fold of the wrist. The result is satisfactory, and there has been no recurrence after one year of follow-up (AU)

Granuloma intradural en un paciente con infusión espinalde morfina y clonidina / Spinal granuloma in a patient receiving a spinal infusion of morphine and clonidine

Los pacientes en tratamiento con infusión espinal demorfina a dosis elevadas presentan como efecto adversoa largo plazo la formación de un granuloma en la puntadel catéter intradural. La subida ininterrumpida de lasdosis de morfina intratecales tras un periodo relativamenteprolongada de estabilidad, la aparición progresivade una sintomatología neurológica característica decompresión radicular o medular, y las imágenes de resonanciamagnética llevan al diagnóstico de este fenómeno.Se presenta un caso clínico de un paciente con dolor neuropáticocentral tras exéresis tumoral, que reúne los tresprincipios mencionados que llevan al diagnóstico de sospechade granuloma intradural (AU)

Patients treated with long-term spinal infusion of highdoses of morphine develop a granuloma at the locationof the catheter tip. Diagnosis is based on a steadyincrease in intrathecal morphine dosage after arelatively prolonged period of stability, on the gradualdevelopment of neurologic signs and symptomssuggesting radicular or spinal cord compression, and onmagnetic resonance images. We describe a man withcentral neuropathic pain after removal of a tumor. Thepresence of all 3 of the aforementioned diagnosticcriteria led to suspicion of a spinal granuloma (AU)

Granuloma a cuerpo extraño, simulando una enfermedad maligna del tracto biliar / Foreign body granuloma simulating malignant disease in the biliary tract

El material de sutura no reabsorbible tipo seda es asiento para la formación de granulomas a cuerpo extraño y cálculos, por lo que debe evitarse su uso en procedimientos quirúrgicos sobre la vía biliar. Presentamos un caso clínico operado por probable tumor de Klastkin, en el que durante el acto quirúrgico se observó una tumoración de 1,5cm de diámetro extrínseca a la vía biliar, de consistencia firme, que fue extirpada sin afectar la vía biliar. Microscópicamente, se apreció material de sutura (seda). El informe de anatomía patológica fue: tumoración de carácter inflamatorio, constituida esencialmente por macrófagos y células gigantes de reacción a cuerpo extraño, identificándose dentro del citoplasma de las células material de sutura. Exponemos este caso en vista de la rareza de esta afección, la dificultad diagnóstica preoperatoria y la posible confusión con otros síndromes anatomoclínicos(AU)

Non-absorbable suture materials, such as silk, are able to form foreign body granulomas and stones and consequently their use should be avoided in surgical procedures in the biliary tract. We present the case of a patient who underwent surgery for a probable Klastkin tumor. During the intervention, a 1.5-cm tumor, with firm consistency, extrinsic to the biliary tract was found; the mass was extirpated with no compromise to the biliary tract. Macroscopic examination revealed suture (silk) material. The histopathological report described an inflammatory tumor, composed essentially of macrophages and foreign body giant cells, and identified a suture within the cell cytoplasm. The interest of this case lies in the rarity of this entity, the difficulty of preoperative diagnosis, and its possible confusion with other anatomic and clinical syndromes(AU)

Cerebral cholesterol granuloma: case report

Intracranial cholesterol granulomas are rare lesions, and have been registered in petrous apex region. The presence of an intracerebral cholesterol granuloma is an uncommun event. We report the case of a 20-years-old woman who undergone craniotomy for resection of a temporal mass. Pathologic examination show a cholesterol granuloma.

Granulomas de colesterol intracranianos são lesões raras, sendo observados na região do ápice petroso. A ocorrência de granuloma de colesterol intracerebral é um evento incomum. Relata-se o caso de mulher de 20 anos submetida a craniotomia para ressecção de processo expansivo temporal, com exame anátomo-patológico evidenciando um granuloma de colesterol.

Sea urchin granuloma / Granulomas por ouriços-do-mar

Injuries caused by venomous and poisonous aquatic animals may provoke important morbidity in humans. The phylum Echinoderma include more than 6000 species of starfish, sea urchins, sand dollars, and sea cucumbers some of which have been found responsible for injuries to humans. Initial injuries by sea urchins are associated with trauma and envenomation, but later effects can be observed. Sea urchin granuloma is a chronic granulomatous skin disease caused by frequent and successive penetration of sea urchin spines which have not been removed from wounds. The authors report a typical case of sea urchin granuloma in a fisherman and its therapeutic implications.

Os acidentes por animais aquáticos traumatizantes e venenosos podem provocar morbidez importante em humanos. Equinodermos marinhos incluem mais de 6000 espécies de estrelas-do-mar, ouriços-do-mar, "bolachas-de-praia" e pepinos-do-mar. Vários equinodermos têm sido responsabilizados por acidentes em humanos. Granulomas por ouriço-do-mar são lesões de caráter granulomatoso, crônicas, causada por acidentes com espículas de ouriço-do-mar. Os autores relatam um caso típico de granulomas por ouriço-do-mar ocorrido em um pescador e enfatizam as implicações terapêuticas aplicadas.

Granuloma de silicona en el pene "siliconoma" / Penile silicone granuloma

OBJETIVO: Mostrar la experiencia adquiridacon un caso de “siliconoma” peneano, de interés clínicopor su infrecuente presentación.METODO /RESULTADOS: Presentamos el caso de unpaciente con alteración de la función sexual secundaria ala inyección subcutánea de silicona líquida en el pene,dando lugar a la formación de un granuloma “siliconoma”peneano y a la migración de partículas del compuesto araíz de pene y a rafe medio escrotal. Se procedió a laextirpación quirúrgica del “siliconoma “ peneano y de laspartículas migradas reparando el defecto peneano conpiel escrotal.CONCLUSIONES: La inyección subcutánea de siliconalíquida es una práctica no justificada que produce efectosdevastadores y requiere cirugías importantes para la eliminacióndel material inyectado

OBJECTIVES: To report our experience with ;;one case of penile silicone granuloma, that has clinical ;;interest for its unfrequent presentation. ;;METHODS/RESULTS: We report the case of a patient with ;;sexual dysfunction secondary to subcutaneous injection of ;;liquid silicone in the penis resulting in a penile granuloma ;;and migration of the particles to the penile root and midline ;;scrotal raphe. We proceeded to the surgical excision of ;;the granuloma and migrated particles, repairing the penile ;;defect with scrotal skin. ;;CONCLUSIONS: Subcutaneous injection of liquid silicone ;;is a practice that does not have any justification because ;;of its devastating effects and requires major perations for ;;the elimination of the injected material

Granuloma de colesterol de mama, una lesión que simula carcinoma mamario / Cholesterol granuloma of the breast. A lesion which mimics carcinoma

El granuloma de colesterol de la mama es una entidad clínico-patológica infrecuente y descrita pocas veces en la literatura médica. Se trata de una respuesta del organismo a la hemorragia localizada o a material lipídico extracelular. Se caracteriza por la presencia de células gigantes multinucleadas fagocitando cristales de colesterol. Su importancia radica en la posible confusión clínica y radiológica con un carcinoma de mama.Se describe el caso de una paciente de 54 años con una masa asintomática en la mama izquierda. (AU)

A retrospective study on cholesteatoma otitis media coexisting with cholesterol granuloma / 华中科技大学学报（医学）（英德文版）

To investigate the etiology and pathogenesis of cholesteatoma otitis media accompanied by cholesterol granuloma and the relationship between cholesteatoma and cholesterol granuloma, 63 cases of middle ear cholesterol granuloma treated in our hospital during the period from March 1988 to May 2000 were retrospectively reviewed. All cases were surgically and pathologically verified. 15 cases of cholesteatoma coexisting with cholesterol granuloma were found among the 63 patients. All 15 cases had a long-term history of otitis media, such as otorrhea (sanguine purulent otorrhea and bloody otorrhea in 8 cases) and perforation of the eardrum (perforation of pars flaccida in 8 cases). Temporal bone CT scans showed cholesteatoma in 11 cases. All patients were treated surgically, and cholesteatoma and cholesterol granuloma were found coexisting alternately, the latter lying mainly in the tympanic antrum, attic and mastoid air cells. Chocolate-colored mucus was accumulated in well-developed mastoid air cells, and glistening dotty cholesterol crystals were also found. In most cases, enlarged aditus, destruction of lateral attic wall, erosion of ossicular chain, exposure of horizontal segment of facial nerve and tegmen of attic were observed. Occlusion of Eustachian tube was noted in 6 cases, and occlusion of tympanic isthmus was revealed in all cases. A post-operative dry ear was achieved in all patients, and hearing improvement was achieved in all 12 cases following tympanoplasty. Cholesteatoma and cholesterol granuloma in middle ear may share a common pathophysiological etiology: occlusion of ventilation and disturbance of drainage. The diagnosis should be considered when patients presented with chronic otitis media with bloody otorrhea. CT and magnetic resonance imaging are useful for the diagnosis before operation. The surgical approach depends on the location, extension and severity of the lesion. The purpose of surgery is to remove the lesion and create an adequate drainage.

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

Granuloma de colesterol de oído medio: causa de hemotímpano idiopático / Cholesterol granuloma of the middle ear: cause of idiopathic hemotympanum

Presentamos un paciente de 49 años con un granuloma de colesterol de oído medio en su único oído funcionante. Como su presentación clínica era compatible con un tumor vascular de oído medio, se realizaron una TC con contraste así como una RM con gadolinio y reconstrucciones vasculares que confirmaron que tanto la arteria carótida como la vena yugular estaban cerca de la lesión pero no afectadas por ella. Este paciente pudo tratarse mediante una cirugía conservadora de la audición. Se revisa el diagnóstico diferencial de las anomalías vasculares del oído medio, en especial en relación con los granulomas de colesterol como causa de hemotímpano idiopático (AU)

We report a case of a 49-year-old man with a cholesterol granuloma of the middle ear in an only hearing ear. As it mimicked a vascular middle ear tumor, a contrast cranial computed tomography and a gadolinium-enhanced-magnetic resonance imaging with vascular reconstructions were performed, confirming that both carotid artery and jugular vein were near the lesion but not involved. This patient could be managed with a conservative hearing preserving approach. Differential diagnosis of vascular middle ear anomalies is reviewed, specially in relation to cholesterol granulomas as a cause of idiopathic hemotympanum (AU)

Granuloma conjuntival causado por fibras sintéticas / Synthetic fiber granuloma of the conjunctiva

Objetivo: Relatar caso de granuloma de conjuntiva por fibras sintéticas. Relato do Caso: Paciente de seis anos, sexo feminino com história de tumoraçäo em conjuntiva tarsal inferior do olho direito há sis meses. Foi realizada exérese da lesäo. O laudo anátomo-patológico mostrou reaçäo inflamatória granulomatosa do tipo corpo estranho com células gigantes multinucleadas fagocitando material birrefringente, compatível com fibras sintéticas. Discussäo: O granuloma de fibras sentéticas de conjuntiva é raro e descrito principalmente em crianças, com acometimento unilateral, em conjuntiva tarsal inferior ou fundo de saco inferior. O freqüente contato com material de pelúcia nesta faixa etária tem sido apontado como fator etiológico. Granuloma de fibras sintética de conjuntiva deve ser considerado no diagnóstico diferencial de lesöes tumorais de conjuntiva em crianças.

Granuloma de colesterol da ponta do rochedo. Relato de caso / Cholesterol granuloma of the petrous apex. Report of a case

Os autores relatam um caso de granuloma de colesterol da ponta do rochedo, em um paciente do sexo feminino, de 74 anos, que se apresentou clinicamente com alteração de nervos cranianos (V, VI, VIII). O diagnóstico foi feito pela ressonância magnética de encéfalo, que identificou lesão com hipersinal em T1 e em T2, sem realce após administração de contraste paramagnético endovenoso. A via subtemporal extradural permitiu acesso direto à ponta do rochedo, com exerése total da lesão. A paciente evoluiu satisfatoriamente no pós-operatório, com melhora da sintomatologia.

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