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BACKGROUND: Foreign body granuloma is an inflammatory tissue reaction to exogenous material. Classically it appears on the face after aesthetic procedures. Herein we report for the first time three cases of facial granulomatous reactions to microbeads after arterial cervico-facial embolization. PATIENTS AND METHODS: Three patients underwent embolization of the facial arteries using Embogold® microbeads in a setting of epistaxis or tumoral hemostasis. Within 10 to 45 days painful, inflammatory, subcutaneous nodules appeared on the homolateral side of the face. Histological samples showed an inflammatory response with giant cells as well as the presence of microbeads in the skin. A favorable outcome was achieved with colchicine in one patient and with surgery in another; the third patient was lost to follow-up. DISCUSSION: The embolizing microspheres produced a local inflammatory reaction, with destruction of the vascular wall and bead migration to facial tissue leading to a granulomatous reaction. The occurrence of three cases within a period of few weeks, with several different operators and batches of products, is surprising considering the long-standing use of the product. There was no common comorbidity in the patients and no suggestion of trauma. Retrospective analysis of the product batches was normal. Gold staining could play a role in severe inflammatory response to Embogold® particles. CONCLUSION: These three cases illustrate the value of discussing potential foreign body granulomatous reaction in cases of facial nodules following cervico-facial embolization. Colchicine may offer a valuable therapeutic alternative.
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Artérias , Embolização Terapêutica/instrumentação , Granuloma de Corpo Estranho/etiologia , Microesferas , Adulto , Idoso , Embolização Terapêutica/efeitos adversos , Epistaxe/terapia , Face/irrigação sanguínea , Humanos , Masculino , Complicações Pós-Operatórias , Cuidados Pré-OperatóriosRESUMO
Mesotherapy is widely used for its lipolytic effect as an alternative procedure to surgical methods. Although many benefits of lipolytic mesotherapy have been observed, numerous side effects have also been reported. Here, we report a case of cutaneous foreign body granulomas that occurred after lipolytic mesotherapy.
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Granuloma de Corpo Estranho/induzido quimicamente , Dermatoses da Perna/induzido quimicamente , Mesoterapia/efeitos adversos , Adulto , Celulite/tratamento farmacológico , Quimioterapia Combinada/efeitos adversos , Feminino , HumanosRESUMO
We report the case of a patient who developed sarcoid granulomas 11 months after starting treatment with pegylated interferon alfa and ribavirin for chronic hepatitis C. The sites of the lesions were related to 3 different foreign bodies: silica in old scars on the skin, hyaluronic acid that had been injected into facial tissues, and silicone in an axillary lymph node draining the area of a breast implant. Systemic sarcoidosis was diagnosed on the basis of a history of dry cough and fever and blood tests that revealed elevated angiotensin converting enzyme and liver enzymes. Interruption of the antiviral therapy led to normalization of liver function tests and disappearance of the skin lesions and lymphadenopathies. Dermatologists and cosmetic surgeons should be aware of the risk of sarcoid lesions related to cosmetic implants in patients who may require treatment with interferon in the future.
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Implantes de Mama/efeitos adversos , Granuloma de Corpo Estranho/induzido quimicamente , Granuloma de Corpo Estranho/complicações , Ácido Hialurônico/efeitos adversos , Sarcoidose/complicações , Dióxido de Silício/efeitos adversos , Silicones/efeitos adversos , Antivirais/efeitos adversos , Feminino , Humanos , Interferon-alfa/efeitos adversos , Pessoa de Meia-Idade , Polietilenoglicóis/efeitos adversos , Proteínas Recombinantes/efeitos adversos , Sarcoidose/induzido quimicamenteRESUMO
Talc, a common adulterant in injectable opioids and filler in oral tablets, is frequently abused as crushed suspensions in injections. This review aims to recognize intradermal drug injection referred to colloquially as "skin popping" or "shooter's patch" as a cause of granulomatous disease and prevention of systemic complications from cutaneous cues.
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OBJECTIVE: Positron emission tomography-computed tomography (PET/CT) is an effective modality for evaluating cervical cancer recurrence. We present two cases of suspected recurrent cervical cancer on PET/CT that were pathologically proven to be granulomas. CASE REPORT: Case 1: A 54-year-old woman with FIGO (2009) stage IB1 cervical cancer underwent radical hysterectomy and adjuvant chemoradiotherapy. Case 2: A 44-year-old woman with FIGO (2009) stage IB2 cervical cancer underwent incidental simple hysterectomy with pelvic lymphadenopathy and adjuvant concurrent cisplatin-based chemoradiotherapy. Both patients had peritoneal or pelvic masses with increased 18F-fluorodeoxyglucose (18F-FDG) uptake on PET/CT after 3 years. These masses were finally pathologically proven to be foreign bodies or inflammatory granulomas with abscess, respectively. CONCLUSION: Foreign bodies or inflammatory granuloma could be one of the differential diagnoses of increased 18F-FDG uptake on PET/CT in patients with cervical cancer after treatment. Pathological evaluation should be considered in these patients to guide further treatment.
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Corpos Estranhos , Neoplasias do Colo do Útero , Adulto , Feminino , Granuloma/diagnóstico por imagem , Granuloma/cirurgia , Humanos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnóstico , Recidiva Local de Neoplasia/cirurgia , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Tomografia por Emissão de Pósitrons/métodos , Compostos Radiofarmacêuticos , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/cirurgiaRESUMO
A 74-year-old Caucasian woman presented with a 2-week history of multiple nodules in both lips and perioral region that caused her mild discomfort while eating. The patient reported hyaluronic acid infiltration on both lips 5 months prior to presentation. The examination revealed multiple, well-defined, millimetric, and firm nodules on both lips and oral mucosa. An excisional biopsy of one of the nodules was performed under local anesthesia. Histopathological analysis demonstrated acute eosinophilic inflammation, fibrosis, and granulomas on mucoid material, positive for colloidal iron stain and Alcian blue stain, alongside a minor salivary gland showed mild atrophy, fibrosis, and fat infiltration. Enhancement of the aged lip using hyaluronic acid, to restore the bulkiness and elasticity that have been lost with age, is very common. Nevertheless, soft tissue fillers are used in a wide age range. Hyaluronic acid represents 78% of the dermal filler injections in the United States, been the second most popular nonsurgical cosmetic procedure after botulinum toxin injection. Foreign body granulomatous reaction is a rare delayed complication that has been well documented elsewhere and it has been associated with poor injection technique. Although it also has been related to hypersensitivity reactions that may be caused by impurities developed during the bacterial fermentation process, treatment of granulomatous reactions with hyaluronidase is recommended.
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Técnicas Cosméticas , Preenchedores Dérmicos , Idoso , Técnicas Cosméticas/efeitos adversos , Preenchedores Dérmicos/efeitos adversos , Feminino , Reação a Corpo Estranho , Humanos , Ácido Hialurônico/efeitos adversos , Hialuronoglucosaminidase , LábioRESUMO
Objective: To evaluate and analyse granulomatous reaction caused by intradermal injections with hyaluronic acid (HA) fillers in the orofacial region. Methods: A retrospective review of 11 cases of foreign body granulomas caused by HA fillers was performed. Demographic data, clinical symptoms, imaging features, treatments, pathology results, history of facial cosmetic procedures and prognosis were reviewed. Results: Most of the cases appeared as painless palpable nodules with no significant growth, located in the cheeks, chin, lips or temples. The nodules were excised, and pathological examination revealed amorphous basophilic material surrounded by foreign body giant cells and macrophages. No patient's clinical and pathological diagnosis was linked to HA during the first appointment. During follow-up, all patients admitted that they had received dermal filler injections from 3 to 10 years previously. Most of the patients had a favourable prognosis; one patient complained of facial asymmetry and another reported mild pain in the upper lip after surgery. Conclusion: The increase in the number of cases showing delayed complications caused by HA fillers merits closer clinical attention. A thorough understanding of the patient's medical history and biopsy specimen are necessary to make a definite diagnosis and offer appropriate treatment.
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Granuloma de Corpo Estranho , Ácido Hialurônico , Face , Granuloma de Corpo Estranho/induzido quimicamente , Humanos , Ácido Hialurônico/efeitos adversos , Lábio , Estudos RetrospectivosRESUMO
Cutaneous granulomatosis is a heterogeneous group of diseases, characterized by a skin inflammatory reaction triggered by a wide variety of stimuli, including infections, foreign bodies, malignancy, metabolites, and chemicals. From a pathogenic point of view, they are divided into non-infectious and infectious granulomas. Pathophysiological mechanisms are still poorly understood. Non-infectious granulomatous skin diseases include granuloma annulare, necrobiosis lipoidica, rheumatic nodules, foreign body granulomas, cutaneous sarcoidosis, and interstitial granulomatous dermatitis. Necrobiosis lipoidica is more frequent in diabetic patients. Infectious granulomas of the skin are caused by mycobacteria, in particular Mycobacterium tuberculosis or atypical mycobacteria; parasites, such as Leishmania; or fungi. Pathogenic mechanisms of M. tuberculosis-related granuloma are discussed. From a clinical point of view, it is useful to divide cutaneous granulomatosis into localized and more disseminated forms, although this distinction can be sometimes artificial. Three types of localized granulomatous lesions can be distinguished: palisaded granulomas (granuloma annulare, necrobiosis lipoidica, and rheumatoid nodules), foreign body granulomas, and infectious granulomas, which are generally associated with localized infections. Disseminated cutaneous granulomas can be divided into infectious, in particular tuberculosis, and non-infectious forms, among which sarcoidosis and interstitial granulomatous dermatitis. From a histological point of view, the common denominator is the presence of a granulomatous inflammatory infiltrate in the dermis and/or hypodermis; this infiltrate is mainly composed of macrophages grouped into nodules having a nodular, palisaded or interstitial architecture. Finally, we propose which diagnostic procedure should be performed when facing a patient with a suspected cutaneous granulomatosis.
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Complicações do Diabetes/diagnóstico , Granuloma de Corpo Estranho/diagnóstico , Granuloma/diagnóstico , Macrófagos/imunologia , Necrobiose Lipoídica/diagnóstico , Sarcoidose/diagnóstico , Pele/patologia , Algoritmos , Complicações do Diabetes/imunologia , Diagnóstico Diferencial , Granuloma/imunologia , Granuloma de Corpo Estranho/imunologia , Humanos , Necrobiose Lipoídica/imunologia , Sarcoidose/imunologiaRESUMO
INTRODUCTION: Aesthetic medicine represents an emerging field for many specialties. Nowadays, a plethora of approaches are available to rejuvenate the human body and face, the latter being a frequent target for the placement of filling substances to correct wrinkles and volume loss. Nevertheless, based on the many products on the market, treating clinicians must pay specific attention to the properties of the respective materials, their associated side effects and any specific handling requirements to prevent potential short- and long-term adverse events. AREAS COVERED: Types of filling materials, including biodegradable and non-biodegradable products, related complications, their conservative and invasive treatment options, as well as prevention strategies are described in this review. EXPERT OPINION: A profound knowledge of the facial anatomy as well as extensive experience with the various filling techniques and suitable materials for the respective areas remains crucial to prevent adverse events associated with filling procedures to the human face. Since side effects such as malar edema and foreign body granuloma do affect patients physically and psychologically to a significant extent and their successful treatment still remains challenging, further in depth studies on the tolerability of many filling materials utilized are required.