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.

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.

Foreign Body Granulomas Simulating Recurrent Tumors in Patients Following Colorectal Surgery for Carcinoma: a Report of Two Cases

We report here two cases of foreign body granulomas that arose from the pelvic wall and liver, respectively, and simulated recurrent colorectal carcinomas in patients with a history of surgery. On contrast-enhanced CT and MR images, a pelvic wall mass appeared as a well-enhancing mass that had invaded the distal ureter, resulting in the development of hydronephrosis. In addition, a liver mass had a hypointense rim that corresponded to the fibrous wall on a T2-weighted MR image, and showed persistent peripheral enhancement that corresponded to the granulation tissues and fibrous wall on dynamic MR images. These lesions also displayed very intense homogeneous FDG uptake on PET/CT.

Histochemical and polarization microscopic study of two cases of vegetable/pulse granuloma.

Vegetable granuloma (VG) or pulse granuloma (PG) results from the implantation of food particles of plant or vegetable origin. It is usually seen in the periapical or in the sulcus areas. These lesions have been described as a distinct entity and classified into central and peripheral lesions according to the location. Central lesions are asymptomatic, whereas peripheral lesions present as painless sub-mucosal swellings. Many authors have postulated that food particles in VG or PG get implanted and are rapidly digested, and sometimes partly get altered by host responses. The cellulose part of plant foods being indigestible persists in the form of hyaline material, whereas the starch matter gets digested. This cellulose moiety invokes chronic granulomatous response.

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 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.

Cholesterol granuloma coincidence with a large and high jugular bulb: report of a case.

We present a case of right middle ear mass who had an abnormal large jugular foramen, high jugular bulb and large jugular vein on the same side. CT scan could not exclude a glomus tumor. Theoretically, retrograde jugular venography and carotid angiography will give the most useful information. However, in this case we tried to use the MRI scan instead. It showed high signal in T1W, T2W, GRT2W which correlated with blood pigments of methemoglobin in middle ear and mastoid. The low signal in MRI scan T1W, T2W clearly showed enlarged jugular vein, high jugular bulb with diverticulum which helped to excluding a glomus tumor. This finally turned out to be a cholesterol granuloma coincidence with abnormal enlarged jugular foramen and jugular vein. We suggest the MRI scan is very helpful and much safer for patients compared to angiography.

Adult filarial worm (Wuchereria bancrofti) in a benign ovarian tumour.

A case of an adult filarial worm (Wuchereria bancrofti) associated with a benign ovarian tumour and a cyst is presented. Possible reasons for the findings of a well preserved part of the worm and a foreign body granuloma in the lymphatic subendothelium are discussed.

An unusual case of hip disability--(a case report).

An unusual case of postero-superior periarticular irritation of the hip joint of six months' duration due to an extension of a pre-sacral foreign body granuloma in an 18 year old unmarried girl is presented. Two wooden sticks which probably were inserted pervaginally by a village midwife to induce an abortion for an unwanted pregnancy had found its way to presacral region. The scanning of the vaginal fornix indicated a possible route through which the sticks might have been migrated.