Reacción granulomatosa de tipo sarcoideo secundaria a biopolímeros: reporte de caso y revisión de la literatura / Biopolymer sarcoid-like foreign-body granulomas: Case report and literature review

La alogenosis iatrogénica es la enfermedad causada por la aplicación de biopolímeros con fines estéticos. Sus manifestaciones clínicas pueden presentarse entre las seis horas y los 30 años posteriores a la aplicación, con síntomas locales o sistémicos. El principal rasgo de la histopatología es la presencia de granulomas por cuerpo extraño con reacción de tipo sarcoideo, la cual es difícil de Interpretar por su asociación con la sarcoidosis. Se reporta aquí el caso de una paciente con lesiones granulomatosas de tipo sarcoideo por reacción a cuerpo extraño, secundaria a la aplicación de múltiples sustancias desconocidas en cara y glúteos.

Iatrogenic allogenosis is a disease caused by the injection of biopolymers with esthetic purposes. Clinical manifestations can occur between six hours and 30 years after the procedure with local and/or systemic symptoms. The pathological findings are characterized by the presence of foreign body granulomas with a sarcoid-like reaction. Its Interpretation Is difficult given Its association with sarcoidosis. We report the clinical case of a female patient with granulomatous lesions In reaction to a foreign body secondary to the multiple application of unknown substances on the face and buttocks.

Disease presentation and surgical treatment of patients with foreign-body granulomas and ASIA syndrome: case series.

BACKGROUND: The result of illicit polymer injection is chronic inflammation with foreign-body granuloma (FBG) formation. Treatment can be divided into medical and surgical. Some patients develop severe complications with need surgical treatment. This study aims to describe patients who underwent surgical removal of the FBGs and autoimmune/inflammatory syndrome induced by adjuvants (ASIA); additionally, we evaluated the quality of life after surgery. METHODS: In this retrospective single-center study, the authors examined data of patients who underwent surgical removal of FBG caused by illicit polymer injection for cosmetic purposes and confirmed ASIA from 2015 to 2020 by three different surgical approaches. Descriptive summary statistics were reported on patient demographics, presenting symptoms and clinical examination features, treatment strategies, histopathology reports and quality of life. RESULTS: The cohort included 11 female patients with FBGs and ASIA. The most affected anatomical zones were the combination of gluteal region, thighs and legs (40%); and thighs with legs (20%). Main presentation was: skin hyperpigmentation (90.9%), skin induration (63.6%), chronic fatigue (63.6%), and ulcers (36.4%). Surgical modalities consisted of: ultrasonic-assisted liposuction in four patients (36.4%); open en bloc excision and primary closure in four patients (36.4%); and open en bloc excision and microsurgical reconstruction in three patients (27.2%). The postoperative quality of life visual analog scale score was 83.9. CONCLUSIONS: ASIA treatment represents a challenge for the plastic surgeon. Adequate surgical treatment emphasizing, when possible, the total or near-total resection of the FBG must be performed to improve ASIA evolution.

How we do it: impacted oesophageal foreign body removal using a dilatation balloon.

BACKGROUND: Ingested foreign bodies are a common presentation to paediatric ENT services. Depending on the site, these are usually managed with flexible or rigid oesophagoscopy and retrieval. This paper presents a novel technique for removing a hollow foreign body that could not be removed using conventional means. METHOD AND RESULTS: After rigid and flexible approaches failed, a guidewire was passed through the foreign body under fluoroscopic guidance and a dilatation balloon passed through the lumen of the object. Inflating the balloon allowed dilatation of the inflamed mucosa above and below the object, facilitating straightforward removal under traction. CONCLUSION: This is a novel and reproducible technique that uses equipment readily available in tertiary referral centres. Employed in this context, the technique enabled removal of an impacted object surrounded by granulation tissue, and would be appropriate for other objects with a lumen.

Evaluation and management of facial granuloma caused by various injection materials.

BACKGROUND: Various substances are currently being used for cosmetic or postsurgical reconstruction reasons. Injecting of various materials into the face may provoke inflammatory or granulomatous reactions, infection and tissue necrosis. Among these reactions are foreign body granulomas. This study aims to describe the clinical characteristics of and therapeutic approaches used in patients with facial foreign body granulomas caused by the injection of various substances. METHODS: From 2007 to 2020, a total of 64 patients visited our hospital due to inflammatory signs, palpable masses or surface irregularities. We reviewed patient characteristics, type of injected material, medical history and treatment outcomes. The treatment results were scored with patient satisfaction and statistical analysis of the treatment period was performed. RESULTS: Most patients underwent conservative treatment followed by surgical treatment because of persistent symptoms; one patient did not require surgery. All patients reported good treatment results and satisfaction. The earlier the surgical treatment was performed, the shorter the treatment period and the higher patient satisfaction scoring. CONCLUSION: Granulomatous changes to the face are an emerging concern in various cosmetic procedures and surgeries, including fillers, silicone implants and autologous fat injections. Our findings strongly suggest that patient symptoms require accurate diagnosis and surgical treatment.

Sea Urchin Granuloma of the Hands: A Case Report.

Penetrating wounds from sea urchin spines are marine injuries that may cause morbidity in humans. Seasonal fishing for abalone in Dhofar is associated with an increase in the number of these injuries, as divers may strike their extremities, especially the dorsum of hands and fingers, on the rocks where Echinoderms and juvenile abalone (Haliotis mariae) are anchored. The immediate effect of injuries includes pain, edema, bleeding, erythema, and rarely systemic complications. There can be a delayed effect in the form of chronic granulomatous skin disease, which is a slow developing reaction to retained spine fragments in the wound that may take several months to develop. We report a case of sea urchin granulomas in a 45-year-old male who injured his hands by the spines of sea urchin while harvesting Haliotis mariae. Clinical manifestations, histological patterns, and treatment modalities are discussed here, to enhance the knowledge about these injuries and the available therapies.

Diagnostic value of integrated ¹8F-fluoro-2-deoxyglucose positron emission tomography/computed tomography in recurrent epithelial ovarian cancer: accuracy of patient selection for secondary cytoreduction in 134 patients.

OBJECTIVE: The aim of this study was to evaluate the diagnostic value of integrated ¹8F-fluoro-2-deoxyglucose-positron emission tomography/computed tomography (¹8F-FDG-PET/CT) for suspected recurrence of epithelial ovarian cancer (EOC) with non-disseminated lesions. METHODS: We retrospectively reviewed the medical records of recurrent EOC patients who underwent secondary cytoreduction from January 2000 to December 2013. A total of 134 patients underwent secondary cytoreduction after imaging with either ¹8F-FDG-PET/CT or contrast-enhanced computed tomography (CECT). RESULTS: In a patient-based analysis of 134 patients, 124 (92.5%) were confirmed to be positive for malignancy. Among 72 patients with suspected non-disseminated recurrence on ¹8F-FDG-PET/CT, 65 (89.0%) were confirmed to have recurrence, giving 98.5% sensitivity, 87.7% accuracy, and 88.9% positive predictive value (PPV). In the 65 patients with recurrence, residual tumor remained in 14 patients, giving an accuracy of patient selection for secondary cytoreduction of 69.4% (50/72) and it is higher than that of CECT (64.0%). In 169 lesions removed from patients who underwent preoperative ¹8F-FDG-PET/CT, 135 (79.9%) were confirmed to be positive for malignancy and 124 were accurately detected by ¹8F-FDG-PET/CT, giving 91.9% sensitivity, 81.1% accuracy, and 85.5% PPV. Foreign body granuloma was found in 33.3% of 21 lesions with false-positive ¹8F-FDG-PET/CT findings (7/21). The mean preoperative cancer antigen 125 (CA-125) level in false-positive patients was 28.8 U/mL. CONCLUSION: Compared with CECT, ¹8F-FDG-PET/CT shows higher sensitivity in lesion-based analysis and better accuracy of patient selection for secondary cytoreduction. However, there is still a need for integration of the results of ¹8F-FDG-PET/CT, CECT, and CA-125 levels to aid treatment planning.

Delayed Granulomas after Filler Injection in an Immunosuppressed Patient: A Case Report

Recently, dermal fillers have been used with increasing frequency to improve facial contours for cosmetic purposes. The appreciable increase in such filler procedures has led to more adverse events and complications. Herein, we report the clinical significance and differential diagnosis of delayed multiple granulomas that occurred in a patient with a history of an injection of an unknown substance as a filler 20 years previously. She was also taking oral steroids and tacrolimus for immune suppression after a kidney transplant that she received 10 years before she presented with granulomas.

Diagnostic value of integrated ¹⁸F-fluoro-2-deoxyglucose positron emission tomography/computed tomography in recurrent epithelial ovarian cancer: accuracy of patient selection for secondary cytoreduction in 134 patients / 부인종양

OBJECTIVE: The aim of this study was to evaluate the diagnostic value of integrated 18F-fluoro-2-deoxyglucose-positron emission tomography/computed tomography (18F-FDG-PET/CT) for suspected recurrence of epithelial ovarian cancer (EOC) with non-disseminated lesions. METHODS: We retrospectively reviewed the medical records of recurrent EOC patients who underwent secondary cytoreduction from January 2000 to December 2013. A total of 134 patients underwent secondary cytoreduction after imaging with either 18F-FDG-PET/CT or contrast-enhanced computed tomography (CECT). RESULTS: In a patient-based analysis of 134 patients, 124 (92.5%) were confirmed to be positive for malignancy. Among 72 patients with suspected non-disseminated recurrence on 18F-FDG-PET/CT, 65 (89.0%) were confirmed to have recurrence, giving 98.5% sensitivity, 87.7% accuracy, and 88.9% positive predictive value (PPV). In the 65 patients with recurrence, residual tumor remained in 14 patients, giving an accuracy of patient selection for secondary cytoreduction of 69.4% (50/72) and it is higher than that of CECT (64.0%). In 169 lesions removed from patients who underwent preoperative 18F-FDG-PET/CT, 135 (79.9%) were confirmed to be positive for malignancy and 124 were accurately detected by 18F-FDG-PET/CT, giving 91.9% sensitivity, 81.1% accuracy, and 85.5% PPV. Foreign body granuloma was found in 33.3% of 21 lesions with false-positive 18F-FDG-PET/CT findings (7/21). The mean preoperative cancer antigen 125 (CA-125) level in false-positive patients was 28.8 U/mL. CONCLUSION: Compared with CECT, 18F-FDG-PET/CT shows higher sensitivity in lesion-based analysis and better accuracy of patient selection for secondary cytoreduction. However, there is still a need for integration of the results of 18F-FDG-PET/CT, CECT, and CA-125 levels to aid treatment planning.

Magnetic resonance imaging appearance of foreign-body granulomatous reactions to dermal cosmetic fillers.

Foreign body granulomas can develop after the injection of various cosmetic filling materials into the facial area to flatten wrinkles. Clinically, reactive lesions are easily mistaken for soft-tissue neoplasms or cysts. This report presents a case of foreign body granuloma in a 52-year-old female patient complaining of a painless swelling in the nasolabial region. Both clinical and histological features are described, underscoring the diagnostic role of magnetic resonance imaging findings.

Pencil-core granuloma

Abstract: Pencil core granulomas are still infrequently reported in the literature. A 67-year-old woman presented with a 4mm hard blue subcutaneous nodule on the forehead. She remembered being injured with a pencil tip about 60 years before. The subcutaneous nodule was excised, which microscopically revealed a foreign body reaction with histiocytes containing fragmented coarse black particles. We diagnosed pencil-core granuloma based on the patient's history of pencil tip injury and histological examination findings.

Pulmonary foreign body granulomatosis in a chronic user of powder cocaine / Granulomatose pulmonar de corpo estranho em um usuário crônico de cocaína em pó

ABSTRACT We describe the case of a 33-year-old man, a chronic user of powder cocaine, who presented with dyspnea, fever, night sweats, and significant weight loss. Chest HRCT revealed centrilobular nodules, giving an initial impression of miliary tuberculosis. Therefore, he was started on an empirical, four-drug antituberculosis treatment regimen. Four weeks later, despite the tuberculosis treatment, he continued to have the same symptoms. We then performed transbronchial lung biopsy. Histopathological analysis of the biopsy sample revealed birefringent foreign body granuloma. A corroborative history of cocaine snorting, the presence of centrilobular nodules, and the foreign body-related histopathological findings led to a diagnosis of pulmonary foreign body granulomatosis. This report underscores the fact that pulmonary foreign body granulomatosis should be included in the differential diagnosis of clinical profiles resembling tuberculosis.

RESUMO Descrevemos o caso de um homem de 33 anos de idade, usuário crônico de cocaína em pó, que apresentava dispneia, febre, sudorese noturna e perda de peso significativa. A TCAR de tórax revelou nódulos centrolobulares, dando uma impressão inicial de tuberculose miliar. Por isso, o paciente passou a receber tratamento empírico com quatro tuberculostáticos. Quatro semanas depois, apesar do tratamento antituberculose, o paciente continuou a apresentar os mesmos sintomas. Foi então realizada a biópsia pulmonar transbrônquica. A análise histopatológica da amostra obtida revelou granuloma de corpo estranho birrefringente. A história de uso de cocaína por inalação, a presença de nódulos centrolobulares e os achados histopatológicos de corpos estranhos confirmaram o diagnóstico de granulomatose pulmonar de corpo estranho. Este relato destaca o fato de que a granulomatose pulmonar de corpo estranho deve ser incluída no diagnóstico diferencial de perfis clínicos que se assemelham a tuberculose.

Necrose de parafinoma peniano após injeção de óleo mineral por profissional não médico / Penile paraffinoma necrosis after mineral oil injection applied by a non-medical professional

Parafinoma decorre da implantação de óleo mineral na pele, sendo caracterizado por reação inflamatória do tipo corpo estranho com período de latência variável. As lesões iniciais são nódulos endurecidos, que podem ulcerar, fistulizar ou necrosar. Esta técnica foi muito utilizada para fins estéticos no século XX, não sendo mais realizada por médicos. Contudo, ainda é empregada por profissionais não médicos ou pelos próprios pacientes, principalmente na região genital, para melhoria da prática sexual. Relata-se caso de implante de óleo mineral no pênis, realizado por profissional não médico para fins estéticos, que evoluiu com necrose após três anos.

Paraffinoma results from the implantation of mineral oil in the skin, being characterized by inflammatory reaction of foreign body type, with variable latency period. Initial lesions consist of hardened nodules, which can ulcerate, fistulate or necrose. This technique was widely used for aesthetic purposes in the 20th century, and is no longer performed by physicians. However, it is still used by non-medical professionals or by the patients themselves, mainly in the genital region, aimed at improving sexual activity. This paper reports a case of implantation of mineral oil in the penis, performed by a non-medical professional, for aesthetic purposes that evolved with necrosis after three years.

Magnetic resonance imaging appearance of foreign-body granulomatous reactions to dermal cosmetic fillers

Foreign body granulomas can develop after the injection of various cosmetic filling materials into the facial area to flatten wrinkles. Clinically, reactive lesions are easily mistaken for soft-tissue neoplasms or cysts. This report presents a case of foreign body granuloma in a 52-year-old female patient complaining of a painless swelling in the nasolabial region. Both clinical and histological features are described, underscoring the diagnostic role of magnetic resonance imaging findings.

Atypical Facial Filler Granuloma: Comparative Histologic Analysis with Paraffinoma.

Dermal fillers are generally accepted as safe and well-tolerable cosmetic tools. However, adverse reactions have been reported in the literature. Here, we present a case of atypical facial filler granuloma and compare its histologic features with those of the classic paraffinoma.

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.

Atypical Facial Filler Granuloma: Comparative Histologic Analysis with Paraffinoma

Dermal fillers are generally accepted as safe and well-tolerable cosmetic tools. However, adverse reactions have been reported in the literature. Here, we present a case of atypical facial filler granuloma and compare its histologic features with those of the classic paraffinoma.

Atypical Facial Filler Granuloma: Comparative Histologic Analysis with Paraffinoma

Dermal fillers are generally accepted as safe and well-tolerable cosmetic tools. However, adverse reactions have been reported in the literature. Here, we present a case of atypical facial filler granuloma and compare its histologic features with those of the classic paraffinoma.

Foreign body granulomas after the use of dermal fillers: pathophysiology, clinical appearance, histologic features, and treatment.

A foreign body granuloma is a non-allergic chronic inflammatory reaction that is mainly composed of multinucleated giant cells. Foreign body granulomas may occur after the administration of any dermal filler. Factors such as the volume of the injection, impurities present in the fillers, and the physical properties of fillers affect granuloma formation. The formation of granulomas involves five phases: protein adsorption, macrophage adhesion, macrophage fusion, and crosstalk. The clinical and pathologic features of granulomas vary depending on the type of filler that causes them. Foreign body granulomas can be treated effectively with intralesional corticosteroid injections. Surgical excisions of granulomas tend to be incomplete because granulomas have ill-defined borders and moreover, surgical excisions may leave scars and deformities.

Foreign Body Granulomas after the Use of Dermal Fillers: Pathophysiology, Clinical Appearance, Histologic Features, and Treatment

A foreign body granuloma is a non-allergic chronic inflammatory reaction that is mainly composed of multinucleated giant cells. Foreign body granulomas may occur after the administration of any dermal filler. Factors such as the volume of the injection, impurities present in the fillers, and the physical properties of fillers affect granuloma formation. The formation of granulomas involves five phases: protein adsorption, macrophage adhesion, macrophage fusion, and crosstalk. The clinical and pathologic features of granulomas vary depending on the type of filler that causes them. Foreign body granulomas can be treated effectively with intralesional corticosteroid injections. Surgical excisions of granulomas tend to be incomplete because granulomas have ill-defined borders and moreover, surgical excisions may leave scars and deformities.

Tracheobronchial foreign body aspiration demonstrating serial bronchopulmonary changes on computed tomography.

INTRODUCTION: Tracheobronchial foreign body may often be treated as asthma, chronic bronchitis or etc. especially in patients with no memories of aspiration episodes. CASE PRESENTATION: A 74-year-old woman, suffering from persistent cough, was temporarily misdiagnosed with allergic bronchopulmonary aspergillosis and treated for six months. During this period, computed tomography (CT) findings changed from thickened bronchial walls and a "tree-in-bud" pattern to clubbing bronchiectasis and atelectasis, and no significant bacteria was detected. Finally, a vegetable core was subsequently extracted via flexible bronchofiberscopy. Although the patient's symptoms improved dramatically, the bronchopulmonary lesion remained practically. CONCLUSIONS: We assume that chronologic CT findings of the bronchopulmonary damage by aspiration of a vegetable core, without significant detection of bacteria during the course, will be quite valuable for clinicians.