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Facial granulomas secondary to Dermalive microimplants: Report of a case with histopathologic differential diagnosis among the granulomas secondary to different injectable permanent filler materials.

Wrinkle reduction and the correction of skin defects using injectable aesthetic microimplants are now widely performed by dermatologists and plastic surgeons. In recent years, dermal filler substances containing polymer particle suspensions such as Bioplastique, Artecoll, and Dermalive are the most commonly used materials. These microimplants are permanent, non-biodegradable, and generally well tolerated, although various adverse reactions are still possible. We describe here a patient with facial granulomas secondary to Dermalive injections for correction of naso-labial folds and wrinkles. The particular shape of the injected particles allows for correct identification of the implanted material. Therefore, histopathologic examination is the best means to obtain the correct diagnosis of foreign body granuloma and to identify the type of filler particles. We discuss the histopathologic differential diagnosis among the granulomas secondary to the most commonly used aesthetic permanent filler materials.

Acrylates↗

Necrobiotic granulomas localised to the penis: a possible variant of subcutaneous granuloma annulare.

Three young men developed multiple firm asymptomatic nodules confined to the shaft of the penis. Skin biopsies from all 3 cases showed prominent necrobiotic granulomas indistinguishable from granuloma annulare. One of the patients had repeated recurrent nodules confined to the penis which were removed surgically over a period of 20 months. This unusual, but benign, presentation of granuloma annulare has to be distinguished from other granulomatous and malignant processes which may present as penile nodules.

Adult↗

The effect of sho-saiko-to on the concentration of acid soluble glycoprotein in serum and on granuloma formation in carrageenin cotton pellet-induced granuloma rats.

The effect of sho-saiko-to on the concentration of acid soluble glycoprotein in serum and on the granuloma formation in carrageenin cotton pellet-induced rats was investigated. As a result, a significant negative correlation between the concentration of acid soluble glycoprotein and granuloma weight was observed. Furthermore, both the concentration of acid soluble glycoprotein and the inhibition rate of the granuloma formation were significantly higher in the sho-saiko-to group than in the control group. These results suggest that acid soluble glycoprotein plays an important role in promoting the anti-inflammatory effect of sho-saiko-to.

Acute-Phase Proteins↗

New solitary cysticercus granulomas causing recurrent symptoms in patients with resolved solitary granulomas.

Recurrence of symptoms in a patient with a resolved solitary cerebral cysticercus granuloma (SCCG) is uncommon. Recurrent seizures in these patients are generally attributed to an epileptogenic scar or calcific residue of the granuloma. We report two patients with recurrent seizures and one patient with headache; all three patients were previously diagnosed to have SCCG and had complete resolution of the granuloma on follow-up imaging. Computed tomography (CT) at the time of recurrent symptoms showed a SCCG at a site different from the initial lesion, but in the same cerebral hemisphere in all the three patients. Since a new lesion can cause recurrent symptoms in patients with a resolved SCCG, repeat imaging should be performed in all these patients. We also postulate that recurrent cysticercal lesions in patients who have previously had a SCCG, tend to be solitary.

Animals↗

Contribution to the radiological study of the eosinophilic granuloma of the mandible (unifocal granuloma due to Langerhans' cell histiocytosis).

PURPOSE: The radiological diagnosis of osteolytic lesions of the mandible still constitutes a challenge in some pathological conditions in which the clinical data and the case history are relatively uniform and the radiological picture is lacking in any characteristics. MATERIALS AND METHODS: We reviewed the conventional radiograms of six cases of Langerhans' cell histiocytosis (LCH) of the mandible examined over the last ten years. The X-ray examinations were performed in the lateral-oblique projection to allow a view of the horizontal portion of the mandible almost completely free of overlapping images of other bone structures. RESULTS: We identified a series of radiological patterns for these reticulo-endotheliopathies capable of causing granuloma formed by polynuclear eosinophils, plasma cells, lymphocytes, and large mononuclear macrophages with granulopexic and phagocytic activity that proliferate in the bone tissue and can be identified as the Langerhans' cells of skin, mucosa, periodontal cavities and bone marrow. The granulomatous tissue penetrates the affected organ elements and, in its spread, it compresses, atrophies, and destroys the damaged tissue, replacing it. The alterations produced by Langerhans' cell histiocytic granuloma are most common in the skeletal system affecting, in order of frequency, the skull, the long bones of the limbs, the foot, the ribs and the spine. The oral mucosa is rarely involved. CONCLUSIONS: The radiological investigation of unifocal Langerhans' cell histiocytic granuloma of the mandible is essential in the study of perimandibular swelling, although diagnosis is based on biopsy alone. In addition to digital or conventional radiography, other useful examinations are bone scintigraphy, Colour Doppler US, MR and CT, which enables a correct localisation necessary for planning the biopsy and treatment.

Adult↗

Experimental production of pulmonary granulomas. IV. Eosinophilic granuloma.

Pulmonary granulomas induced in rabbits by the endobronchial instillation of mycobacterial chemical fractions were re-examined for eosinophilic infiltration. Delayed type hypersensitivity reactions either of tuberculin type or of wax D type did not induce but rather suppressed eosinophilic infiltration in the inflamed area, although some peptidoglycans which are antigenic for the induction of immediate hypersensitivity and fatty acid fractions were weak stimulators of eosinophilic infiltration. Bacterial endotoxin, LPS, was a potent stimulator. It was found that some long chain fatty acids can cause severe eosinophilic infiltration in the induced granulomas. Arachidonic acid was the most active of those examined, so the activity of its metabolites was tested and PGE2 was found to be most active. As the eosinophilic infiltration was markedly suppressed in animals treated with a cyclooxygenase inhibitor (aspirin), the stimulators of eosinophilic infiltration were not fatty acids themselves but their metabolites, PGE2 and some others. The site of permeation of eosinophils from the circulation was found to be arteriolar in the inflamed lung. The granulomatous lesion with eosinophilic infiltration in rabbits is discussed to shed light on the aetiology of eosinophilic granuloma in the human lung.

Animals↗

[Differential diagnostic aspects of lethal midline granulomas (granuloma gangraenescens].

The lethal midline granuloma and limited Wegener's granulomatosis show clinical similarity, although they are of different etiology. The following case of a 53-year-old woman shows how difficult it is to establish the precise diagnosis of lethal midline granuloma. The diagnosis depends on the pathological finding of a lymphoma. The lymphoma can be differentiated in a T- or a B-cell lymphoma by immunostaining. However, the diagnostic yield of biopsies from the nose is not perfect. It would be, therefore, important to find other diagnostic criteria. The presence of the c-ANCA is a helpful tool, but in the case of limited Wegener's granulomatosis, it has a sensitivity of 50%. The prognosis of the lethal midline granuloma is poor even if an adequate radiation therapy is instituted.

Diagnosis, Differential↗

[Reticular elastolytic giant cell granuloma. A variant of the annular elastolytic giant cell granuloma].

The case report presented describes a new variant of annular elastolytic giant cell granuloma. Over a period of 10 years, a 40-year-old woman had developed reticular, brown to livid, partly atrophic skin lesions on the shoulders and decolletée. The patient had no subjective symptoms. Histology revealed a patchy lymphohistiocytic infiltrate in the dermis, with many giant cells. Elastic fibres were less frequently found in these infiltrates; in a few of the giant cells and macrophages fragments of elastic fibres were demonstrated within the cytoplasm. There were no deposits of mucin. For this new variant we propose the term "reticular elastolytic giant cell granuloma."

Adult↗

Lethal midline granuloma starting as granuloma laryngis.

We report a case of lethal midline granuloma in a 34-year-old male patient. The patient was referred to our hospital because of long-lasting hoarseness. He was treated for granuloma laryngis. After two years nasal obstruction developed followed by ulceration of the hard palate and destruction of part of the nose and the upper lip. A biopsy demonstrated polymorphic infiltrate consisting of small lymphocytes, plasma cells, macrophages, atypical lymphoid cells and eosinophils. Radiotherapy was very effective and led to long-term remission. The different etiological aspects of this syndrome are discussed.

Adult↗

Synthetic fiber granuloma. 'Teddy bear' granuloma of the conjunctiva.

Conjunctival synthetic fiber ("teddy bear") granulomas result from a granulomatous response to synthetic fabric fibers introduced into the conjunctival sac. There is a striking propensity for these lesions to develop in the pediatric age group, to be unilateral, and to be situated in the inferior conjunctival fornix. It is believed that proximity of the eye to comforting blankets, fabric toys, or forcibly applied pullover sweaters may provide the opportunity for ocular inoculation. Described below is the case of a 6-year-old girl who had a conjunctival synthetic fiber granuloma that exhibited the characteristic clinical and pathologic features of these lesions.

Child↗

Pyogenic granuloma: pyogenic again? Association between pyogenic granuloma and Bartonella.

BACKGROUND: Pyogenic granulomas (PG) are benign vascular lesions which were thought to have an infectious etiology, yet none has been found. Bacillary angiomatosis (BA), which presents as disseminated vascular lesions in immunosuppressed patients, and verruga peruana (VP), which presents as crops of vascular nodules in immunocompetent persons, are caused by infection with Bartonella. Thus, the question was raised whether Bartonella could be associated with the development of PG, also a vasoproliferative lesion like BA and VP. The objective of this study was to determine through a case-control study whether such an association exists. METHODS: Patients who presented with PG and age and sex-matched controls with capillary hemangiomas and senile (cherry) angiomas were tested for serum IgG antibodies against Bartonella using an immunofluorescence antibody method. The prevalence of positive serology was compared between the groups. RESULTS: Twenty PG patients and 20 control patients with hemangiomas or angiomas were studied. Six out of 20 PG patients tested positive (30%), while none of the 20 control patients tested positive (0%). The difference between the proportions of seropositivity in the two groups reached statistical significance (p = 0.02, df = 1). CONCLUSIONS: Pyogenic granuloma patients were determined to have a statistically higher prevalence of Bartonella seropositivity compared with control patients. Further studies are needed to confirm the association and establish a possible etiological link. Such an association could have potential therapeutic importance. A nonsurgical approach with antibiotics may be possible and may decrease the recurrence rate and occurrence of satellite lesions.

Adult↗

Immunohistologic separation of B-cell-positive granulomas from B-cell-negative granulomas in paraffin-embedded tissues with special reference to tumor-related sarcoid reactions.

Frozen and formalin-fixed paraffin-embedded tissue sections were studied concurrently in 17 cases of granulomatous lesions of different etiologies using antibodies recognizing either fixation-sensitive or fixation-resistant antigens. In fixed tissues, the antibodies 4KB5 and L26 for B cells and UCHL1 and MT1 for T cells gave results similar to those obtained in frozen tissues with anti-leu-12/leu-14 for B cells and T-3 for T cells. Paraffin-embedded sections from 35 additional cases of granulomatous lesions were studied retrospectively using the same markers. The combined results from all 52 cases show that granulomas can be divided into two main "families" according to the presence or absence of B cells within the granulomas: one is a B-cell-negative family of lesions to which sarcoidosis and mycobacterial infection belong; the other is a B-cell-positive family of lesions to which toxoplasmosis, granulomatous lesions of unknown significance and tumor-related sarcoid reactions belong.

Antibodies, Monoclonal↗

The Schistosoma japonicum egg granuloma. II. Cellular composition, granuloma size, and immunologic concomitants.

Studies of granulomatous hypersensitivity to Schistosoma japonicum eggs were performed at various time periods up to 20 wk after the induction of light infections in mice. Cell populations which were determined in granulomas isolated from the livers revealed a maximum in the total number of cells at 6 wk with a decline of 36% by 20 wk. Large mononuclear cells were predominant at all time periods, with eosinophils being the second most common cell. Measurements of granuloma diameters around single viable eggs in the livers also revealed peak size at 6 wk with a decline of 51% between 16 and 24 wk. Immunodiffusion analysis demonstrated the presence of precipitating antibodies as early as 7 wk after infection. Investigations of lymphocyte blastogenesis revealed a profound depression in response to T-cell mitogens by 8 wk of infection. Studies of footpad swelling to soluble S. japonicum egg antigens revealed massive immediate reactions starting at 6 wk. but no delayed reactivity over a period from 3 to 20 wk. All of these results are related to differences in the biology of S. japonicum in comparison with S. mansoni with respect to the earlier onset of egg production, the much larger numbers of eggs produced, and the possibility of differences in the antigens emitted by the eggs.

Animals↗

Annular elastolytic giant cell granuloma--actinic granuloma?

A 56-year-old woman with annular elastolytic giant cell granuloma is reported. She had annular, slowly growing lesions on sun-exposed areas and the dorsum of one foot. Biopsies from both areas revealed a mid-dermal inflammatory infiltrate with many giant cells engulfing elastic fibres. The current nosological situation of this process is discussed. Actinic granuloma (AG) is a term coined by O'Brien in 1975 to describe a cutaneous process characterized by multiple annular lesions located on sun-exposed skin areas. The histopathology is defined by the presence of multinucleated giant cells containing elastic fibres at the lesion edge, and the absence of these fibres at the lesion centre. The nosology of this disease and the role of actinic exposure as a triggering factor for it has been much discussed in recent years. We report a new case of AG not limited to photo-exposed areas.

Female↗

Zirconium granuloma resulting from an aluminum zirconium complex: a previously unrecognized agent in the development of hypersensitivity granulomas.

Zirconium compounds have been associated with the development of hypersensitivity granulomas. However, aluminum zirconium complexes have not previously been shown to induce sensitization. We present the clinical and histologic findings of a case in which a patient developed an acute hypersensitivity reaction to an aluminum zirconium complex.

Adult↗

Eosinophilic granuloma of the clivus: case report, follow-up of two previously reported cases, and review of the literature on cranial base eosinophilic granuloma.

OBJECTIVE AND IMPORTANCE: To our knowledge, this is the first reported case of the use of stereotactic radiotherapy for an eosinophilic granuloma (EG) of the clivus. We report follow-up information on two previously reported cases and suggest a management plan for this rare lesion. CLINICAL PRESENTATION: We report the case of a 4.5-year-old boy who presented with a complete abducens palsy on the right with an associated head turn. A computed tomographic scan of his head revealed a lytic lesion on that side, and magnetic resonance imaging showed the mass to be of low intensity on T1-weighted images and of high intensity on T2-weighted images with heterogeneous enhancement. INTERVENTION: A transnasal stereotactic biopsy was performed, revealing an EG. The patient was treated with stereotactic radiotherapy, and he became symptom-free with radiographic resolution of his lesion. Reviewing the literature, we found 13 series with 87 cases of EG in the petrous portion of the temporal bone. EG in the cranial base occurring outside of the temporal bone or in the temporal bone and extending intracranially is, however, quite rare, with only nine other cases reported, two of them clival. CONCLUSION: These findings suggest a classification schema in which cranial base EG lesions be grouped with either the more common extracranial petrous temporal bone lesions or the very rare intracranial lesions. Although there are few cases in the literature, treatment results indicate that clival EG, and perhaps all intracranial cranial base EGs, be treated by a biopsy alone, followed by surgery or stereotactic radiotherapy if there is an incomplete resolution of the symptoms or if there is a recurrence.

Child, Preschool↗