Dense Fibrous Bands Research Articles

Fibrolamellar Hepatocellular Carcinoma in Young Adult: A Case Report and Literature Review

Fibrolamellar carcinoma (FLC), a truly unique and uncommon variation of hepatocellular carcinoma (HCC), accounting for barely 1%–9% of all HCC cases. Fibrolamellar carcinoma, an unclear malignancy, appears to be more commonly observed in youthful individuals without any preexisting liver conditions. The nomenclature "fibrolamellar" originates from the presence of dense fibrous collagen bands enveloping the neoplastic cells. Contrary to hepatocellular carcinoma (HCC), cirrhosis and viral hepatitis infection do not serve as predisposing factors for fibrolamellar carcinoma (FLC). Additionally, FLC is not typically associated with increased levels of serum alpha-fetoprotein. Patients with FLC frequently manifest with nonspecific abdominal discomfort, queasiness, general discomfort, and decreased in body mass. Surgical intervention, specifically resection or liver transplantation, serves as the cornerstone of treatment and represents the sole potentially curative avenue. FLCs, or fibrolamellar carcinomas, have historically exhibited lower responsiveness to chemotherapy compared to conventional hepatocellular carcinomas (HCC). Nevertheless, it is important to note that in cases of advanced FLCs, the utilization of multi-modality treatments has shown promising effectiveness. The purpose of this review is to explain the clinical characteristics, diagnostic techniques, and therapeutic approaches for this uncommon tumor in order to enhance the knowledge of healthcare professionals.

Ellagic acid increases implantation rates with its antifibrotic effect in the rat model of intrauterine adhesion.

Intrauterine adhesions (IUA) are defined as the adhesion of opposing endometrial tissue with dense fibrous adhesive bands within the uterine cavity. With the increase in cesarean sections and endometrial surgical procedures, intrauterine adhesions have become a problem with increasing incidence and decreasing implantation. The purpose of the study was to investigate the effect of ellagic acid (EA), a phenolic compound, on fibrosis in IUA model rats. Another goal of the study was to increase endometrial receptivity with EA. The groups in the study were planned as control, DMSO, EA, IUA, IUA+DMSO, and IUA+EA, with 8 Sprague Dawley rats in each group. EA was administered at a dose of 100mg/kg/day for 35 days. At the end of the experiment, the uterine tissues of the rats were removed. Histochemical staining was used to validate the IUA model and determine the degree of fibrosis. The levels of some fibrosis-related genes and proteins in the obtained uterine tissues were evaluated. In addition, implantation rates were determined. In our findings, it was observed that the fibrotic structure was decreased in the treated IUA+EA group compared to the IUA group, while fibrotic improvement was supported by down-regulation of TGFβ1 activity and up-regulation of BMP7 activity. The increase in the expression of the endometrial marker LIF with EA treatment was consistent with the increase in implantation rates with treatment. As a result of the study, it can be said that EA applied as a treatment against IUA causes healing in uterine tissue by reducing fibrosis and increases implantation rates by increasing endometrial receptivity.

Timolol For the Treatment of Infected Pyogenic Granuloma (pg) Over the Nose.

Pyogenic granuloma (PG) is a benign vascular neoplasm, which exhibits several clinical features suggestive of reactive neovascularization. It is common in children and young adults, with a slight predominance in women. PG may occur spontaneously or may result from local trauma. Histologically the lesion of pyogenic granuloma. Proliferating capillaries are often grouped into lobules by dense fibrous bands, hence the synonym lobular capillary hemangioma The lesion is often clutched by an epithelial. On dermoscopy Red homogenous areas intersected by whitish lines – most common in pyogenic granuloma. There are no standard guidelines for the management of PG So invasive or noninvasive approach. Key Message Topical timolol therapy may be the first line of treatment for infected pyogenic granulomas; no adverse systemic effects were reported, over delicate areas like the nose - face on young children, older people, where invasive methods are not preferred, topical timolol may be a therapy option. Objectives to determine whether topical timolol is safe and effective for treating Infected pyogenic granulomas.. Methods We report an A 15-year-old female patient came in with a history of a single, rapidly expanding red lesion on the left side of her nose that had been developing in size for more than a month and was accompanied by minor pain and itching. In addition to unilateral purulent discharge from inside the nose, there was a history of a mild bleeding episode a few days before to consultation. The patient disclosed that she had her nose pierced a month earlier. Suggesting that infected pyogenic granuloma (PG) may coexist. The patient was prescribed timolol twice daily and trimethoprim/polymyxin four times daily with a pyogenic granuloma as the presumptive diagnosis. Results Significant improvement was noted with topical timolol with reduction of the lesion size decrease of bleeding tendency and here symptoms had resolved. Limitations we observed Effects of treatment only in 8 weeks. Conclusion Infected pyogenic granulomas may benefit from topical timolol therapy Longer studies are needed to evaluate resolution and recurrence Rates.

Assessment of Changes in Birefringence and Orientation of Collagen Fibres in Different Grades of Oral Submucous Fibrosis and Oral Squamous Cell Carcinoma using Picrosirius Red and Polarising Microscopy

Introduction: Oral submucous fibrosis (OSMF) is a potentially malignant disease with a prevalence of 7-13%. It is characterised by the fibroelastic changes due to excessive deposition of collagen which results in dense fibrous bands and epithelial changes. About 90-95% of oral cancers are Oral Squamous Cell Carcinoma (OSCC). Stroma produced by the invading neoplastic cells are rich in collagen fibres. These collagen fibers have been the main focus of study to understand the pathogenesis of these lesions. Hence, these fibres have been evaluated under polarised microscopy following staining with Picrosirius red stain. Aim: To evaluate changes in birefringence, thickness and orientation of collagen fibres in different histopathological stages of OSMF and OSCC. Materials and Methods: This observational study involved sections of clinically and histopathologically confirmed cases of OSCC and OSMF from Department of Oral Pathology and Microbiology, Rajarajeswari Dental College and Hospital, Bangalore. The study was conducted for a duration of one year from April 2017 to March 2018. The study included total 60 cases among which 20 for each-normal mucosa, OSCC and OSMF. Tissue sections were stained with Picrosirius red stain and collagen fibres were analysed for colour, thickness and orientation under polarised microscope. Chi-square test was used for statistical analysis. Significance was set at p-value <0.05. Results: Comparison of birefringence of collagen fibres between OSMF, OSCC and normal mucosa was not statistically significant (p-value=0.37). Orientation of collagen fibres between OSMF, OSCC and normal mucosa was statistically significant with (p-value=0.02). Conclusion: This study showed a change in colour from yellow orange to orange red in advanced OSMF cases which indicated progression of disease and tightly packing of collagen fibres, suggestive of presence of thick fibres in the extracellular matrix. In OSCC, the colour change from yellow orange to orange red and haphazardly arranged collagen fibres was indicative of transformation of preneoplastic to carcinoma stage.

Molecular characterization and function of tenomodulin, a marker of tendons and ligaments that integrate musculoskeletal components.

SummaryTendons and ligaments are dense fibrous bands of connective tissue that integrate musculoskeletal components in vertebrates. Tendons connect skeletal muscles to the bone and function as mechanical force transmitters, whereas ligaments bind adjacent bones together to stabilize joints and restrict unwanted joint movement. Fibroblasts residing in tendons and ligaments are called tenocytes and ligamentocytes, respectively. Tenomodulin (Tnmd) is a type II transmembrane glycoprotein that is expressed at high levels in tenocytes and ligamentocytes, and is also present in periodontal ligament cells and tendon stem/progenitor cells. Tnmd is related to chondromodulin-1 (Chm1), a cartilage-derived angiogenesis inhibitor, and both Tnmd and Chm1 are expressed in the CD31− avascular mesenchyme. The conserved C-terminal hydrophobic domain of these proteins, which is characterized by the eight Cys residues to form four disulfide bonds, may have an anti-angiogenic function. This review highlights the molecular characterization and function of Tnmd, a specific marker of tendons and ligaments.

Efficacy of Muscle Relaxants in Routine Treatment Protocol of OSMF and Regional Epidemiological

Oral submucous fibrosisis a chronic disorder presenting with the plaguing symptoms of burning sensation in mouth, intolerance to spicy food and progressive trismus. OSMF is insidious in onset characterized by fibrosis of the lining mucosa of the upper digestive tract involving the oral cavity, oropharynx and hypopharynx and the upper third of oesophagus. The fibrosisinvolves the lamina propria and the submucosa and may extend into the underlying musculature resulting in the deposition of dense fibrous bands, resulting in limited mouth opening. It is widely prevalent in all age groups and across all socioeconomic strata in India. OSMF is etiologically related to chewing of areca nut [betel nut] and its commercial products, a habit prevalent in India and South-East Asia. This increaing prevalence is not only our concern but its treatment challenges is also our concern. Though a benign disease, the frequency of malignant change in patients with OSMF ranges from 3% to 6%. We have various established treatment modalities available, medical and surgical both. But the results vary. Hence after understanding its etiopathogenesis and reviewing various treatment modalities, we planned to carry out the study to find out the efficacy of muscle relaxants to treat OSMF.

A descriptive and morphometric study of the fabellofibular, arcuate popliteal and popliteofibular ligaments

Objectives: The anatomical relationship of the fibrous structures in the posterolateral corner of the knee is highly complex, with many different descriptions of these structures in the literature. Discrepancy in the definitions of FF, AL and PF are a problem for both clinicians and anatomists. This study aimed to examine these structures and describe their features to clarify our understanding of their morphology. Methods: The posterolateral corner of the knee joint was bilaterally dissected in 10 male cadavers. Fibrous structures originating from the fibular head as a common mass were defined in relation to their attachment sites and positions according to the inferior lateral genicular vessels. The fabellofibular ligament (FF) was grouped into two categories, depending on the presence of a dense, fibrous tissue band. The arcuate popliteal ligament components were grouped into superficial (ALs) and deep (ALd) by their position relative to the inferior lateral genicular vessels. The popliteofibular ligament (PF) was identified as the fibrous bundle attached to the inferior border of popliteus tendon (PT). Dimensions of these structures were measured, and statistical analyses undertaken using paired and independent t-tests (p<0.05 significant). Results: FF had a dense fibrous band in 11 out of 20 knees. The fabella thickness was significantly higher in cases which FF had a dense fibrous band (p=0.04). ALs and PF were present in all knees. Absence of ALd was observed in 5 out of 20 knees. Conclusion: Findings indicate the structural relationship between ALs and FF, variability in the morphology of the ligaments and a positive relationship between fabella thickness and FF morphology. Some structures were consistently present (AL, PF), while ALd was only present intermittently. We suggest descriptions of the posterolateral ligaments of knee that utilize attachment sites, relationships with the inferior lateral genicular vessels, and developmental relationships to the popliteus muscle to clarify terminology for these structures. Keywords: arcuate popliteal ligament; fabellofibular ligament; popliteofibular ligament, posterolateral corner reconstruction

Definition of the to be named ligament and vertebrodural ligament and their possible effects on the circulation of CSF.

Few studies have been conducted specifically on the dense connective tissue located in the posterior medial part of the cervical epidural space. This study was undertaken to examine the presence of this connection between the cervical dura mater and the posterior wall of spinal canal at the level of C1–C2. 30 head-neck specimens of Chinese adults were used. Gross dissection was performed on the suboccipital regions of the 20 specimens. Having been treated with the P45 plastination method, 10 specimens were sliced (9 sagittal and 1 horizontal sections). As a result, a dense fibrous band was identified in the nuchal ligament of 29 specimens (except for one horizontal section case). This fascial structure arose from the tissue of the posterior border of the nuchal ligament and then projected anteriorly and superiorly to enter the atlantoaxial interspace. It was termed as to be named ligament (TBNL). In all 30 specimens the existence of a fibrous connection was found between the posterior aspect of the cervical dura mater and the posterior wall of the spinal canal at the level of the atlas to the axis. This fibrous connection was identified as vertebrodural ligament (VDL). The VDL was mainly subdivided into three parts, and five variations of VDL were identified. These two structures, TBNL and VDL, firmly link the posterior aspect of cervical dura mater to the rear of the atlas-axis and the nuchal region. According to these findings, the authors speculated that the movements of the head and neck are likely to affect the shape of the cervical dural sleeve via the TBNL and VDL. It is hypothesized that the muscles directly associated with the cervical dural sleeve, in the suboccipital region, may work as a pump providing an important force required to move the CSF in the spinal canal.

A Cervical Myelopathy Caused by Invaginated Anomaly of Laminae of the Axis in Spina Bifida Occulta With Hypoplasia of the Atlas

A case report and review of previous literature are presented. The objective of this manuscript was to report a case of cervical myelopathy caused by invaginated anomalous laminae of the axis in a spina bifida occulta patient with hypoplasia of the arch of the atlas and to discuss the etiology of this disease. To the authors' knowledge, few cases of cervical myelopathy due to invaginated anomalous laminae of the axis have been reported, none of which is combined with hypoplasia of the arch of atlas. Treatment was surgical removal of the invaginated laminae. The patient's history, clinical examination, imaging findings, and treatment were reported, and the etiology was discussed. Characteristic findings were revealed from imaging studies and multiplane reconstruction of the computed tomography images. The patient was treated with a posterior decompressive operation based on the images. A rapid improvement was observed after the surgery, and the patient's neurology was completely restored 1 month later. We reported a rare characteristic anomaly of the laminae of the axis with hypoplasia of the posterior arch of atlas. A multiplane reconstruction of the computed tomography images was very necessary for treatment of this case. Possible causes of this anomaly may be the failure of ossification or fusion of the embryological term, whereas invagination of the osteophyte may be associated with the traction of the dense fibrous band during growth and development. Surgical removal of the laminae could result in a satisfactory outcome.

Latissimus dorsi tendon transfer for massive irreparable cuff tears: An anatomic study

The purpose of this study was to describe landmarks for latissimus dorsi tendon transfer in massive irreparable tears of the rotator cuff. Nine pairs of embalmed cadaveric shoulders were dissected. Crucial structures were identified, and their relationship with various bony and soft-tissue reference points was documented. Identification of the dense fibrous band, at the confluence of the teres major and latissimus dorsi musculotendinous unit, facilitates localization of the radial nerve, which crosses deep to this landmark. The axillary nerve can be seen to exit the quadrangular space 27 mm medial to the latissimus dorsi insertion into the proximal humerus, whereas the thoracodorsal neurovascular pedicle inserts into the latissimus dorsi 110 mm from the humeral tendon's humeral attachment. Harvest of the latissimus dorsi tendon can be safely accomplished by identifying the dense fibrous band and releasing the tendon within 2 cm of its humeral attachment.

Hepatic fibrosis and cirrhosis in the Fontan circulation: a detailed morphological study

Aims:To describe the histological features of the liver in patients with a Fontan circulation.Methods:Specimens from liver biopsies carried out as part of preoperative assessment prior to extracardiac cavopulmonary conversion of...

Pleiotrophin Secreted from Human Breast Cancer MCF-7-Ptn Cells Activates Stromal Fibroblasts, Induces Epithelial Island Formation, and Remodels the Microenvironment.

Pleiotrophin (PTN, Ptn) is an 18 kD cytokine that is expressed in many human breast cancers and its gene is inappropriately expressed in cell lines derived from these breast cancers. To study the siginificance of inappropriate expression of Ptn in human breast cancer cells on surrounding stromal cells, we first compared nude mouse xenografts of MCF-7 and MCF-7-Ptn cells. MCF-7-Ptn cells lack the Receptor Protein Tyrosine Phosphatase (RPTP)b/z, the PTN receptor, and thus are not responsive to PTN through autocrine or paracrine stimulation. The MCF-7-Ptn cell xenografts grew rapidly whereas MCF-7 cells xenografts were barely detectable 6 weeks after injection. MCF-7-Ptn cells that were co-injected with equal numbers of NIH3T3 cells grew even more rapidly in the flanks of the nude mice. Surprisingly, the MCF-7-Ptn cell explants developed a morphological phenotype remarkably similar to that of the human invasive ductal carcinoma. We then co-cultured MCF-7 cells that express Ptn (MCF-7-Ptn cells) with NIH 3T3 cells. Secretion of PTN from MCF-7-Ptn cells induced formation of sharply defined clusters of MCF-7-Ptn cells, termed “epithelial islands”, that were surrounded by dense fibrous bands interspersed with NIH 3T3 cells that morphologically closely resemble carcinoma associated fibroblasts (CAFs). A striking increase in tropoelastin and expression of type IV procollagen mRNA was identified in NIH3T3 cells co-cultured with MCF-7-Ptn cells. Furthermore, different markers often resulting from stromal cell-carcinoma cell interactions in breast cancer, including protein kinase C (PKC)-d, and both human and murine matrix metalloproteinase (MMP) 9 were identified either in cells or in the culture media taken from MCF-7-Ptn/NIH3T3 cell co-cultures. The induction of these biochemical and morphological features in the co-cultures of MCF-7-Ptn and NIH3T3 cells was demonstrated to be Ptn expression dependent, PTN-secretion dependent, and NIH3T3 cell dependent. The data suggest that PTN secretion alone from human breast cancer cells with inappropriate expression of Ptn is sufficient to markedly remodel the microenvironment of the breast cancer cell and induce a morphological transition of the MCF-7-Ptn cells and NIH3T3 cells to patterns resembling breast carcinomas through activation of the PTN/RPTPb/z signaling pathway in NIH3T3 cells and reciprocal signaling between the carcinoma stromal cells and the PTN secreting breast cancer cells.

Myxoid lipoadenoma of parathyroid gland: a case report and literature review

Myxoid lipoadenoma of the parathyroid gland is a rare variant of parathyroid adenoma. We present the case of a 40-year-old man with asymptomatic hypercalcemia who underwent surgical removal of a parathyroid adenoma. Histologically, the tumor consisted of monomorphous round-to-oval chief cells arranged in several architectural patterns including solid sheet-like, trabecular, and follicular. The tumor stroma was prominently myxoid with interspersed mature adipose tissue. Immunohistochemistry confirmed expression of thyroid transcription factor and parathyroid hormone by all tumor cells and a low proliferation rate with a Ki-67 labeling index of at most 5%. Although the lesion exhibited characteristics that have been previously associated with "atypical parathyroid adenoma," such as dense fibrous bands within the tumor and a trabecular growth pattern, there was no further evidence, neither histologically nor clinically, for malignant behavior of the tumor.

The effect of DNA topoisomerase inhibitor-loaded films on postsurgical adhesion formation in the rat

Postsurgical adhesion formation is a leading cause of infertility in women of reproductive age. Adhesions occur when trauma to the peritoneum initiates an inflammatory cascade that eventually culminates in fibroblast proliferation, deposition of collagen and the formation of dense fibrous bands between affected organs. We have previously shown that the potent antiproliferative agent camptothecin, when loaded into hyaluronic acid (HA) film, reduces both the strength and extent of postsurgical adhesions in the rat cecal sidewall model.

でん部にみられた脂肪腫様脂肪肉腫の１例

We reported a 74-year-old women of lipoma-like liposarcoma. She has had a subcutaneous mass in the left buttock for about 10 years and received operations twice for the lipoma at a previous hospital, but she had repeated recurrence of the tumor. Clinical findings showed a subcutaneous mass about 21cm in the left buttock. CT examination showed a lipoma-like shadow with septums. Pathological findings showed the tumor was composed of mature adipose tissue and contained atypical cells within dense fibrous bands. We diagnosed this tumor as lipoma-like liposarcoma. The recurrence of the tumor was found by MRI examination 2 years and 8 months after the operation. We performed wide local excision with a margin of surrounding normal muscle for the recurrent tumor. There have been no recurrences and distance metastases of the tumor for 8 months.The characteristic of the lipoma-like liposarcoma, shown by CT and MRI scans, a giant lipoma-like tumor with dense fibrous structures, present among the muscles of the limbs. Because of the marked tendency of local recurrence of the tumor, we carefully discussed the condition and decided that the tumor margin should be excised. After the operation, no recurrence has been seen for 8 months. [Skin Cancer (Japan)2002; 17: 65-69]

Pulmonary artery fibrous bands : Report of a case with extensive lung infarction and superinfection with coccidioides immitis, pseudomonas, and acid-fast bacilli

A 46-year-old woman presented with shortness of breath and frequent lower respiratory tract infections. A ventilation-perfusion scan showed markedly reduced perfusion of the right lung, and pulmonary arteriogram showed stenosis of the right pulmonary artery. A right pneumonectomy revealed dense white fibrous bands partially occluding the pulmonary artery branches and two large abscess cavities filled with pus in the upper and lower lobes. Microscopic examination revealed extensive necrosis of lung parenchyma, suppurative granulomatous inflammation with Coccidioides immitis organisms and rare acid-fast bacilli. Pulmonary artery fibrous bands were originally believed to be congenital; however, they are now known to be sequelae of thromboembolic phenomena.

Persistent Subcutaneous Nodules in Patients Hyposensitized With Aluminum-Containing Allergen Extracts

The development of persistent nodules that cause pain and itching at a vaccination or hyposensitization injection site is a rare event. These lesions have been mainly attributed to a hypersensitivity reaction to aluminum hydroxide, which is used as an absorbing agent in many vaccines and hyposensitization preparations. Patch tests with standard antigens and aluminum compounds and histopathologic and ultrastructural studies were performed on 10 patients with persistent subcutaneous nodules on the upper part of their arms after injection of aluminum-adsorbed dust and/or pollen extracts. The nodules appeared 1 month to 6.5 years after injections. The results of patch tests with 2% aluminum chloride were positive in five patients. Histopathologic examination revealed two different patterns: some biopsy specimens (from lesions of less than 9 months' duration) showed a pure foreign body histiocytic reaction characterized by extracellular amorphous dermal basophilic deposits with a histiocytic-macrophagic reaction; others showed a delayed hypersensitivity granulomatous reaction in association with an histiocytic foreign body response. The lesions were characterized by a unifocal or multifocal unencapsulated granulomatous reaction in the deep dermis and/or subcutaneous tissue. Eosinophilic necrotic areas surrounded by dense fibrous bands and a massive inflammatory infiltrate (lymphoid follicles, large histiocytic cells, abundant eosinophils, and some plasma cells) were observed. A granular basophilic material in extracellular spaces and within the cytoplasm of some histiocytes was also noted. Electron microscopic studies revealed intracytoplasmic and extracellular deposits of a fibrillar electron-dense material. Persistent subcutaneous nodules that develop after the administration of aluminum-containing preparations may show two characteristic histopathologic patterns. A pure histiocytic foreign body reaction was observed in early lesions, and a delayed hypersensitivity granulomatous reaction was seen in older lesions. No relationship between histopathologic pattern and patch test results was observed. Aluminum-free preparations should be used in patients in whom these nodules develop.

A thyroid biopsy with histologic features of both Riedel's thyroiditis and the fibrosing variant of Hashimoto's thyroiditis

We describe a 36-year-old woman with clinical, laboratory, and histologic features of both Riedel's thyroiditis and the fibrosing variant of Hashimoto's thyroiditis. Features of the former included a hard, fixed thyroid mass and extensive involvement of perithyroidal tissues by dense fibrosis with lymphocytes, histiocytes, and plasma cells. Features supporting Hashimoto's thyroiditis included high serum titers of antimicrosomal and antithyroglobulin antibodies and the histologic findings within the thyroid gland itself: dense fibrous bands dividing the thyroid parenchyma into nodules composed of lymphoid follicles with germinal centers, plasma cells, and oxyphilic metaplasia of follicular epithelial cells. Although Riedel's thyroiditis and the fibrosing variant of Hashimoto's thyroiditis were once considered morphologic variants of the same disease, since the 1970s these diseases have been considered as distinct clinicopathologic entities. The co-existence of both diseases in a patient is rare and is probably coincidental in this instance.

Variations in anatomy of the ulnar nerve at the cubital tunnel: pitfalls in the diagnosis of ulnar neuropathy at the elbow.

Two processes account for most instances of ulnar neuropathy at the elbow: compression in the retroepicondylar groove, and compression by the humeroulnar aponeurotic arcade joining the two heads of the flexor carpi ulnaris. While conventional electrodiagnostic criteria may localize an ulnar neuropathy to the elbow, separating retroepicondylar compression from humeroulnar arcade compression is more difficult. In 130 cadaver elbows, we examined the relationships between the medial epicondyle, flexor carpi ulnaris, and ulnar nerve. The humeroulnar arcade lay from 3 to 20 mm distal to the medial epicondyle, the intramuscular course of the nerve through the flexor carpi ulnaris ranged from 18 to 70 mm, and the nerve exited the flexor carpi ulnaris 28 to 69 mm distal to the medial epicondyle. In 6 specimens, dense fibrous bands bridged directly between the medial epicondyle and the olecranon proximal to the cubital tunnel proper; accessory epitrochleoanconeus muscles were present in 14 specimens: both may cause ulnar neuropathy at the elbow. Anatomical variations may contribute to the difficulty in separating causes of ulnar neuropathy at the elbow.

Injection-Site Granuloma due to Aluminum

Three patients had subcutaneous nodules at the sites of previous injections of vaccine containing tetanus toxoid. Biopsy and microscopic findings in all three cases showed foci of granulomatous inflammation, consisting of lymphoid follicles, in the deep dermis and subcutaneous tissues and a surrounding infiltrate of lymphocytes, histiocytes, plasma cells, and eosinophils. Occasional zones of eosinophilic necrosis were seen within the inflammatory foci, and surrounding dense fibrous bands were present in some areas. A solochrome-azurin stain showed aluminum crystals in the nodules from two patients. From the evidence available, we believe that these nodules are a complication of inoculations with aluminum-containing vaccines.