Foreign Body Granulomatous Reaction Research Articles

Abdominal Mesh Implant Showing FDG Uptake on PET/CT.

F-18 fluorodeoxyglucose (FDG) uptake by a mesh implant might be caused by a foreign body granulomatous reaction with inflammation and fibrosis, which can be demonstrated by positron emission tomography/computed tomography (PET/CT). A 71-year-old man underwent F-18 FDG PET/CT for the follow-up evaluation after an operation for colonic adenocarcinoma. On PET/CT imaging, there was a rectangular-shaped FDG uptake (maximal standardized uptake value, maxSUV: 3.4) in the anterior abdominal wall. On the review of the medical records, the patient had a history of herniorrhapy for the reinforcement of the abdominal wall 2months previously, using a mesh implant consisting of polytetrafluoroethylene (Teflon). We report a case of FDG uptake associated with surgical procedures including mesh implant on F-18 FDG PET/CT.

Angiocentric Systemic Granulomatosis

As part of a review of substance abuse deaths in Dutchess County, New York, the Dutchess County Medical Examiner's Office identified 3 cases of angiocentric systemic foreign-body granulomatosis discovered at autopsy. Our investigation disclosed that in all 3 cases patients surreptitiously injected crushed oral prescription medication. Of the patients, 2 obtained intravenous access through central venous lines, the other patient was found to have injected herself intramuscularly. Autopsy demonstrated lung abnormalities due to diffuse deposits of foreign material within and around vessels, associated with foreign-body granulomatous reaction. We also identified a systemic distribution of this foreign material deposited beyond the lungs in the brain, heart, kidneys, and spleen. We present these cases along with a review of the literature of systemic embolization of foreign material in previously documented cases of deaths due to parenteral abuse of oral medications.

Sarcoidosis or foreign-body granulomatous reaction during interferon treatment?

Sarcoidosis or foreign-body granulomatous reaction during interferon treatment?

Foreign body granulomatous reactions to cosmetic fillers: a clinical study of 15 cases

Subcutaneous or submucosal infiltration of cosmetic materials is a very common practice, because of the ease with which such materials can be deposited, and their presumed innocuousness. However, in recent years there have been reports of foreign body granulomatous reactions occurring many years after infiltration. Data were collected on the clinical manifestations, histopathological findings, treatment, and course of the lesions of 15 patients. One male and 14 females presented orofacial swelling an average of 7 years after the infiltration of silicone (n = 9), hyaluronic acid (n = 2), collagen (n = 2), methacrylate (n = 1), and polyalkylimide (n = 1). The patients were treated mainly with systemic corticosteroids, and were followed for an average of 17 months. Systemic corticosteroids are able to control granulomatous reactions, which manifest in the form of outbreaks and tend to undergo spontaneous remission over the years.

Utilização de adesivo de fibrina em cirurgias oftalmológicas

To evaluate the use of fibrin glue and its complications in different ophthalmic surgeries. A retrospective and non-comparative case series study. 161 eyes were evaluated. The mean age was 51.8 years. Fibrin glue (Beriplast--Aventis Behring, Germany) was used in all patients for tissue adherence or incisional closure. Main preoperatives diseases were pterygium (76 patients), superior limbic keratoconjunctivitis (4 patients), limbal tumor (4 patients), conjunctivochalasis (21 patients), bullous keratopathy (31 patients), limbal stem cell deficiency (7 patients), alkali injury (6 patients), Stevens-Johnson syndrome (2 patients), cataract (5 patients) and glaucoma (5 patients). Complications occurred in 28 patients (17.4%). Detachment of the fixed tissue and granulomatous foreign body reaction were the main complications. Detachment occurred in 10 cases (5.6%) (7 in amniotic membrane transplantation in bullous keratopathy, 2 in autologous conjunctival grafting for pterygium surgery, 1 in autologous limbal transplantation in a Stevens-Johnson syndrome). Granulomatous foreign body reaction was described in 9 patients (5.6%) (5 in amniotic membrane transplantation due to acute alkali injury, 1 in autologous limbal graft due to chronic burn injury, and 3 in autologous conjunctival transplant due to pterygium surgery). All the complications described occurred in the first week after surgery. Despite the limitations related to the retrospective and non-comparative setting, this study suggests that the use of fibrin glue seems to be safe and effective for tissue fixation or incisional closure presenting low rates of complications in ocular surface and anterior segment surgeries.

AlloDerm in Breast Reconstruction:2 Years Later

Sir: Recently, we have seen a significant amount of attention directed toward the placement of acellular dermal grafts in breast reconstruction as first described by Dr. Parikh et al.1 In our practice, we were presented with a patient who had previously undergone bilateral breast reconstruction using this technique who had become disillusioned with her silicone implants and had requested autologous reconstruction. At operation for removal of bilateral implants and reconstruction by deep inferior epigastric perforator flaps, we encountered the acellular dermal graft material that had been placed 2 years previously. This presented us with a unique opportunity to examine the biological material currently being used commonly in breast reconstruction after it had been in situ for 24 months. Grossly, the material was easily discernible from the adjacent natural structures. However, it did appear that the material had incorporated into the surrounding architecture, requiring electrocautery to dissect it free. After complete removal, the material was sent to the surgical pathology laboratory, noting the history of breast cancer. Also requested were hematoxylin and eosin stains. After neoplasm had been ruled out, the pathologist had noted two important findings: (1) foreign body granulomatous reaction, presumably related to polypropylene suture (Fig. 1); and (2) significant deposition of collagen fibrils (Fig. 2). Both of these findings were noted to be “indistinguishable from the patient's own tissue.”Fig. 1.: Foreign body granulomatous reaction, presumably to polypropylene suture material, reported to be indistinguishable from the patient's own tissue (hematoxylin and eosin; original magnification, ×2000).Fig. 2.: Collagen fibrils in the graft material reported to be indistinguishable from the patient's own tissue (hematoxylin and eosin; original magnification, ×2000).Considering the increase in the use of acellular dermal grafts in breast reconstruction, we felt it important to communicate these findings to the community. It is likely that in the years to come we will gain more experience with the use of acellular dermal graft material in breast reconstruction and with the long-term results. DISCLOSURE None of the authors has received funding for this work or has any commercial association, financial interest, or disclosures to report in conjunction with this article. Martin I. Newman, M.D. Department of Plastic and Reconstructive Surgery Michel C. Samson, M.D. Department of Plastic and Reconstructive Surgery Mariana Berho, M.D. Department of Pathology Cleveland Clinic Florida Weston, Fla.

Endoscopic Transsphenoidal Drainage of a Big Petrous Apex Cholesterol Granuloma

Introduction: Petrous apex cholesterol granulomas are the most commonly seen benign tumors that occur at the pneumatized cells in this region. They occur as a foreign body granulomatous reaction to cholesterol crystals, which are the end products of hemosiderin arising from erythrocyte breakdown after a local hemorrhage. Their management is principally watchful waiting, as long as they are not symptomatic. However, because of their expansive pressure on adjacent structures, giant cholesterol granulomas cause neurological symptoms, such as headache or cranial nerve deficits, rather than otologic ones. Once surgery is indicated in this difficult-to-reach area, appropriate treatment is controversial; it is a choice between traditionally used surgical drainage procedures (infralabyrinthine, infracochlear) and approaches that aim for total removal (transtemporal, extended translabyrinthine, transcochlear, transotic). These treatment modalities have, respectively, either high recurrence rates or risk high morbidity because of exposing and removing critical areas and structures. In cases with anatomical features suitable for transsphenoidal surgery, the endonasal endoscopic approach promises a reasonable and durable drainage pathway to the nasal cavity.

Granulomatous Foreign-Body Reaction Involving Oral and Perioral Tissues After Injection of Biomaterials: A Series of 7 Cases and Review of the Literature

Injectable implants used for soft-tissue augmentation may lead to a granulomatous foreign-body reaction. The aim of this report is to present 7 new cases of foreign-body granulomas involving the oral and perioral tissues, after injection of biomaterials to achieve soft-tissue augmentation. In addition, the clinical and epidemiological profile of this condition is summarized, based on a review of the English-language literature of all previously described cases. We report on 7 new cases of granulomatous foreign-body reaction involving the oral and perioral tissues after the injection of biomaterials. A comprehensive literature review is also presented. The literature search revealed 49 cases of this condition affecting the oral and perioral tissues. Our 7 patients were female, with a mean age of 52.8 years (range, 34 to 70 years). The lower lip was affected in 4 cases, 1 case was located in the upper lip, 1 case in the buccal mucosa, while 1 case involved 2 different sites (upper lip and buccal mucosa). Histopathologic examination revealed numerous cells with clear, often multiple, cytoplasmic vacuoles, bearing a resemblance to lipoblasts. Immunohistochemistry revealed diffuse positivity for the histiocytic marker CD68. The diagnosis of granulomatous foreign-body reactions may be challenging because of their microscopic resemblance to liposarcoma, and because of the occasional reluctance of patients to report the previously performed esthetic procedure. A clinical history, histopathologic examination, and immunohistochemical analysis (as needed) are essential in achieving an accurate diagnosis.

Analysis of Tissue Responses to Glass Implants xB2O3 (1-X) Bi2O3 in Wistar Rats

The aim of this study was to evaluate rat soft tissue reactions to glass xB2O3 (1-x) Bi2O3 by using a histological analysis. Glass (0.01 g) in glycerin (0.1 ml) was implanted into the cervical, interscapular and lumbar subcutaneous space of Wistar female rats (n=16). We used eight types of glasses, and injected eight lots of animals with gradient different Boron and Bismuth concentrations. Tissue specimens were analyzed at the biological time points of 7, 14 and 28 days by optical microscopy. A massive inflammatory reaction with an intense foreign body reaction and an increased invasion of fibrovascular tissue was observed by day 7-14 post-inoculation. The granulomatous foreign body reaction increased at 28 days. Cell population changed from mainly neutrophils, lymphocites, mast cells, eosinophils, and fibroblasts to mainly lymphohistiocytes, macrophages and epitheloid cells with increase neoangiogenesis after 28 days

Femoral Component Fracture Due to Osteolysis After Cemented Mobile-Bearing Total Knee Arthroplasty

A 58-year-old man with osteoarthritis in the left knee underwent a total knee arthroplasty with a New Jersey anterior-posterior gliding low contact stress mobile-bearing implant. All femoral, tibial, and patellar components were implanted with bone cement. Pain developed at 43 months postsurgery, and plain radiography revealed a vertical crack in the femoral component and osteolysis at the medial femoral condyle. The femoral and tibial components were revised, and the bone defect at the medial femoral condyle was reconstructed using an allogeneic strut bone graft. Microscope examination identified polyethylene particles with foreign body granulomatous reaction, and scanning electron microscopy revealed fatigue failure of the femoral component. Osteolysis due to polyethylene particles can lead to fracture of the femoral component after cemented anterior-posterior gliding low contact stress mobile-bearing total knee arthroplasty.

Foreign-Body Granulomas within Intramyocardial Arteries in a Transcoronary Safety Assessment in Pigs

Foreign-body granulomas within intramyocardial arteries were detected in three domestic pigs (Sus scrofa domestica) in a routine transcoronary safety assessment study. The foreign bodies stained light grayish-blue by hematoxylin and eosin (H&E) and were strongly birefringent by polarized light microscopy. By their morphological features, they were identified as cotton fibers. Embolization of foreign-body material into the myocardial arteries following catheter-based procedures is an unusual event, and its occurrence may lead to granulomatous foreign-body reaction and misinterpretation of histological results.

A giant upper eyelid ossifying pilomatrixoma

Pilomatrixoma of the eyelid is extremely rare in middle age and rarely develops into a large tumor. A 45-year-old female developed a painless, progressive swelling (3.0 cm x 2.0 cm) of the left upper eyelid over a period of two years. Overlying skin was normal in color and texture. A differential diagnosis of dermoid, epidermoid cyst, chalazion and basal cell carcinoma was made. An excisional biopsy was performed. A diagnosis of pilomatrixoma was made on histopathological features (dystrophic calcification of matrix with keratin and foreign body granulomatous reaction, basaloid cells and shadow cells/ghost cells). It also comprises ossification apart from the usual calcification. This is a report of an unusually large ossifying pilomatrixoma in left upper eyelid of a middle-aged woman. The patient should be followed up at regular intervals to rule out any recurrence or malignant transformation.

Pneumopathie lipidique exogène associée à une sarcoïdose systémique avec atteinte hépatique nodulaire

In a patient with basal alveolar shadowing the diagnosis of exogenous lipoid pneumonia (ELP) requires a past history of chronic ingestion of liquid paraffin and the presence of numerous macrophages containing oil droplets in the bronchial lavage (BL). Additional radiological abnormalities suggest an associated disease, notably infection or cancer, as has been described in the literature. We report the case of a 50 year old woman presenting with alveolar shadowing in the left lung associated with ipsilateral mediastinal nodes and a pleural effusion in addition to two hepatic nodules. As the diagnosis of ELP did not explain the radiological features a thoracotomy and liver biopsies were performed. Histological examination of the hepatic, pulmonary and lymph node biopsies excluded cancer and mycobacterial disease and showed a florid granulomatous foreign body reaction associated with pulmonary and hepatic sarcoidosis. After a 3 month course of oral corticosteroids the mediastinal lymphadenopathy, pleural effusion and hepatic nodules resolved. The patient has maintained her recovery without further treatment for 4 years. The final diagnosis was ELP and systemic sarcoidosis with nodular hepatic involvement.

Foreign body reaction mimicking a second primary tumour of the oesophagus

To present a significant complication of pharyngolaryngeal reconstruction, which resulted in diagnostic confusion as it mimicked a second primary tumour of the head and neck. Case report and review of the world literature. A 61-year-old man developed a granulomatous foreign body reaction, mimicking a second primary tumour, at the distal end of a salivary bypass tube, following pharyngolaryngectomy and reconstruction using a tubed anterolateral thigh flap. Clinically and radiologically, this was felt to represent a second primary tumour of the oesophagus, but biopsies revealed full thickness inflammation of the mucosa and granulation tissue. Repeat oesophagoscopy two weeks after removal of the tube showed complete resolution. No record of an oesophageal foreign body reaction to a Montgomery salivary bypass tube has previously been reported in the world literature. This report highlights the potential for such a lesion to cause diagnostic confusion with a second primary tumour.

Granuloma formation and occlusion of an unruptured aneurysm after wrapping

Excessive granulomatous foreign-body reaction is a very rare complication after wrapping of intracranial aneurysms. The pathogenetic mechanisms underlying this process are unknown. We report on a patient who developed a space-occupying granulomatous abscess after wrapping of an unruptured aneurysm of the M2/M3 bifurcation. The patient underwent revision craniotomy for abscess removal. The aneurysm was explored and found to be completely thrombosed and excluded from the circulation. Exuberant granulomatous foreign-body reaction was pathologically confirmed and Candida parapsilosis was isolated from the pus. The patient underwent an antifungal treatment regimen and recovered with no residual neurological deficits. Our findings support the assumption that a low-grade infectious process might trigger excessive inflammatory reaction after wrapping. We suggest that this process may also result in complete thrombosis of cerebral aneurysms, which is otherwise a rarely observed phenomenon.

Adverse reactions to polylactic acid injections in the periorbital area

Correction of aging changes and contour deformities has been addressed largely by tissue augmentation agents whose volume is injected into tissues to achieve the required result. Polylactic acid (PLA) is an agent that is injected with the aim of enhancing the host's own collagen deposition. We describe the development of multiple nodules and one case of a foreign-body granuloma formation following the administration of PLA to the face for correction of rhytides and contour deformities. Methods Four case presentations, including clinical history, injection protocol, histopathology, individual treatment, and their outcomes, are discussed with pertinent literature review. Four patients who received injections of PLA developed nodules that were clinically similar in size, shape, and consistency. Histopathologic examination revealed the presence of a foreign-body granulomatous inflammatory reaction in one of the patients. Cosmetic treatment with PLA may be complicated by disfiguring nodules that may mask a granulomatous reaction. PLA-induced nodules and foreign-body granulomas have proven difficult to treat. Therefore, PLA should only be injected in the infraorbital area by experienced injectors who have had appropriate training. In addition to this, PLA should be injected in a "depot" method below the muscle at a significantly diluted volume. Due to the complications encountered after the use of PLA, we feel that a cautionary warning regarding the use of PLA in this area may be prudent regardless of the abovementioned precautions.

Pulmonary Complications of Illicit Drug Use

The aim of this manuscript is to summarize an approach to the differential diagnosis of the pulmonary complications of illicit drug use based on the computed tomography findings. The various pulmonary complications of illicit drug use result in 5 main patterns of parenchymal abnormality: nodules, ground-glass opacities, consolidation, air trapping, and emphysema. Other thoracic manifestations of illicit drug use include pulmonary arterial hypertension, pneumomediastinum, bacterial endocarditis, discitis, and septic arthritis.

Characteristics of genesis and development of peritoneal adhesion by different causes: experiment with rats

To investigate the characteristics of genesis and development of peritoneal adhesion by different causes. 236 rats underwent laparotomy with their vermiform processes lifted up and were randomly divided into 5 groups: Group A (control group), with the vermiform process exposed to air for 5 min, Group B, with the vermiform process smeared with talcum powder; Group C, with the vermiform process scraped by scalpel; Group D, with the tip of vermiform process stabbed by needle so as to squeeze the contents of intestine to cause infection; and Group E, with the artery of vermiform process ligated. Then the abdominal incision was sutured. 1, 2, 4, and 6 weeks after the treatment 11-12 rats from each group were randomly to undergo laparotomy. The degree of adhesion was graded blindly by Bhatia's method. The vermiform process was resected to undergo pathological examination and examination of the level of organ hydroxyproline (OHP) was detected. (1) At different time points the adhesive grades of Groups B-E were all significantly higher than that of Group A (all P < 0.05) and the adhesive grades of Groups B and D were both significantly higher than those of Groups C and E (both P < 0.05). There were no significant differences in the adhesive degree 1, 2, and 4 weeks after the treatment between Groups C and E, however, the adhesive degree of Group E was significantly lower than that of Group C (P < 0.05). (2) There were not significant differences in the OHP levels at any time points in Group A (all P > 0.05). There were not significant differences in the OHP levels 1, 2, and 4 weeks after the treatment (all P > 0.05), and the levels 8 weeks after the treatment were all significantly lower than those 1, 2, and 4 weeks after the treatment (all P < 0.05) in Groups B, D, and E. In Group C the OHP level 2 weeks after the treatment was 0.275 +/- 0.031 microg/mg protein, significantly lower than that 1 week after (0.221 +/- 0.036 microg/mg protein, P < 0.05), and the OHP level 8 weeks after the treatment was 0.254 +/- 0.039 microg/mg protein, significantly lower than those 1, 2, and 4 weeks after (all P < 0.05). The OH levels 1, 2, and 4 weeks after the treatment of the 4 experimental groups were all significantly higher than that of the control group (all P < 0.05). 8 weeks after the treatment the level of OHP of Groups B was significantly higher than that of Group A (P < 0.05), however, the OHP levels of Group C, D, and E had all decreased to almost similar to that of Group A (all P > 0.05). (3) The adhesive degrees of Groups C and E were significantly positively correlated with the OHP level (both P < 0.05), however, the adhesive degrees of Groups B and D were not significantly correlated with the OHP level (both P > 0.05). The adhesive degrees 1, 2, and 4 weeks after the treatment of the 5 groups were all significantly positively correlated with the OHP levels (all P < 0.05, however, the adhesive degrees 8 weeks after the treatment of the 5 groups were all not significantly correlated with the OHP levels (all P > 0.05). (4) The main pathological changes of Group B were foreign body granuloma reaction and fibroplasia in Group B and unspecific inflammatory reaction and fibroplasia in Groups C, D, and E. Abdominal adhesions resulting from different causes show different characteristics. The abdominal adhesion caused by foreign bodies and that caused by infection are relatively severe and more difficult to recover than those caused by injury and ischemia. It is more reliable to use OHP level as a marker of abdominal adhesion in the early stage.

A case of anterior internal ophthalmomyiasis: case report

A case of anterior internal ophthalmomyiasis is described. A 27-year-old female from Northern Brazil presenting with anterior uveitis and vitritis had a fly larva surgically removed from the anterior chamber of the left eye. The species was Cochliomyia hominivorax. The larva was covered by macrophages and foreign body giant cells characterizing a foreign body granulomatous reaction.

Histologic Study of Tissue Reaction to the Gastric Band: Does it Contribute to the Problem of Band Erosion?

One of the major complications of gastric banding is intragastric migration of the band. The frequency ranges from 0.5% to 3.8%, and removal of the band is always required. We undertook a prospective study with the aim to determine the reasons for this significant complication in bariatric surgery. 480 morbidly obese patients underwent adjustable gastric banding in our Surgical Department, from February 1998 to October 2005. 31 of them were reoperated for different surgical problems, at an average time of 39 months after the bariatric procedure. During the reoperation, some fragments of fibro-adipose tissue in close contact with the band were removed. They were examined, focusing on the following parameters: acute and chronic inflammation, fibrosclerosis, and foreign body granulomatous reaction. Histological assessment showed the presence of acute and chronic inflammation, generally of mild and medium grade; fibrosclerosis was present mostly in a severe form, indicating a biological periprosthesic wall that separates and protects the gastric wall from the band; no cases of foreign body reaction were observed, nor were silicone inclusions found inside the inflammatory cells. The histologic changes of periprosthesic tissue do not appear to account for endoluminal migration of the gastric band. Thus, band erosion could have a closer correlation with other causes, such as infection of the band or intraoperative surgical damage, possibly due to direct mechanical action or to the thermal effect of the electric scalpel.