Leuprolide acetate is an established luteinizing hormone-releasing hormone (LHRH) agonist used as a first-line treatment in advanced prostate cancer. An 80-year-old man presented with a localized erythematous patch with an indurated plaque and nodule and pustules on the left upper arm. The patient had been treated for metastatic prostate cancer with subcutaneous injections of leuprolide acetate 18 months previously. Histopathologic findings revealed granulomas with multinucleated giant cells from the dermis to the subcutaneous fat layer. The granuloma contained numerous round vacuoles. Cultures from the tissue for bacteria, fungi, and mycobacteria were all negative. The diagnosis of leuprolide acetate-induced foreign body granuloma was made by clinicopathologic findings. Various theories on the mechanism of local reactions to leuprolide have been suggested. The formation of granulomas may be related to the poly (lactic-co-glycolic acid) polymers or leuprolide itself. The depth of injection could have also contributed; therefore, intramuscular injection is recommended to minimize granuloma formation. To the best of our knowledge, there has been no reported case of leuprolide-induced foreign body granuloma in a patient with prostate cancer in the Korean literature. Dermatologists need to know that leuprolide acetate depot injection may cause a granulomatous reaction.
Aged, 80 and over ; Arm ; Bacteria ; Dermis ; Diagnosis ; Foreign Bodies* ; Fungi ; Giant Cells ; Gonadotropin-Releasing Hormone ; Granuloma ; Granuloma, Foreign-Body* ; Humans ; Injections, Intramuscular ; Injections, Subcutaneous ; Leuprolide* ; Polymers ; Prostate* ; Prostatic Neoplasms* ; Subcutaneous Fat ; Vacuoles

Leuprolide acetate is an established luteinizing hormone-releasing hormone (LHRH) agonist used as a first-line treatment in advanced prostate cancer. An 80-year-old man presented with a localized erythematous patch with an indurated plaque and nodule and pustules on the left upper arm. The patient had been treated for metastatic prostate cancer with subcutaneous injections of leuprolide acetate 18 months previously. Histopathologic findings revealed granulomas with multinucleated giant cells from the dermis to the subcutaneous fat layer. The granuloma contained numerous round vacuoles. Cultures from the tissue for bacteria, fungi, and mycobacteria were all negative. The diagnosis of leuprolide acetate-induced foreign body granuloma was made by clinicopathologic findings. Various theories on the mechanism of local reactions to leuprolide have been suggested. The formation of granulomas may be related to the poly (lactic-co-glycolic acid) polymers or leuprolide itself. The depth of injection could have also contributed; therefore, intramuscular injection is recommended to minimize granuloma formation. To the best of our knowledge, there has been no reported case of leuprolide-induced foreign body granuloma in a patient with prostate cancer in the Korean literature. Dermatologists need to know that leuprolide acetate depot injection may cause a granulomatous reaction.
Aged, 80 and over ; Arm ; Bacteria ; Dermis ; Diagnosis ; Foreign Bodies* ; Fungi ; Giant Cells ; Gonadotropin-Releasing Hormone ; Granuloma ; Granuloma, Foreign-Body* ; Humans ; Injections, Intramuscular ; Injections, Subcutaneous ; Leuprolide* ; Polymers ; Prostate* ; Prostatic Neoplasms* ; Subcutaneous Fat ; Vacuoles

Leuprorelin acetate is a synthetic analog of luteinizing hormone-releasing hormone (LHRH). Recently, hormone-dependent tumors (prostate cancer and breast cancer) have been treated without surgery using this LHRH agonist. A 74-year-old man presented with a subcutaneous tumor in the abdomen. He had received a subcutaneous injection of depot leuprorelin acetate 2 months previously and radiotherapy for prostate cancer. The subcutaneous tumor was totally excised. Histopathologic findings revealed necrosis of fat tissue, many granulomatous nodules composed of giant cells with vacuoles in the dermis and subcutis, and inflammatory cell infiltrates, including mainly lymphohistiocytes. A diagnosis of foreign body granuloma due to depot injection of leuprorelin acetate was made. He revisited our hospital after 1 month with a subcutaneous tumor on his Lt. upper arm. He had received a subcutaneous injection of leuprorelin acetate 1 week ago on that site. We treated it with intralesional triamcinolone injection. Here, we report a case of granulomatous reaction due to leuprorelin acetate injection, which produced subcutaneous nodules.
Abdomen ; Aged ; Arm ; Breast ; Dermis ; Diagnosis ; Foreign Bodies* ; Giant Cells ; Gonadotropin-Releasing Hormone ; Granuloma, Foreign-Body* ; Humans ; Injections, Subcutaneous* ; Leuprolide* ; Necrosis ; Prostatic Neoplasms ; Radiotherapy ; Triamcinolone ; Vacuoles

Cholesterol granuloma is a histopathological diagnosis with features of cholesterol clefts, foreign body giant cells, and macrophages filled with hemosiderin. It is commonly found in the mastoid or petrous apex, but the involvement of paranasal sinuses is very rare. Radiologically, cholesterol granuloma show typical findings of hyperintense signals on both T1- and T2-weighted images on magnetic resonance imaging (MRI). We report two cases of cholesterol granuloma in the sphenoid sinus, which were first misinterpreted as mucoceles due to unusual MRI images.
Cholesterol* ; Diagnosis ; Giant Cells, Foreign-Body ; Granuloma* ; Hemosiderin ; Macrophages ; Magnetic Resonance Imaging ; Mastoid ; Mucocele ; Paranasal Sinuses ; Sphenoid Sinus*

BACKGROUND: As the desire to maintain a youthful appearance escalates nationwide, the numbers of patients presenting with complications subsequent to cosmetic treatments performed by non-professionals are increasing. OBJECTIVE: The purpose of this study was to overview complications from cosmetic therapeutic attempts by non-professionals, and to discuss their management from a dermatologist's point of view. METHODS: During the period January 1st, 2011 to December 31st, 2013, a total of 24 patients who visited the Severance Hospital at Yonsei University for complications that developed after cosmetic treatments by oriental doctors, non-medical personnel, and general practitioners were enrolled in this study. Patient clinical characteristics, past history, diagnosis, biopsy results, and treatment information were collected. RESULTS: The most common complication was a granulomatous foreign body reaction (n=15, 62.5%), followed by skin necrosis (n=8, 33.3%), and misdiagnosis and malpractice by non-professionals (n=5, 20.8%). Three patients had more than 2 complications combined. Patients with granulomatous foreign body reactions were usually managed with conservative treatments or excisions, while those with skin necrosis were managed with debridement and secondary intention healing. CONCLUSION: As the number of cosmetic therapeutic attempts made by non-professionals increases, dermatologists need to understand the potential complications that can arise following these procedures, and should take an active role in managing the patients.
Adolescent ; Biopsy ; Debridement ; Diagnosis ; Diagnostic Errors ; Foreign Bodies ; Foreign-Body Reaction ; General Practitioners ; Granuloma, Foreign-Body ; Humans ; Intention ; Malpractice ; Necrosis ; Skin

BACKGROUND: Basal cell carcinoma (BCC) is the most common form of skin cancer and possesses various clinical features including translucency, ulceration, pigmentation, telangiectasia, and rolled borders. Accordingly, many cutaneous lesions can mimic BCCs and differential diagnosis is difficult. OBJECTIVE: To clarify the differences in clinical characteristics between BCCs and BCC-mimicking lesions (BMLs), and to determine which clinical characteristics are helpful for an accurate clinical diagnosis of BCC. METHODS: We performed clinicopathologic analysis of cutaneous lesions that received a clinical diagnosis of BCC. All lesions included in this study showed more than one of the following characteristics of BCCs: translucency, ulceration, flecked pigmentation, black or blue hue, telangiectasia, and rolled borders. We compared six clinical characteristics between the BCC group and the BML group. RESULTS: Among 48 lesions in the BML group, there were 15 premalignant or malignant lesions and 33 benign lesions. Various dermatoses mimicking BCC that have not been reported in the dermatological literature were identified, including angiosarcoma, vulvar intraepithelial neoplasm, foreign body granuloma, intravascular papillary endothelial hyperplasia, sarcoidosis, and others. Compared to the BML group, the BCC group had a significantly higher frequency of translucency (76.3% vs. 52.1%, p<0.001), ulceration or erosion (44.2% vs. 27.1%, p=0.022), black or blue hue (40.0% vs. 22.9%, p=0.020), and rolled borders (49.5% vs. 14.6%, p<0.001). Cutaneous lesions with two or less clinical features of BCC were significantly more likely to be BMLs. CONCLUSION: The results of this study could be helpful for the differential diagnosis of BCCs and BCC-mimicking cutaneous lesions.
Carcinoma in Situ ; Carcinoma, Basal Cell ; Diagnosis ; Diagnosis, Differential ; Granuloma, Foreign-Body ; Hemangiosarcoma ; Hyperplasia ; Pigmentation ; Sarcoidosis ; Skin Diseases ; Skin Neoplasms ; Telangiectasis ; Ulcer

OBJECTIVES: Dental technicians are exposed to methyl methacrylate(MMA) and hard metal dusts while working, and several cases of hypersensitivity pneumonitis caused by the exposure have been reported. The authors experienced a case of hypersensitivity pneumonitis in a female dental technician who had 10 years' work experience and report the case with clinical evidence. METHOD: The patient's work, personal, social, and past and present medical histories were investigated based on patient questioning and medical records. Furthermore, the workplace conditions and tools and materials the patient worked with were also evaluated. Next, the pathophysiology and risk factors of pneumonitis were studied, and studies on the relationship between hypersensitivity pneumonitis and a dental technician's exposure to dust were reviewed. Any changes in the clinical course of her disease were noted for evaluation of the work-relatedness of the disease. RESULTS: The patient complained of cough and sputum for 1 year. In addition, while walking up the stairs, the patient was not able to ascend without resting due to dyspnea. She visited our emergency department due to epistaxis, and secondary hypertension was incidentally suspected. Laboratory tests including serologic, electrolyte, and endocrinologic tests and a simple chest radiograph showed no specific findings, but chest computed tomography revealed a centrilobular ground-glass pattern in both lung fields. A transbronchial biopsy was performed, and bronchoalveolar washing fluid was obtained. Among the findings of the laboratory tests, microcalcification, noncaseating granuloma containing foreign body-type giant cells, and metal particles within macrophages were identified histologically. Based on these results, hypersensitivity pneumonitis was diagnosed. The patient stopped working due to admission, and she completely quit her job within 2 months of restarting work due to reappearance of the symptoms. CONCLUSION: In this study, the patient did not have typical radiologic findings, but pathological evaluation of the lung biopsy from the bronchoscope led to the suspicion of pneumonitis. Under the microscope, the sample contained fibrotic changes in the lung, multinucleated giant cells, and particles in macrophages and was diagnosed as dental technician pneumoconiosis by the pathology. Working as a dental technician had directly exposed her to light metal dust and MMA, and her clinical symptoms and radiologic findings subsided after withdrawal from exposure to the workplace. These outcomes led to the diagnosis of hypersensitity pneumonitis due to MMA exposure and strong work-relatedness.
Alveolitis, Extrinsic Allergic* ; Biopsy ; Bronchoscopes ; Cough ; Dental Technicians* ; Diagnosis ; Dust ; Dyspnea ; Emergencies ; Epistaxis ; Female* ; Giant Cells* ; Giant Cells, Foreign-Body ; Glycogen Storage Disease Type VI ; Granuloma ; Humans ; Hypersensitivity* ; Hypertension ; Lung ; Macrophages ; Medical Records ; Pathology ; Pneumoconiosis ; Pneumonia ; Radiography, Thoracic ; Risk Factors ; Sputum ; Thorax ; Walking

Cholesterol granuloma of the breast is a rare, benign disease. Here, we present the unique ultrasonographic findings of breast cholesterol granuloma manifesting as an intracystic mass. The findings of this case report may help expand existing knowledge regarding differential diagnosis of intracystic breast masses, which are found on ultrasonographic examination.
Biopsy, Needle ; Breast Diseases/pathology/surgery/*ultrasonography ; *Cholesterol ; Diagnosis, Differential ; Female ; Granuloma, Foreign-Body/pathology/surgery/*ultrasonography ; Humans ; Mammography ; Middle Aged ; *Ultrasonography, Mammary

Cholesterol granuloma is a histological term used for the description of a tissue response to a foreign body such as cholesterol crystals. Cholesterol granuloma is histologically characterized as fibrous granulation tissue containing cholesterol crystals within surrounding giant cells. Cases of cholesterol granuloma of the pancreas are very rare. We report a case of a 47-year old male who had a cholesterol granuloma of the pancreas. Abdominal CT showed 24 mm-sized cyst in the pancreas and peri-pancreatic regional mass infiltrating to the stomach. PET-CT revealed increased 18F-FDG uptake at the cyst and peri-pancreatic mass. Thus, Whipple's operation was done. The disease was confirmed by surgical pathologic examination of the tissue. Pathologic examination of resected specimen showed numerous cholesterol crystals surrounded by multinucleated foreign body giant cells. We report on this case and give a brief review of the literature.
*Cholesterol ; Diagnosis, Differential ; Fluorodeoxyglucose F18/chemistry/diagnostic use ; Granuloma, Foreign-Body/*pathology/radionuclide imaging/surgery ; Humans ; Male ; Middle Aged ; Pancreas/pathology ; Positron-Emission Tomography ; Tomography, X-Ray Computed

An ingested fish bone presenting as an unresolving inflamed neck mass is rare. The purpose of this article was to describe the clinical and microscopic features of a foreign-body granuloma in submandibular region that resulted from a fish bone embedded in the floor of mouth. A 45-year-old male patient complained of a hard mass in submandibular region. Computer tomography allowed that localize of the lesion and the fish bone penetrating a submandibular gland. We successfully operated on the patient to excise the mass. A microscopic examination showed a anewly-formed granuloma, composed of lympocytes and epithelioid cells, and some microabscess with neurophiles. The final diagnosis was a foreign-body granuloma with a fish bone. Even though foreign-body granulomas in submandibular region are rare lesions, surgeons should be familiar with their features and include them in the differential diagnosis of tissue masses.
Diagnosis, Differential ; Epithelioid Cells ; Granuloma ; Granuloma, Foreign-Body ; Humans ; Male ; Middle Aged ; Mouth Floor ; Neck ; Submandibular Gland