Presentation
Here we present an unusual clinical presentation of a silicone granuloma in a patient with a 27-year history of a wide excision of a melanoma of the right lower extremity and subsequent soft-tissue reconstruction using a silicone device. [ncbi.nlm.nih.gov]
CASE REPORT The patient, a 54-year-old woman, presented to our emergency room with 4 days of erythema, induration, and pain in her bilateral buttocks (Fig. 1). [journals.lww.com]
Entire Body System
- Intermittent Fever
After six weeks, she noted improvement in her pain, swelling, and intermittent fevers. However, since her admission, the skin overlying the injection sites had become even more thickened and hyperpigmented. [ncbi.nlm.nih.gov]
Immune System
- Cervical Lymphadenopathy
This case highlights the importance for otolaryngologists to consider silicone granuloma among the differential diagnoses of cervical lymphadenopathy in patients with a history of silicone breast implants. [ncbi.nlm.nih.gov]
The most frequently involved cervical lymph node chain was the transverse cervical, with 7 cases ( Fig. 2 ). In addition, CT studies also detected a significant increase of non-cervical lymphadenopathies in 8 patients, mainly axillary. [elsevier.es]
Gastrointestinal
- Dysphagia
In February 1993, she noticed edema of her distal phalanges, Raynaud's phenomenon in both hands, flu-like symptoms, fatigue, intermittent diarrhea, abdominal pain, tearing in both eyes, dyspnea on exertion, dysphagia, and odynophagia. [ncbi.nlm.nih.gov]
- Odynophagia
In February 1993, she noticed edema of her distal phalanges, Raynaud's phenomenon in both hands, flu-like symptoms, fatigue, intermittent diarrhea, abdominal pain, tearing in both eyes, dyspnea on exertion, dysphagia, and odynophagia. [ncbi.nlm.nih.gov]
Musculoskeletal
- Knee Pain
Presented here is a case of painful filler migration to the knee with granuloma formation after free-silicone gluteal injection. [ncbi.nlm.nih.gov]
Skin
- Skin Ulcer
Skin ulcer: A long-term complication after massive liquid silicone oil infiltration. Aesthetic Plast Surg 2013;37:1220-4. 9. Fumo G, Ferreli F, Murgia S, Galletti R, Pau M. [ijps.org]
- Disfiguring Scar
However, the lack of well-documented controlled trials limits its usage, and there have been multiple reports describing the complications of silicone injection such as cellulitis, abscess, ulceration, disfiguring scarring, and foreign body migration. [journals.lww.com]
Face, Head & Neck
- Facial Ulceration
Severe granulomatous reaction and facial ulceration occurring after subcutaneous silicone injection. J Am Acad Dermatol. 1996;34(5):849–52. 2. Duffy DM. Injectable liquid silicone: new perspectives. In: Klein AW, editor. [wjso.biomedcentral.com]
Urogenital
- Sexual Dysfunction
A 52-year-old man was referred to the Urology Department with significant enlargement of the penis and sexual dysfunction of 1-year duration. [clinicalimagingscience.org]
Workup
MRI of the penis by combining both conventional and functional information represents an important imaging tool in the preoperative workup of silicone-induced penile lipogranuloma. [clinicalimagingscience.org]
Microbiology
- Nocardia Asteroides
Multiple cultures were negative except for 1, which grew Nocardia asteroides complex. Treatment was changed to a combination of trimethoprim and sulfamethoxazole. [jamanetwork.com]
Other Pathologies
- Granulomatous Tissue
Pathology results confirmed granulomatous tissue without malignancy. There were no postoperative complications and the patient was discharged after five days in the hospital. [jcasonline.com]
Biopsy
- Foam Cell
Foreign body giant cell reaction is minimal. - In case of extracapsular rupture - There are many giant cells of the foreign body type often containing silicones and foam cells together with lymphocytes. [histopathology-india.net]
Treatment
The refractory silicone granuloma responded dramatically to treatment with etanercept. [ncbi.nlm.nih.gov]
Pain improved tremendously; however, the induration and subcutaneous nodules remained unchanged (after 1 month of treatment with etanercept). Treatment of silicone granulomas is difficult and often unsuccessful. [jamanetwork.com]
treatments and I have heard used in silicone related illness treatments as well. [gotpummped.wordpress.com]
Prognosis
The disease has a relatively higher occurrence among young people, and its prognosis (3-year-survival of only 38%) is extremely poor compared to breast cancer. [ncbi.nlm.nih.gov]
Breast cancer diagnosis and prognosis in augmented women. Plast Reconstr Surg. 2006;118(3):587–93. discussion 594-6. 14. Peng HL, Wu CC, Choi WM, Hui MS, Lu TN, Chen LK. [wjso.biomedcentral.com]
Etiology
[…] mammoplasty and joint prostheses ( Hum Pathol 1980;11:240 ) Once released into tissue, silicone migrates to distant sites through lymphatic channels and bloodstream Once it reaches lymph nodes, it elicits a reaction and cause silicone lymphadenopathy Etiology [pathologyoutlines.com]
The extent of lymphocytic cuffing was more extensive than typically observed in sarcoidosis, but pathology alone could not rule out sarcoidosis or an infectious etiology. [avensonline.org]
Epidemiology
The role of silicone gel in relation to connective tissue disease or amyloidosis has not been proved by current serologic, immunologic, or epidemiologic tests. [doi.org]
Pathophysiology
[…] enlargement of regional lymph nodes caused by the presence of silicone carried from tributary organs Either an incidental finding or causes painful / enlarged lymph node May be associated with granulomatous inflammation ( Histol Histopathol 1997;12:1003 ) Pathophysiology [pathologyoutlines.com]
Understanding their pathophysiology is essential in differential diagnosis and appropriate management. [aestheticsjournal.com]
"Amyloidosis and silicone synovitis: Updated classification, updated pathophysiology, and synovial articular abnormalities". Radiologic Clinics of North America. 34 (2): 375–94, xi. PMID 8633122. [en.wikipedia.org]
Prevention
Thick sections (10-30 micrometer thick) prevent loss of silicone droplets during tissue processing. The silicones can be detected by adding stamp pad ink to the mounting medium. [histopathology-india.net]
An interleukin 1 receptor antagonist was started to prevent the extension of amyloidosis, but to no avail as far as the kidneys are concerned. [doi.org]
Counselling the patient and adopting preventative measures such appropriate filler choice and prevention of infection should be part of every case of dermal filler injections. [aestheticsjournal.com]
When comparing with other causes of implant rupture, CSG potentially damaging effect may most likely only play a minor role in implant rupture but is surgically preventable. [pubs.sciepub.com]
It is used to prevent and treat acute attacks of malaria. It is also used to treat discoid or systemic lupus erythematosus and rheumatoid arthritis in patients whose symptoms have not improved with other treatments. [gotpummped.wordpress.com]