Granulomatous reaction to injectable hyaluronic acid (Restylane) diagnosed by fine needle biopsy

• Published in: Journal of clinical pathology Vol. 60; no. 9; pp. 1060 - 1061
• Main Authors: Al-Shraim, Mubarak, Jaragh, Mohammad, Geddie, William
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and Association of Clinical Pathologists 01.09.2007; BMJ; BMJ Publishing Group LTD; BMJ Group
• Subjects: Biological and medical sciences; Biopsy; Biopsy, Fine-Needle; Case Reports; Diagnosis, Differential; Facial Neoplasms - diagnosis; Facial Neoplasms - secondary; Female; fine needle biopsy; foreign body reaction; Granuloma, Foreign-Body - chemically induced; Granuloma, Foreign-Body - pathology; Humans; hyaluronic acid; Hyaluronic Acid - adverse effects; Hyaluronic Acid - analogs & derivatives; Injections, Subcutaneous; Investigative techniques, diagnostic techniques (general aspects); Medical sciences; Metastasis; Middle Aged; Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques; Patients; Rhytidoplasty - adverse effects; Skin; Thyroid gland; Ultrasonic imaging; Massachusetts; Anatomic pathology; Fine needle; Biopsy; Glycosaminoglycan; Diagnosis; Injection; Hyaluronic acid
• ISSN: 0021-9746; 1472-4146
• DOI: 10.1136/jcp.2007.048330

[...]questioning of the patient revealed injection of Restylane at the site of the nodule ten months before. Because of the referring surgeon's concern that the observed acellular material might be thyroglobulin eliciting a giant cell response, the reserved cytospin slides were used for immunohistochemical staining for TTF-1 and thyroglobulin (Ventana: TTF-1 clone 8G7G3/1, thyroglobulin clone 2H11/6E1). [...]it is not totally non-immunogenic and is said to be contraindicated in patients with autoimmune diseases, or patients taking immunosuppressant therapy. 3 The short-term adverse effects of injection may include a transient acute inflammatory response in about 4-5% of patients, manifested clinically as redness, bruising, pain and swelling localised to the site of the injection. 4 8 A few reports describe a delayed inflammatory response consisting of a granulomatous foreign body reaction occurring at the site of the injection. 2, 4, 5 The aetiology of this granulomatous reaction has been ascribed to protein impurities resulting from the bacterial fermentation. 6 To the best of our knowledge this is the first report of diagnosis of this reaction by fine needle aspiration biopsy.