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

Al‐Shraim, Mubarak; Jaragh, Mohammad; Geddie, William

doi:10.1136/jcp.2007.048330

Cited by 26 publications

(14 citation statements)

References 13 publications

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“…While numerous studies have demonstrated that exogenous, high molecular weight HA can inhibit the infiltration, proliferation, and cytokine production of macrophages [28–31, 52, 53], there is an equally large body of evidence showing that HA can be associated with macrophage activation and adhesion as well as foreign body giant cell response [54–58]. It is important to note that previous studies investigated HA in endogenous, soluble, injectable, or pure hydrogel form, in either cell culture or in vivo injury models; all of which differ from the form of HA and in vivo model system employed in this study.…”

Section: Discussionmentioning

confidence: 99%

Characterization of and host response to tyramine substituted-hyaluronan enriched fascia extracellular matrix

Chin

Calabro

Rodríguez

et al. 2011

J Mater Sci: Mater Med

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Naturally-occurring biomaterial scaffolds derived from extracellular matrix (ECM) have been previously investigated for soft tissue repair. We propose to enrich fascia ECM with high molecular weight tyramine substituted-hyaluronan (TS-HA) to modulate inflammation associated with implantation and enhance fibroblast infiltration. As critical determinants of constructive remodeling, the host inflammatory response and macrophage polarization to TS-HA enriched fascia were characterized in a rat abdominal wall model. TS-HA treated fascia with cross-linking had a similar lymphocyte (P = 0.11) and plasma cell (P = 0.13) densities, greater macrophage (P = 0.001) and giant cell (P < 0.0001) densities, and a lower density of fibroblast-like cells (P < 0.0001) than water treated controls. Treated fascia, with or without cross-linking, exhibited a predominantly M2 pro-remodeling macrophage profile similar to water controls (P = 0.82), which is suggestive of constructive tissue remodeling. Our findings demonstrated that HA augmentation can alter the host response to an ECM, but the appropriate concentration and molecular weight needed to minimize chronic inflammation within the scaffold remains to be determined.

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Section: Discussionmentioning

confidence: 99%

Characterization of and host response to tyramine substituted-hyaluronan enriched fascia extracellular matrix

Chin

Calabro

Rodríguez

et al. 2011

J Mater Sci: Mater Med

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“…1,[4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] Before 1999, the reported rate of delayed reactions to HA fillers was 0.07%. The introduction of highly purified products decreased the incidence of such side effects to 0.02%, 1 which is now the accepted safety threshold for HA-based products.…”

Section: Discussionmentioning

confidence: 99%

Resistant and Recurrent Late Reaction to Hyaluronic Acid–Based Gel

Artzi

Loizides²,

Verner

et al. 2016

Dermatologic Surgery

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“…However, combining the clinical history, presence of multinucleated giant cells, variable foreign material morphology, and radiographic features together supported our diagnosis in this case. The formation of subcutaneous nodules as a result of injectable soft tissue fillers is an uncommon adverse event but is well documented, with foreign body granulomas occurring weeks after injection . This case illustrates multiple potential diagnostic pitfalls in the cytologic evaluation of this reaction to HA fillers that have not been previously described.…”

Section: Discussionmentioning

confidence: 99%

“…Artificial HA fillers are generally well tolerated but rarely can produce localized transient allergic symptoms, superficial bruising due to anti‐coagulative effects of HA, and vascular occlusion . Rare instances of foreign body granulomas have also been reported and are hypothesized to result from protein and bacterial DNA impurities left by the production process causing an inflammatory reaction . Here we report a case of foreign body giant cell reaction to HA filler injection that posed a diagnostic dilemma by mimicking either a primary parotid gland neoplasm or a metastatic lesion.…”

Section: Introductionmentioning

confidence: 92%

Hyaluronic acid induced foreign body reaction mimicking neoplastic parotid cytology

Davis

Basu

Suyash

et al. 2019

Diagnostic Cytopathology

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Masses near the angle of the mandible containing extracellular matrix or mucin on cytology raise concern for various benign and malignant parotid gland neoplasms. Here a 76‐year‐old female with a history of cosmetic hyaluronic acid (HA) filler injections presented with a painless 6 mm left sided facial mass. Injection of hyaluronidase into the mass had failed to cause regression, raising concern for a neoplastic process. Fine‐needle aspiration (FNA) showed amorphous, mucinous/extracellular matrix‐like material in a background of numerous histiocytes and occasional multinucleated giant cells, consistent with a foreign body giant cell reaction to HA. This uncommon reaction to HA filler creates previously unrecognized diagnostic pitfalls because of its resemblance on FNA to the extracellular matrix or mucin found in many salivary neoplasms.

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

Cited by 26 publications

References 13 publications

Characterization of and host response to tyramine substituted-hyaluronan enriched fascia extracellular matrix

Characterization of and host response to tyramine substituted-hyaluronan enriched fascia extracellular matrix

Resistant and Recurrent Late Reaction to Hyaluronic Acid–Based Gel

Hyaluronic acid induced foreign body reaction mimicking neoplastic parotid cytology

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