Hyaluronic acid induced foreign body reaction mimicking neoplastic parotid cytology

Abstract

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.

Delayed adverse reaction to a natural dermal filler mimicking salivary gland neoplasia

“…Reported clinical mimics include adenoma, pleomorphic adenoma, sclerotic minor salivary gland, fibroma, basal cell carcinoma, mucocele, salivary gland tumor and benign soft tissue neoplasm (Table 1 ) (Eversole et al 2013 ; Farahani et al 2012 ; Pinheiro et al 2019 ; Shahrabi-Farahani et al 2014 ; Tamiolakis et al 2018 ; Mandel et al 2010 ; Davis et al 2019 ). Clinical and cytologic/histologic mimics include foreign-body granulomatous reaction ( n = 24), while purely cytologic/histologic mimics include liposarcoma ( n = 12) and mucoepidermoid carcinoma ( n = 2) (Eversole et al 2013 ; Pinheiro et al 2019 ; Shahrabi-Farahani et al 2014 ; Jham et al 2009 ; Singh et al 2010 ; Davis et al 2019 ). The current case is interesting in the clinical concern and subsequent FNA diagnosis suggestive of either a pleomorphic adenoma or a mucoepidermoid carcinoma.…”

“…The role of FNA cytology (FNAC) in the diagnosis of foreign-body granulomas to dermal fillers is controversial. While some reports show FNAC to be a less invasive, useful method to confirm clinical suspicions of adverse reactions to dermal fillers (Faria et al 2014 ), others express many potential diagnostic pitfalls in the cytologic evaluation of reactions to dermal fillers (Davis et al 2019 ). The latter sentiment is reinforced in our case, which was misdiagnosed as a pleomorphic adenoma or mucoepidermoid carcinoma on FNAC.…”

Introducing aesthetic regenerative scaffolds: An immunological perspective

“…Currently, dermal fillers are injected with the goal of producing collagen through a direct transduction mechanism of fibroblast stretching. Such dermal fillers include hyaluronic acid-based 84,85 or polyl-lactic acid-based [86][87][88] products that can produce a fibrotic FBR. By understanding how biomaterials influence inflammatory pathways toward healing by regeneration rather than by fibrosis, we can broaden our strategies beyond collagen stimulation.…”

Approach to Fine Needle Aspiration of Giant Cell-rich Tumors of Soft Tissue

“…The foreign material can often be seen within the cytoplasm. 4,5 Depending on the material, this may be polarizable. In the background, lymphocytes, plasma cells, scattered histiocytes or cohesive granulomas, and occasionally neutrophils as well as necrosis can be seen (Fig.…”

“…The giant cells themselves may have nuclei randomly distributed within the cytoplasm, or infrequently may exhibit clusters of nuclei polarized at one end of the cell. The foreign material can often be seen within the cytoplasm 4,5. Depending on the material, this may be polarizable.…”