title: Necrobiotic palisading suture granulomas involving bone and joint: report of two cases.
abstract: Biomaterial used in surgery is relatively inert and non-toxic; however, adverse reactions may follow implantation of such foreign material. We describe the first two cases of bone and joint destruction by necrobiotic palisading suture granulomas. The hypersensitivity reaction occurred years after shoulder repair using silk sutures. One patient received chemotherapy for a mistaken diagnosis of tuberculous arthritis. Although very rare, foreign material should be included in the differential diagnosis of necrotizing granulomas. A history of surgery and microscopic examination with polarized light should allow recognition of this entity.
authors.affiliation: Department of Pathology, St. Mary's Hospital, McGill University, Montreal, Quebec, Canada.
authors.forename: V A
authors.initials: VA
authors.lastname: Marcus
authors.forename: I
authors.initials: I
authors.lastname: Roy
authors.forename: J D
authors.initials: JD
authors.lastname: Sullivan
authors.forename: J R
authors.initials: JR
authors.lastname: Sutton
mesh_terms: D000328:Adult; D004342:Drug Hypersensitivity / Q000209:etiology* / Q000473:pathology; D006099:Granuloma / Q000139:chemically induced* / Q000473:pathology; D006801:Humans; D019476:Insect Proteins / Q000009:adverse effects*; D008297:Male; D017441:Necrobiotic Disorders / Q000139:chemically induced* / Q000473:pathology; D011183:Postoperative Complications; D012782:Shoulder / Q000473:pathology* / Q000601:surgery; D012785:Shoulder Joint / Q000473:pathology*; D047011:Silk; D013537:Sutures / Q000009:adverse effects*
chemical_list: D019476:Insect Proteins; D047011:Silk