title: Unusual palisading and necrotizing granulomas associated with a lubricating agent used in lipoplasty.
abstract: Palisading granulomas with necrobiosis are frequently encountered in dermatopathology, with granuloma annulare, necrobiosis lipoidica diabeticorum, and rheumatoid nodule being the most frequently rendered diagnoses. We report a series of 9 patients who developed palisading, necrobiotic, and necrotizing granulomas, associated with the presence of foreign material introduced through the use of a lubricating agent containing a copolymer (Carbopol 934) for liposuction. The patients ranged in age from 29 to 54 years old and presented with multiple, disfiguring, and nonhealing wounds at sites where lipoplasty had been performed. All specimens showed similar histologic findings, with the formation of palisading granulomas around extensive areas of necrobiosis with foci of true necrosis. Spaces containing minute fragments of crystalloid-appearing foreign material, birefringent with polarized light, were also identified. Special stains including acid fast, Gram, Giemsa, and/or periodic acid-Schiff were negative for organisms in all cases, as were cultures performed in 5 cases. Given the presence of foreign material and true necrosis, these findings were inconsistent with granuloma annulare, necrobiosis lipoidica diabeticorum, or rheumatoid nodule and were interpreted as a unique reaction to the foreign material. Therefore, this seems to be a distinct reaction pattern that has not been previously reported in the literature and may be important to include in the differential diagnosis in patients with necrotizing granulomatous disease.
authors.affiliation: Department of Pathology, Los Angeles Medical Center, University of California-Los Angeles, 4867 Sunset Boulevard, Los Angeles, CA 90027, USA.
authors.forename: Rebecca P
authors.initials: RP
authors.lastname: Shanesmith
authors.forename: Prokopis I
authors.initials: PI
authors.lastname: Vogiatzis
authors.forename: Scott W
authors.initials: SW
authors.lastname: Binder
authors.forename: David S
authors.initials: DS
authors.lastname: Cassarino
mesh_terms: D000179:Acrylates / Q000009:adverse effects*; D000328:Adult; D003937:Diagnosis, Differential; D005260:Female; D005549:Foreign-Body Reaction / Q000473:pathology*; D016460:Granuloma Annulare / Q000139:chemically induced* / Q000473:pathology*; D006801:Humans; D015187:Lipectomy; D054327:Lubricants / Q000009:adverse effects*; D008875:Middle Aged; D009336:Necrosis; D012867:Skin / Q000473:pathology; D014945:Wound Healing
chemical_list: D000179:Acrylates; D054327:Lubricants; C453622:carbopol 934P