[Foreign body granuloma after lower eyelid avulsion and surgical revision with silicone tube splint]

Unusual behavior of foreign body granuloma that grew rapidly in the radiation field during radiation therapy

We report our experience with two cases of a rapidly growing benign tumor in the radiation field despite radiotherapy. Case 1 was a 75-year-old man who was diagnosed as having postoperative recurrence of esophageal carcinoma in the right chest wall and underwent radiotherapy. A small nodule in the recurrent lesion grew to 20 mm in diameter at 70 Gy. The biopsy specimen was diagnosed as foreign body granuloma (FBG) with no malignancy. Case 2 was a 78-year-old woman who was diagnosed with axillary lymph node metastases of operated lung cancer and underwent lymphadenectomy and postoperative radiotherapy. No subcutaneous tumor was seen at the beginning of radiotherapy. However, a small nodule appeared in the radiation field at 40 Gy, and it had grown to 30 mm in diameter at 70 Gy. The biopsy specimen was diagnosed as FBG, showing granulation because of a remnant of surgical suture. Both FBGs disappeared within 3-6 months after radiotherapy. In cases in which a tumor has arisen from a site where surgical treatment had been performed and the tumor shows unnatural growth despite radiotherapy, FBG should be considered in the differential diagnosis.

Histopathologie nach Implantation von Lidgewichten

BACKGROUND

Various implants are used to treat lagophthalmos in facial paralysis. The implantation of gold or platinum eyelid weights (lid loading) is being used increasingly. Histological changes have not yet been systematically examined in the implant capsule during explantation of the eyelid weight.

MATERIAL AND METHODS

Of 26 explanted implants, 18 implants in 17 patients were followed-up using light microscopy from 1997 to 2004. We semi-quantitatively evaluated the density of the inflammatory infiltrate and recorded the occurrence of foreign bodies in the tissue. The inflammatory infiltrate was also immunohistochemically examined to characterize cellular composition.

RESULTS

In the semi-quantitative examination of inflammatory infiltration density, 60% of the gold implants showed a moderately dense or dense inflammatory infiltrate, while there was moderately dense infiltration in only 12.5% of the platinum implants. The immunohistochemical examination revealed a mixed lymphocytic inflammatory infiltrate which tended to a preponderance of B lymphocytes (humoral response). This is typical of unspecific chronic inflammation.

CONCLUSIONS

Both gold and platinum are suitable for treating lagophthalmos, however, platinum has a higher density and better biocompatibility than gold.