Track: Case Reports

Abstract:

Foreign body reaction refers to the inflammatory response of the immune system to exogenous or endogenous materials that the body perceives as foreign. These reactions have most commonly been reported in response to suture material, tattoos, or cosmetic fillers. In this case, a 52-year-old man presented to the clinician with complaints of a palpable right flank mass. The patient denied any history of abdominal surgery or penetrating trauma. The lesion was suspected to be a lipoma, and the clinician proceeded with excision. Pathology revealed a subcutaneous nodular proliferation of foamy macrophages admixed with a dense infiltrate of lymphocytes and neutrophils. At the center of the inflammation, there were large cystic spaces with peripheral pink wispy material surrounded by a thin layer of degenerative debris. Submitted special stains (PAS/D, AFB FITE, Gram) were negative for organisms. Additional inquiry revealed that while excising the nodule, the clinician removed two white cylindrical foreign bodies and similar objects were found within the tissue at the time of grossing. Overall, the histologic findings were consistent with a foreign body giant cell reaction to exogenous material. Upon specific additional questioning, the patient confirmed a history of testosterone implant insertion. Hormonal testosterone implants are meant to dissolve over a period of 3-6 months after insertion, gradually releasing testosterone into the bloodstream. As hormone replacement implants grow in popularity and providers increasingly using them for off-label purposes, pathologists may encounter similar cases more frequently; recognition of the highly inflammatory reaction they may incite will be important.

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Eric Rosenbaum