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Granulomatous reaction to injectable hyaluronic acid (Restylane) diagnosed by fine needle biopsy

Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada

Correspondence to:
Dr William Geddie
Department of Laboratory Medicine and Pathobiology, University Health Network, 200 Elizabeth street, 11E219, Toronto, Ontario M5G 2C4, Canada; william.geddie@uhn.on.ca 5 April 2007

Keywords: hyaluronic acid; foreign body reaction; fine needle biopsy

The first 150 words of the full text of this article appear below.

The hyaluronic acid (HA) derivative Restylane is now the most common injectable soft tissue filler used for facial wrinkle augmentation. Although it is generally well tolerated and absorbed within months, nodule formation at the injection site has been documented.

A 62-year-old woman with a history of carcinoma of the breast six years previously was referred to a fine needle aspiration (FNA) clinic for biopsy of a subcutaneous facial nodule. On palpating the nodule six weeks prior to presentation she was referred for ultrasound examination; findings were reported as being consistent with a lymph node, raising concern of possible metastatic carcinoma of the breast. Serendipitously the same ultrasound examination led to discovery of a thyroid nodule that was aspirated and found to be papillary carcinoma, broadening the differential diagnosis of the facial nodule to metastatic thyroid carcinoma.

On physical examination the lesion was a 1 cm subcutaneous nodule overlying the lower . . . [Full text of this article]