An evidence-based, peer-reviewed journal for practicing clinicians in the field of dermatology
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51 JCAD journal of clinical and aesthetic dermatology April 2017 • Volume 10 • Number 4 C A S E r E p o r T pain and swelling, but both recurred within two weeks of the operation. After this failed measure, the patient initiated care at the authors' institution, being initially seen by OB/GYN. Work-up included a magnetic resonance imaging (MRI) (Figures 1 and 2), which showed innumerable small T2 hyperintense nodules throughout the gluteal region with extension into and throughout the ischiorectal fossa and bilateral pelvic sidewall. Extension of these nodules was seen throughout the perineum and into the subcutaneous tissues adjacent to the right labia, with continued extension of these nodules into the right inguinal canal. The right labia was asymmetrically larger than the left, which was relatively spared of the T2 hyperintense nodular structures. Given the prior failure of an excisional procedure and the diffuse spread of the injected silicone, surgical therapy was deemed inappropriate and the patient was referred to dermatology for alternative treatment options. At presentation to the dermatology clinic, physical exam showed that the right labia majora was significantly enlarged compared to the left labia majora (Figure 3). The right labia exhibited pitting edema; there was subtle overlying erythema and mild warmth. Several small nodules deep in the subcutaneous tissue of the labia and buttocks could be felt, but were not easily visualized. These nodules were tender to deep compression. Punch biopsies from the right labia majora and right inferior buttocks revealed a dense granulomatous infiltrate in the dermis and subcutis (Figure 4). Histiocytes, some multinucleate, were noted to contain clear vacuolar spaces within their cytoplasm, findings consistent with silicone granulomas. No intralymphatic granulomas were seen. Laboratory work-up, including basic metabolic panel, liver function tests, complete blood count, and testing for hepatitis B, hepatitis C, and human immunodeficiency virus (HIV) were [Abstract continued] but attempted therapies have i ncluded surgery, local steroid injections, systemic steroids, tetracycline antibiotics, and other immune modulators. Treatment must be tailored to the individual case, considering the patient's preferences and medical history. J Clin Aesthet Dermatol. 2017;10(4):50–54. Figure 1. Coronal view MrI showing extension of T2 hyperintense nodules into the subcutaneous tissues adjacent to the right labia Figure 2. Sagittal view MrI showing T2 hyperintense nodules scattered throughout the right buttock and perineum.