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Lipogranuloma

Lipogranuloma (Greek. Lipos - fat + granuloma; synonym: oleogranuloma, paraffin) is a focal chronic inflammation at the site of introduction of fatty substances or necrosis of adipose tissue due to trauma, inflammation, ischemia, etc.

Lipogranuloma is an unusual inflammatory reactive process associated with endogenous or exogenous lipid materials. Lipogranuloma most often affects the penis and scrotum in young men and the mammary glands in women.

There are artificial (injection) lipogranulomas, traumatic (for example, in newborns), inflammatory and ischemic (for example, after typhus). Lipogranulomas can occur not only in adipose tissue, but also in internal organs, for example, in the lungs (lipoid pneumonia). Spontaneous widespread lipogranulomatosis or recurrent, non-suppressed nodular panniculitis is also observed (see Weber –Criscane disease).

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It is known that lipogranuloma or sclerosing lipogranuloma is a tissue reaction to exogenous foreign bodies or endogenous lipids, and its etiology has not yet been clearly defined. This disease is classified according to its cause. The main type is caused by the destruction of endogenous lipids, and the secondary type is caused by the introduction of exogenous foreign materials such as paraffin, mineral or vegetable oils and silicone.

In addition, primary systemic sclerosing lipogranulomas can be associated with major systemic diseases, such as lipid metabolism disorders, diabetes mellitus and renal syndrome, which can cause an accumulation of lipids in the tissues. Allergic mechanisms have also been suspected as the main cause of primary hardening. Cellular immune responses have been proposed as the mechanism responsible for the formation of the primary scrotal lipogranuloma. In some cases, endogenous lipid degeneration is directly related to allergic reactions to overheating, cooling and various injuries, which have also been proposed as a causative factor. However, other cases of primary lipogranuloma have been reported without any plausible history or evidence of causal factors in the literature. Secondary lipogranuloma usually develops after subcutaneous injections of foreign bodies for cosmetic or reconstructive purposes, or local use of oil-based medications.

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Oleogranulomas are most commonly found in the genitourinary system, and also affect other organs, such as the spleen, liver, mesentery, chest, scalp, eyelid, and nose.

Oleogranulomas of the mammary gland in women is a relatively rare disease. Oleogranulomas are non-allergic reactions to foreign bodies that are commonly found in areas where lipid material has been injected either traumaticly or with a specific purpose. It was reported that after injection of lipid substances for cosmetic purposes and after injury or specific therapy, several types of oleogranule develop. Oleogranulomas can develop after the release of silicone gel from breast implants and after phenothiazine therapy.

Histopathologically, oleogranuloma is characterized by multiple fatty vacuoles surrounded by granulomatous tissue consisting of multinucleated giant cells, epithelioid histiocytes and fibrosis. Regardless of the type of exogenous substances responsible for secondary lipogranuloma, including paraffin, petroleum jelly, mineral oils, lanolin and silicone, a similar histopathological appearance occurs after injection.

Macroscopically, oleogranulomas have the form of a dense knotted node. If the node is located under the skin, the latter is usually not changed. On the incision in oleogranuloma, cystic cavities are often defined, made of fat.

Histologically detect granulation tissue with the presence of multicore giant lipophages and xanthoma cells, as well as cysts lined with large cells containing fat. In fresh lipogranulomas, foci of necrosis of adipose tissue are determined. In long-existing oleogranulomas, fibrous tissue with xanthoma cells and giant multinuclear lipophages predominate. Sometimes in oleogranuloma there are bumps resembling those observed in tuberculosis or sarcoidosis. Such changes may be associated with allergic autoimmune processes.

Despite fibrosis, lipogranuloma tends to gradual progression with involvement of the surrounding tissues in the process, so self-healing occurs rarely. Sometimes, in subcutaneous oleogranulomas, inflammatory necrotic processes result in long-term healing fistulae. The outcome of lipogranuloma can be calcification (see).

Surgical treatment of oleogranulomas - excision of lipogranulomas within healthy tissues.