Tumefactive foreign body giant cell reaction following high‐pressure paint injection injury: A case report and review of literature

• Published in: Journal of cutaneous pathology 2017-05, Vol.44 (5), p.474-476
• Main Authors: Mauzo, Shakuntala H., Swaby, Michael G., Covinsky, Michael H.
• Format: Article
• Language: English
• Subjects: Antigens, CD - metabolism; Antigens, Differentiation, Myelomonocytic - metabolism; Case reports; Dermis; fibrohistiocytic proliferation; Finger Injuries - metabolism; Finger Injuries - pathology; Fingers - pathology; Foreign-Body Reaction - metabolism; Foreign-Body Reaction - pathology; giant cell tumor of tendon sheath; Giant Cell Tumor of Tendon Sheath - metabolism; Giant Cell Tumor of Tendon Sheath - pathology; Giant cells; Giant Cells, Foreign-Body - metabolism; Giant Cells, Foreign-Body - pathology; Humans; Injection; Male; Metastases; Middle Aged; Neoplasm Proteins - metabolism; Paint; paint injection injury; Pressure; pseudoneoplasm; S100 Proteins - metabolism; Sarcoma - metabolism; Sarcoma - pathology; Stroma; X-rays
• ISSN: 0303-6987; 1600-0560
• DOI: 10.1111/cup.12905

High‐pressure paint injection injury is an uncommon but well‐described injury. The histologic features of long‐term paint injection injury with retained material are less recognized. A 46‐year‐old male presented clinically as “recurrent giant cell tumor of tendon sheath.” The right index finger demonstrated fusiform enlargement by a pigmented mass with diffuse infiltration into the soft tissue of the hand. Histologically the tumor showed multiple giant cells in a fibrotic stroma extending into the dermis. There were multiple types of foreign material including diffuse brown black pigment, weakly optically polarizing foreign material and white inclusions with a “train track” appearance. The cells were positive for CD68 and negative for S100 antigen. Further investigation revealed that the patient had a history of high‐pressure paint injection injury to his digit 6 years prior. Foreign material injected under high pressure into tissues may result in a pseudo‐neoplastic foreign body granulomatous reaction that can mimic giant cell tumor of tendon sheath. Our case demonstrates that this reaction can be florid and can have slow growth over years. A high index of suspicion, a good clinical history and careful examination can distinguish these 2 entities.