Silicone Migration and Silicone- Induced Granulomas following Injection in the Buttocks of an HIV Patient: a Case Report and Review of Management

Background: The use of liquid injectable silicone for soft tissue augmentation is a controversial practice because this material has been implicated in a variety of adverse reactions, sometimes with latent periods of decades, when the patient does not remember which product was injected. The histopathologic findings may allow the identification of the injected filler and is considered the gold standard for diagnosis. Method: We report the case of a 43-year-old homosexual men with medical history of HIV (CD4 >900 UI/ml, viral load < 40cp/ml, on HAART) and hepatitis C who presented with a painful lumbosacral mass 7 years after a soft-tissue augmentation of the buttocks with an unknown product. The medical treatment was insufficient until the patient assessment. It was unclear what the mass represented, and he underwent surgical excision under general anaesthesia, with the histopathologic examination of the biopsy specimen. After surgery the patient presented no complications and was discharged on POD 1. Results: Histopathologic evaluation revealed the liquid injectable silicone migration accompanied by a granulomatous response and presence of cells with collection of lipid-containing cytoplasmic vacuoles resembling lipoblasts. This pattern can be clinically and histologically confusing for a liposarcoma, especially when this occurrence appears years after injection. Conclusions: Migration and granulomatous reaction to silicone may occur as much as 10-20 years after injection and the patient often does not initially divulge a history of silicone augmentation, making diagnosis difficult. Complete surgical excision of the mass and histopathologic evaluation resulted in complete resolution and identification of the responsible filler. Abundant empty vacuoles that distort the nuclear contours in the cells that imbibed silicon may be a confounding factor with adipose neoplasms, such a liposarcoma and this diagnosis must be ruled out.