Tetzner Ana Cristina, Viana Laura Regina Mendes, Abreu Lucas Guimarães, Mendonça Elismauro Francisco, Arantes Diego Antônio Costa, Vasconcelos Ana Carolina Uchoa, Gomes Ana Paula Neutzling, Nonaka Cassiano Francisco Weege, Alves Pollianna Muniz, Tapia Roberto Onner Cruz, Mesquita Ricardo Alves, de Sousa Sílvia Ferreira, Silva Tarcília Aparecida, Caldeira Patrícia Carlos
Department of Oral Pathology and Surgery, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
Department of Children Oral Health, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
J Oral Pathol Med. 2025 Mar;54(3):141-150. doi: 10.1111/jop.13604. Epub 2025 Jan 29.
Cosmetic injections are increasing, as their complications, which can be misdiagnosed as neoplastic lesions. This study aimed to detail clinical, pathological, histochemical, and immunohistochemical features of adverse reactions to cosmetic fillers in the oral and maxillofacial region.
Samples were retrieved from five pathology laboratories. Hematoxylin-eosin (H&E), Alcian Blue, Sirius Red, and Toluidine blue stains were performed, as well as immunohistochemistry for CD68, CD3, and CD20. H&E was evaluated under polarization. Descriptive statistics were performed.
Twenty-three cases were included. Polymethyl-methacrylate was the most common material. Most reactions affected women, lips and were asymptomatic, with a variable time of evolution, presenting as nodules. Materials had different shape and size on H&E. Giant cells were commonly found, except in silicone and hyaluronic acid. Foreign-body granuloma was frequent in polymethyl-methacrylate. Calcium hydroxyapatite and poly-L-lactic acid were refractile under polarized light. Hyaluronic acid and polyacrylamide hydrogel were metachromatic by Toluidine blue. Alcian blue was positive in all cases of hyaluronic acid. Mast cells were detected in all materials, except hyaluronic acid and polyacrylamide hydrogel. Eosinophils were rarer than mast cells. Numerous CD68-positive cells were seen in all cases. All cases had CD3-positive cells, with variable amounts. CD20 was scant or negative in most cases.
An evident macrophage reaction is observed in all aesthetic fillers, frequently associated with giant cell formation. Despite similarities, there are specific features of each material and the host response that assist the correct histopathological diagnosis. Immunohistochemistry for CD68 and Toluidine blue stain are useful in doubtful cases.
随着美容注射的增加，其并发症可能被误诊为肿瘤性病变。本研究旨在详细阐述口腔颌面部美容填充剂不良反应的临床、病理、组织化学和免疫组织化学特征。
从五个病理实验室获取样本。进行苏木精-伊红（H&E）、阿尔辛蓝、天狼星红和甲苯胺蓝染色，以及针对CD68、CD3和CD20的免疫组织化学检测。在偏振光下评估H&E染色。进行描述性统计。
纳入23例病例。聚甲基丙烯酸甲酯是最常见的材料。大多数反应累及女性、唇部，且无症状，演变时间不一，表现为结节。材料在H&E染色下具有不同的形状和大小。除硅酮和透明质酸外，常见巨细胞。聚甲基丙烯酸甲酯中异物肉芽肿常见。羟基磷灰石钙和聚-L-乳酸在偏振光下呈折光性。透明质酸和聚丙烯酰胺水凝胶经甲苯胺蓝染色呈异染性。阿尔辛蓝在所有透明质酸病例中均呈阳性。除透明质酸和聚丙烯酰胺水凝胶外，在所有材料中均检测到肥大细胞。嗜酸性粒细胞比肥大细胞少见。所有病例均可见大量CD68阳性细胞。所有病例均有CD3阳性细胞，数量不等。大多数病例中CD20稀少或为阴性。
在所有美容填充剂中均观察到明显的巨噬细胞反应，常伴有巨细胞形成。尽管存在相似性，但每种材料及宿主反应都有特定特征，有助于正确的组织病理学诊断。CD68免疫组织化学和甲苯胺蓝染色在疑难病例中有用。
