Published online Oct 26, 2019. doi: 10.12998/wjcc.v7.i20.3322
Peer-review started: May 5, 2019
First decision: September 9, 2019
Revised: September 22, 2019
Accepted: September 25, 2019
Article in press: September 25, 2019
Published online: October 26, 2019
Polyacrylamide hydrogel (PAAG) injections were once common in breast augmentation and have been prohibited for augmentation mammaplasty in China since a large number of patients who underwent breast augmentation with PAAG injections have continued to seek medical advice as a result of related complications. Among all these complications, distant migration is relatively rare.
A 49-year-old female presented at the hospital with a one-year history of a vulvar lump. The sonography of the lump showed several subcutaneous fluid-filled regions from the left vulva to the pubic symphysis, which suggested possible fat liquefaction. An enhanced magnetic resonance imaging (MRI) revealed a cystic area, which was considered a benign lesion. Intraoperative observations showed that the mass did not have an obvious capsule, the subcutaneous tissue presented as a cavity, and some yellow material came out of this cavity. A culture of the drainage did not show bacterial contamination. Histopathology revealed a foreign body granuloma. After resection and closed drainage, lumps were successively observed in the left lower abdomen and the bilateral hypochondriac region with infections. Sonography found that the hypoechoic areas in the bilateral hypochondriac region seemed continuous with deep in the breasts. The patient reported that she had undergone surgery with PAAG injections 20 years ago after she was repeatedly asked about her past history. Finally, a diagnosis of distant migration of PAAG was made.
PAAG gel can migrate after long periods of time. A diagnosis should not be limited to the area where the symptom develops.
Core tip: Among the complications of PAAG injections, distant migration is relatively rare. Symptoms at presentation depend on the course and sometimes may be misdiagnosed. Here, we present a rare case of a patient who repeatedly presented with lumps and infections, without bacterial contamination or an obvious histopathologic explanation. This case shows that PAAG gel can migrate after long periods of time, and debridement surgery may be necessary even without symptoms. It took four months to make an accurate diagnosis since the patient did not disclose her history, which serves as a reminder not to limit our diagnostic ideas to the symptomatic area.