Case History
The images below are from a fine needle aspiration of a cord-like subcutaneous mass along the nasolabial fold.
What is the most likely clinical vignette?
A. A 17-year-old with metastatic osteosarcoma
B. A 40-year-old with a history of travel to the American Southwest
C. A 23-year-old with polysubstance abuse
D. A 61-year-old with prior cosmetic filler injections
Answer: D. A 61-year old with prior cosmetic filler injections
Discussion:
The cytology smears show a giant cell and histiocytic reaction with acellular material in the background. Although the preparations are very cellular, definitive features of malignancy are not present. Additionally, examination under polarized light shows birefringent structures suggestive of starch granules. Given the location and cytologic features, findings are most consistent with reaction to cosmetic filler injections. These reactions can occur over a year after the procedure, and thus may not be suspected clinically.
Case contributed by: Diana Lin, M.D., Associate Professor, Anatomic Pathology, UAB Pathology