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Needle swelling in bodybuilders misleads doctors
Doctors who see muscular patients with suspicious swellings in their arms, shoulders, buttocks or legs should not sound the alarm immediately,
but first check thoroughly whether the person has been injecting illegal substances. The Canadian pathologist Ilan Weinreb comes to this conclusion
in an article that will appear soon in Human Pathology. He discovered relatively harmless swellings in steroids users.
When a doctor discovers a swelling in a body, he automatically thinks of cancer. Cells in a cancerous swelling are mutants. They grow and multiply.
Malignant cancer cells travel through the body and grow at the cost of the body's vital organs.
They are fatal, which is why doctors want to act quickly if they find cancer. But not all swellings in the body are due to cancer.
Weinreb, a pathologist, found swellings in two chemical bodybuilders that were harmless.
Weinreb has examined swellings in bodybuilders in recent years. One of the bodybuilders was a man of 49 who had a large swelling in his thigh.
[Probably where the injection needle is shown on the picture above.]
At first the doctors thought they would have to operate, but when the man said that where the swelling was was where he normally injected steroids,
they decided to first take a sample. The swelling was not cancerous. And the doctors decided it would be best to leave the swelling alone.
Another case involved a bodybuilder in his thirties. He had a swelling deep in the muscle tissue of his upper arm, a cause for alarm among the doctors at first. Which is why they removed it. A year later the bodybuilder returned – this time with a swelling in his thigh. The doctors feared that the cancer had developed secondary's. Until the man said that both swellings were located where he injected himself with steroids.
When the doctors examined the swelling in the man's thigh they discovered the probably cause of the swelling:
They found foreign body giant cells: immune cells that are often found where foreign material has entered the body.
The immune system uses the foreign body giant cells to engulf the alien cells. The bodybuilder's foreign body giant cells can be seen in the photo below.
The cavities you see contain "obvious foreign material" as Weinreb calls it. He suspects that the foreign material entered the body with the steroids injections.
Weinreb believes that the pseudo tumor's found in bodybuilders are partly due to the non-sterile conditions found in UGL's where more and more steroids are being produced.
Another factor may be that the steroids themselves stimulate the immune system thereby causing more severe inflammatory reactions.
Doctors that examine swellings in bodybuilders should first ascertain whether they are the result of steroids injections, Weinreb thinks.
This is not easy, as many users prefer not to reveal their steroids habit. But because swellings caused by injecting are usually not dangerous, it's worth questioning in detail. It saves "unnecessarily aggressive surgery".
Source:
Hum Pathol. 2009 Dec 28. [Epub ahead of print].
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The second patient presented a more
Doctors who see muscular patients with suspicious swellings in their arms, shoulders, buttocks or legs should not sound the alarm immediately,
but first check thoroughly whether the person has been injecting illegal substances. The Canadian pathologist Ilan Weinreb comes to this conclusion
in an article that will appear soon in Human Pathology. He discovered relatively harmless swellings in steroids users.
When a doctor discovers a swelling in a body, he automatically thinks of cancer. Cells in a cancerous swelling are mutants. They grow and multiply.
Malignant cancer cells travel through the body and grow at the cost of the body's vital organs.
They are fatal, which is why doctors want to act quickly if they find cancer. But not all swellings in the body are due to cancer.
Weinreb, a pathologist, found swellings in two chemical bodybuilders that were harmless.
Weinreb has examined swellings in bodybuilders in recent years. One of the bodybuilders was a man of 49 who had a large swelling in his thigh.
[Probably where the injection needle is shown on the picture above.]
At first the doctors thought they would have to operate, but when the man said that where the swelling was was where he normally injected steroids,
they decided to first take a sample. The swelling was not cancerous. And the doctors decided it would be best to leave the swelling alone.
Another case involved a bodybuilder in his thirties. He had a swelling deep in the muscle tissue of his upper arm, a cause for alarm among the doctors at first. Which is why they removed it. A year later the bodybuilder returned – this time with a swelling in his thigh. The doctors feared that the cancer had developed secondary's. Until the man said that both swellings were located where he injected himself with steroids.
When the doctors examined the swelling in the man's thigh they discovered the probably cause of the swelling:
They found foreign body giant cells: immune cells that are often found where foreign material has entered the body.
The immune system uses the foreign body giant cells to engulf the alien cells. The bodybuilder's foreign body giant cells can be seen in the photo below.
The cavities you see contain "obvious foreign material" as Weinreb calls it. He suspects that the foreign material entered the body with the steroids injections.
Weinreb believes that the pseudo tumor's found in bodybuilders are partly due to the non-sterile conditions found in UGL's where more and more steroids are being produced.
Another factor may be that the steroids themselves stimulate the immune system thereby causing more severe inflammatory reactions.
Doctors that examine swellings in bodybuilders should first ascertain whether they are the result of steroids injections, Weinreb thinks.
This is not easy, as many users prefer not to reveal their steroids habit. But because swellings caused by injecting are usually not dangerous, it's worth questioning in detail. It saves "unnecessarily aggressive surgery".
Source:
Hum Pathol. 2009 Dec 28. [Epub ahead of print].
Human Pathology
Volume 41, Issue 3, March 2010, Pages 452-455Case study
Author links open overlay panelIlan Weinreb MD a b, John R. Goldblum MD c, Brian P. Rubin MD, PhD cShow more
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Summary
Traumatically induced inflammation or reactive processes are a relatively well-known phenomenon in both skin and soft tissue. These include panniculitides, fat necrosis, nodular fasciitis, and nonspecific fibrosis. Occasionally, traumatic reactions can be associated with factitial injury due to self-induced blunt trauma or injection of chemical agents. Factitial pseudotumors of soft tissue mimicking neoplasms and occurring in deep-seated locations are rare and not well recognized. We have had the opportunity to review a handful of cases over the years of soft tissue pseudotumors caused by self injection of steroids for the purposes of bodybuilding. Three of these cases in 2 patients are presented here. One patient developed a deep lateral thigh mass that was radiologically suspicious for sarcoma but upon core biopsy was found to be a lipogranulomatous reaction. The second patient had 2 masses occurring in the upper and lower extremity with an interval of 1 year between the two. This patient had both masses resected. The first had the appearance of a giant cell tumor with no immediately discernible foreign material. The second mass was initially presumed to be a metastasis from the upper extremity tumor and showed similar areas to the first specimen; however, it also had areas of obvious reactive features with foreign material. These features were found in the first tumor as well upon retrospective review. Both patients admitted to self injection of anabolic steroids after further history was sought by the clinicians. Deep soft tissue pseudosarcomas caused by injection of steroids are not well documented, and patient's reluctance to provide this information leads to difficulty in arriving at a correct diagnosis. Recognition of this possibility is important in avoiding incorrect diagnoses and unnecessary treatments.Introduction
Traumatically induced inflammation or reactive processes are a relatively well-known phenomenon in both skin and soft tissue. In the skin, trauma can be associated with panniculitis [1], whereas in soft tissue, it can be associated with fat necrosis [2] or nodular fasciitis [3], although most cases of the latter are not associated with trauma. Occasionally, traumatic reactions can be associated with factitial injury due to self-induced blunt trauma or injection of chemical agents [1]. The difficulty in recognizing these factitial panniculitides is partly based on the lack of clinical information provided to the clinician and pathologist at the time of presentation. Factitial pseudotumors of soft tissue are rare and not well recognized. We have had the opportunity to review several cases over the years of large deep-seated soft tissue masses clinically suspected to be soft tissue sarcomas, which have been caused by self injection of anabolic steroids for the purposes of bodybuilding. Three of these cases were available for re-review, with 2 occurring in the same patient.Section snippets
Materials and methods
All surgical specimens had been fixed in 10% neutral buffered formalin and had undergone routine processing. Hematoxylin and eosin slides were available in all 3 cases for re-review. Immunohistochemical stains were performed on 3- to 4-μm–thick sections from representative formalin-fixed, paraffin-embedded tissue on case 1. This case had been stained with CD68, S100, and AE1/AE3. These immunohistochemical slides were also reviewed.Case reports
The first patient was a 49-year-old man with a large left lateral thigh mass. It was clinically and radiologically believed to be an aggressive lesion, and there was no history of trauma to the area. A core biopsy was performed, and a benign reactive proliferation was diagnosed. On retrospect, clinical information was obtained; and the patient indicated that he had been injecting anabolic steroids at this site. There was no further clinical follow up.The second patient presented a more
