Foreign body reaction

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Classification according to ICD-10
M60.2 Foreign body granuloma in soft tissue, not elsewhere classified
L92.3 Foreign body granuloma in the skin and subcutaneous tissue
ICD-10 online (WHO version 2019)

Foreign body reactions are undesired local immunological reactions triggered by solid, mostly foreign substances ( foreign bodies , Latin corpus alienum ) within the organism .

description

X-ray of a man suffering from silicosis

Foreign bodies can get into an organism in different ways. Typical routes are through breathing (examples: asbestos fibers , dust containing quartz ), accidents with open wounds or parenterally (mostly iatrogenic , i.e. caused by medical measures such as implantations ). Cells of the mononuclear phagocyte system (MPS, a non-specific cellular defense system with an elimination function) try to eliminate the foreign bodies. In this form - particularly any foreign bodies from poorly biodegradable substances - foreign body granulomas . These non- infectious granulomas are nodular new tissue formations consisting of epithelial cells , mononuclear cells or giant cells that wrap around the foreign body and encapsulate it.

The foreign bodies can be, for example, crystalline or amorphous plastics, metals or natural substances . In most cases, the foreign bodies are of exogenous origin, that is, they entered the body from outside. A special form of foreign body reaction is caused by endogenous "foreign bodies". This is inter alia the Cholesteringranulom obtained by cholesterol crystals is caused and by uric acid crystals caused gout .

The chronic inflammatory reactions triggered by the foreign body can lead to a degeneration of the cells in the long term and thus to the development of cancer . This can often be observed, for example, in asbestosis , which can lead to pleural mesothelioma (lung cancer).

The interactions of particulate foreign bodies with the organism cannot be predicted in many cases and are therefore often examined in animal models . For example, titanium white or soot or coal dust are insoluble and chemically inert and neither lead to inflammatory reactions nor to damage to the macrophages or the lysosome . The exogenous particles are stored in the histocytes . In the case of the carbon particles , these cells are pigmented black ( anthracotic pigment ). The lung tissue of miners exposed to coal dust is often pigmented deep black. These deposits do not lead to pathological changes in the cells or the surrounding tissue, provided that it is only coal dust. Crystalline silicon dioxide and barium sulfate are also insoluble and chemically inert. Inhaled dusts of crystalline silicon dioxide ( quartz ) can lead to the silicosis , a foreign body reaction, which miners fear . Barium sulfate is a many decades proven and oral administration harmless X-ray contrast agent . If it is accidentally administered intraperitoneally (into the abdominal cavity), this error is fatal in 20 to 50 percent of cases .

Biocompatible materials, as used in practice for implants, only cause a moderate amount of long-term foreign body reactions. In these cases one speaks of biomaterials .

Certain oils and waxes, such as paraffin or petroleum jelly, can also trigger foreign body reactions in the form of lipid granulomas .

Examples

Capsular contracture is a foreign body reaction - in this case to a silicone implant.
Large foreign body granuloma in the tibia around the tip of the anchorage of a prosthetic knee. You can see in the X-ray that the normal bone structure is dissolved in this zone.
  • Inhaling quartz-containing mixed dusts can lead to anthracosilicosis ( pneumoconiosis ). This disease is characterized by perivascular granuloma formation with hyaline fibrosis.
  • Asbestosis is a non-specific, chronic inflammatory foreign body reaction.
  • The poor biocompatibility of implants can lead to severe inflammatory reactions with chronic pain. In inguinal hernia surgery , for example, this is a relatively common complication that can lead to extreme pain.
  • Until the development of biocompatible implants, conventional implants for the treatment of an atrial septal defect often led to foreign body reactions, which manifested themselves in an increased proliferation of connective tissue, thromboembolism and perforations in the area of ​​the implant.
  • The so-called in-stent re stenosis is a foreign body reaction to a stent in the form of intimal hyperplasia . Until the development of intracoronary short-term irradiation using brachytherapy , in-stent restenosis was a dreaded complication after the implantation of a stent, which often led to patient death in the form of acute, subacute or late stent thrombosis . There are now also drug-eluting stents (DES) that release anti-proliferative agents such as sirolimus , paclitaxel or zotarolimus . With both approaches, the proliferation in the area of ​​the implant is suppressed. Newer concepts work with bioresorbable stents, for example based on polylactates (PLA) or special magnesium alloys.
  • In connection with breast enlargement , capsular contractures are a foreign body reaction of the organism to the implant. They are the most common complications after silicone breast implants are implanted. The incidence is around 4 percent after two years and 15 percent after ten years or more.
  • In model organisms , smooth-surfaced implants, for example made of nylon , glass or polyester, can lead to sarcomas as a result of a foreign body reaction . It is not the material that plays a role, only its surface texture (smooth).
  • The abrasion of prostheses , such as a joint prosthesis , can also lead to foreign body reactions. The joint socket in particular - mostly made of polyethylene - tends to wear and tear, which irritates the synovia and can lead to " prosthetic synovitis ". Within ten years, this leads to a loosening of the joint socket in 25 percent of joint prostheses.
  • A swallowed fishbone can in certain cases cause a foreign body reaction in the form of a foreign body granuloma.

Individual evidence

  1. ↑ a b c d R. Büttner and C. Thomas: Allgemeine Pathologie. Schattauer Verlag, 2003, ISBN 3-7945-2229-X . limited preview in Google Book search
  2. ↑ S. Martiny: Magnetic resonance tomography with a 3D T2-weighted turbo spin echo sequence of different resolution: representation of anatomical details and pathological changes in axial recordings, maximum intensity projections and three-dimensional volume reconstructions. Dissertation, Rheinisch-Westfälische Technische Hochschule Aachen, 2006, p. 20.
  3. ↑ A. Roessner: General pathology and foundations of special pathology. Elsevier and Urban & Fischer Verlag, 2008, ISBN 3-437-41541-7 , p. 28. Limited preview in Google book search
  4. ↑ B. Krug: Thoraxdiagnostik. Georg Thieme Verlag, 2004, ISBN 3-13-137011-4 , limited preview in the Google book search
  5. ↑ H. Abdolvahab-Emminger among others: Exaplan: the compendium of clinical medicine. Volume 1, Elsevier and Urban & Fischer Verlag, 2008, ISBN 3-437-42462-9 , p. 1359.
  6. ^ R. Berchtold: Surgery. Elsevier and Urban & Fischer Verlag, 2008, ISBN 3-437-44481-6 , p. 18. Restricted preview in Google book search
  7. ↑ KM Müller and M. Krismann: Asbestos-associated diseases: pathological-anatomical findings and insurance-medical aspects. In: Dtsch Arztebl 93, 1996, pp. A-538 / B-438 / C-411
  8. ↑ A. Soleimanian: Hernia surgery: The quality depends on the surgeon, not on the technique. In: Dtsch Arztebl 105, 2008, p. A-2080
  9. ↑ N. Siegmund-Schultze: Gentle closure of septal defects. In: Dtsch Arztebl 104, 2007 with p. A-2162 / B-1914 / C-1850
  10. ↑ S. Silber et al.: Safety and feasibility of intracoronary brachytherapy with the Novoste ™ system in the context of international multicenter studies. In: Zeitschrift für Kardiologie 89, 2000, pp. 323–329. doi : 10.1007 / s003920050492
  11. ↑ PW Serruys et al: Coronary artery stents. In: N Engl J Med 354, 2006, pp. 483-495. PMID 16452560
  12. ↑ S. Silber: Antiproliferative coated stents and intracoronary brachytherapy: Similarities and differences. In: Z Kardiol 91, 2002, pp. 443-457. doi : 10.1007 / s00392-002-0817-z
  13. ↑ S. Silber et al .: Acute risk of myocardial infarction in the absence of clopidogrel administration after coronary stent implantation. In: Dtsch Arztebl 103, 2006, pp. A-2863 / B-2489 / C-2394.
  14. ↑ N. Handel et al: A long-term study of outcomes, complications, and patient satisfaction with breast implants. In: Plast Reconstr Surg 117, 2006, pp. 757-767. PMID 16525261
  15. ↑ TF Henriksen et al .: Incidence and severity of short-term somlications after breast augmentation: results from a nationwide breast implant registry. In: Ann Plast Surg 51, 2003, pp. 531-539. PMID 14646643
  16. ↑ I. Kumala et al .: Local complications after cosmetic breast implant surgery in Finland. In: Ann Plast Surg 53, 2004, pp. 413-419. PMID 15502454
  17. ↑ a b P. Schmidt-Rhode et al.: Safety of silicone breast implants. German Society for Gynecology and Obstetrics eV; Guidelines, recommendations, opinions; As of August 2008
  18. ↑ R. Junghans et al: Foreign body granuloma of the pancreatic head through a fishbone - a very rare differential diagnosis of the pancreatic head tumor. In: Der Chirurg 70, 1999, pp. 1489-1491. doi : 10.1007 / PL00002582

further reading

  • NJ Hallab and JJ Jacobs: Biologic effects of implant debris. In: Bull NYU Hosp Jt Dis 67, 2009, pp. 182-188. PMID 19583551 (Review)
  • P. Thevenot et al .: Surface chemistry influences implant biocompatibility. In: Curr Top Med Chem 8, 2008, pp. 270-280. PMID 18393890 (Review)
  • JM Anderson et al: Foreign body reaction to biomaterials. In: Semin Immunol 20, 2008, pp. 86-100. PMID 18162407 (Review) PMC 2327202 (free full text)
  • DT Luttikhuizen et al: Cellular and molecular dynamics in the foreign body reaction. In: Tissue Eng 12, 2006, pp. 1955-1970. PMID 16889525 (Review)