Yonsei Med J.  2007 Jun;48(3):421-424. 10.3349/ymj.2007.48.3.421.

Incidence Rate of Injection-Site Granulomas Resulting from the Administration of Luteinizing Hormone-Releasing Hormone Analogues for the Treatment of Prostatic Cancer

• Shiota M
• Tokuda N
• Kanou T
• Yamasaki H

• KMID: 724096
• DOI: http://doi.org/10.3349/ymj.2007.48.3.421

Abstract

PURPOSE
Granulomas resulting from the administration of luteinizing hormone-releasing hormone analogues (LH-RH analogues) are thought to be very rare. We report on our clinical experience with injection-site granulomas that result from the administration of LH-RH analogues, and we evaluate the incidence rate of these granulomas. MATERIALS AND METHODS: We used the clinical records of 118 patients who were administered LH-RH analogues in 2005. We describe the clinical data of patients who experienced injection-site granulomas and evaluated the incidence rate. RESULTS: Five patients demonstrated injection-site granulomas due to LH-RH analogue administration. The incidence rate was 4.2% (5 of 118 patients). Most of the granulomas occurred after the first or second administration of 11.25mg of leuprorelin acetate. CONCLUSION: The occurrence of granulomas resulting from the administration of LH-RH analogues was thought to be very rare. Our study, however, revealed a higher incidence rate than expected, especially for leuprorelin acetate.

Keyword

Goserelin acetate; granulomas; LH-RH analogue; leuprorelin acetate; prostatic neoplasms

MeSH Terms

Aged
Aged, 80 and over
Antigens, CD/analysis
Antigens, CD3/analysis
Antigens, Differentiation, Myelomonocytic/analysis
Antineoplastic Agents, Hormonal/administration & dosage/adverse effects
Gonadotropin-Releasing Hormone/administration & dosage/*adverse effects/analogs & derivatives
Goserelin/administration & dosage/adverse effects
Granuloma/*etiology/metabolism/pathology
Humans
Injections, Subcutaneous/adverse effects
Leuprolide/administration & dosage/adverse effects
Male
Prostatic Neoplasms/*drug therapy

Figure

• 

  Fig. 1 A microscopic view of the nodule which occurred after leuprorelin acetate administration, demonstrating giant cells associated with granulomatous changes. Haematoxylin and eosin × 100.

• 

  Fig. 2 A microscopic view of the nodule which formed after the goserelin acetate administration, showing similarities to the leuprorelin acetate-dependent nodule. Haematoxylin and eosin × 100.

• 

  Fig. 3 Inflammatory cells are mainly CD3 positive T-lymphocytes, suggesting a delayed-type hypersensitivity.

• 

  Fig. 4 Inflammatory cells are mainly CD68 positive histiocytes, suggesting a delayed-type hypersensitivity.

Reference

1. Fawcett HA, Smith NP. Injection-site granuloma due to aluminum. Arch Dermatol. 1984. 120:1318–1322.

2. Whitaker IS, Fazel MZ, Joshi HB, Moseley RP, Turner WH. Leuprorelin acetate granulomas: recurrent subcutaneous nodules mimicking metastatic deposits at injection sites. BJU Int. 2002. 90:350.

3. Saxby M. Leuprorelin acetate granulomas: recurrent subcutaneous nodules mimicking metastatic deposits at injection sites. BJU Int. 2003. 91:125.

4. Yasukawa K, Sawamura D, Sugawara H, Kato N. Leuprorelin acetate granulomas: case reports and review of the literature. Br J Dermatol. 2005. 152:1045–1047.