leuprolide and Granuloma

Leuprorelin acetate, an agonist of gonadotropin-releasing hormone (GnRH), is indicated in the treatment of prostate cancer. Recently, depot formulations of leuprorelin acetate have been widely used. We report three patients who showed a granulomatous reaction after treatment using a leuprorelin acetate 3-month depot formulation. These patients presented with 5-6-cm subcutaneous nodules at injection sites, which developed after the depot type was changed from a 1-month to a 3-month formulation. Skin biopsy showed epithelioid cells and foreign body giant cells containing round, translucent microspheres which formed sarcoidal granulomas. Changing to other GnRH agonists resulted in no further problems. We have reviewed the previous reports of leuprorelin acetate-induced granuloma formation. The formation of such granulomas may be related to the polymers that allow slow release after injection, or leuprorelin acetate itself may be responsible. The depot injection methods using leuprorelin also seem to have a causal effect in granuloma formation. Dermatologists need to know that depot leuprorelin acetate may cause a granulomatous reaction which produces a subcutaneous nodule that might be misdiagnosed as a malignant tumour.

Topics: Aged; Aged, 80 and over; Antineoplastic Agents, Hormonal; Delayed-Action Preparations; Granuloma; Humans; Injections, Subcutaneous; Leuprolide; Male; Prostatic Neoplasms; Skin Diseases

A 73-year-old man presented with an ulcer and a subcutaneous nodule where he was receiving leuprorelin acetate injections to treat his prostatic carcinoma. Pathological findings of a skin biopsy showed many epithelioid granulomas with multinuclear giant cells, which contained small vacuoles. Recently, these lesions have been suggested to be caused by a type IV allergic response to the copolymer of lactic and glycolic acids used as a vehicle for drug administration. When urologists treat a prostatic adenocarcinoma with subcutaneous infusion of leuprorelin acetate, they should be aware of this potential side effect of the drug because the resulting granulomar formation may interfere with the effect of the drug. If patients suffer from subcutaneous nodules, urologists should consider changing the drug to an other type of luteinizing hormone-releasing hormone analogues such as goserelin acetate. This reaction to leuprorelin acetate has been reported in only seven cases including our case.

Topics: Aged; Antineoplastic Agents, Hormonal; Granuloma; Humans; Injections, Subcutaneous; Leuprolide; Male; Prostatic Neoplasms; Skin Diseases

Topics: Aged, 80 and over; Antineoplastic Agents, Hormonal; Granuloma; Humans; Injections, Subcutaneous; Leuprolide; Male; Prostatic Neoplasms; Skin Diseases

We investigated the incidence of granuloma and its related factors in 180 patients with prostate cancer who showed subcutaneous granuloma formation during androgen deprivation therapy with subcutaneously administered leuprorelin acetate. A granuloma was defined as a persistent induration over 30 mm in diameter in the injected portion. Small indurations which often developed and disappeared after every injection were excluded. The survey was performed using a questionnaire after receiving written informed consent. Among the 180 patients with prostate cancer, 21 (11.7%) developed a granuloma at the injection portion, and subsequently the injection of leuprorelin acetate had to be discontinued. Eighteen of the 21 patients alternatively received goserelin acetate. Three patients had high-grade granulomas with ulcer and abscess formation, and were successfully treated with oral antibiotics. The average duration between the first injection of leuprorelin acetate and granuloma formation was 20.2 months (range : 4 to 62 months). There was no association between granuloma formation and patient backgrounds, such as allergic predisposition and past history. Twenty-one of the 180 prostatic cancer patients developed subcutaneous granuloma induced by the injection of leuprorelin acetate. The investigation showed an unexpectedly high incidence of granuloma formation. We must explain the risk of developing subcutaneous granuloma to the patients before introducing leuprorelin acetate.

Topics: Aged; Aged, 80 and over; Antineoplastic Agents, Hormonal; Granuloma; Humans; Incidence; Injections, Subcutaneous; Leuprolide; Male; Middle Aged; Prostatic Neoplasms; Retrospective Studies; Risk Factors; Surveys and Questionnaires

Leuprorelin is a luteinizing hormone-releasing hormone (LH-RH) agonist that is used as an agent of androgen deprivation in some patients with prostate cancer. When administered in depot form, local granulomatous reactions may occur at the injection site, which may mimic masses and which are associated with treatment failure. We present a patient who, over a period of 5 years, developed multiple intramuscular gluteal masses while receiving leuprorelin therapy via intramuscular depot injections; biopsy of one of the masses showed the specific histologic features of leuprorelin granuloma. To our knowledge, this entity has not been described in the radiology literature. Awareness of this entity is necessary to suggest the correct diagnosis in patients with a history of leuprorelin depot injections.

Topics: Antineoplastic Agents; Delayed-Action Preparations; Granuloma; Humans; Leuprolide; Magnetic Resonance Imaging; Male; Middle Aged; Muscular Diseases; Recurrence; Tomography, X-Ray Computed

Gonadorelin analogues (LHRH) are used for the endocrine treatment of prostatic cancer, central early puberty and various gynaecological conditions. Cutaneous adverse events seldom occur. We report a case of injection-site granulomas induced by leuprorelin acetate (Enantone®).. A 76-year-old man presented with several subcutaneous nodules on his left arm. The nodules were hard but painless. He had received subcutaneous injections of Enantone® for prostatic cancer. Histological examination of a skin biopsy specimen demonstrated granulomatous inflammation with a necrotic centre; screening for an infectious aetiology was negative. Serial sections showed giant cells containing translucent round microspheres in the subcutaneous tissue. Limitation to the leuprorelin acetate injection sites in the arm and detection at histological analysis of microspheres probably bound to an injected product militated in favour of granulomas caused by injections of Enantone®.. Injection-site granulomas caused by Enantone® are rare. Their formation may depend on the mode of administration: the more superficial the injection, the higher the risk of developing granulomas. The formation of these lesions is probably a foreign body reaction to the excipient.

Topics: Aged; Antineoplastic Agents, Hormonal; Granuloma; Humans; Leuprolide; Male; Prostatic Neoplasms

Leuprorelin acetate-induced granulomas in subcutaneous injection sites have been occasionally reported, but there have been no detailed morphological examinations. Histopathology of leuprorelin acetate-induced granulomas in six patients was studied, and one of them was evaluated by electron microscopy. Study using haematoxylin and eosin staining revealed that there were many intracytoplasmic vacuoles in the granulomas and degeneration of fat tissue. Ultrastructurally, electron-lucent spherical bodies (microcapsules of leuprorelin acetate products) were observed in the granuloma cells. Needle-shaped crystalloid structures in lipid droplets (degenerated lipid droplets) were observed in the granuloma cells and fat tissue. Degeneration of fat tissues caused by leuprorelin acetate is one of main factors responsible for granuloma formation.

Topics: Aged; Aged, 80 and over; Antineoplastic Agents, Hormonal; Granuloma; Humans; Injections, Subcutaneous; Leuprolide; Male; Microscopy, Electron; Prostatic Neoplasms

We present our experience with 7 patients who developed injection site granuloma with leuprorelin acetate injection. Although isolated case reports exist, this is the largest collection of cases from a single center. The exact mechanism of the granuloma formation is not well understood, although theories are associated with the vehicle used for injection. Our discussion focuses on the nature of the granuloma formation and its etiology. The reaction appears to be more common with leuprorelin acetate than with other forms of luteinizing hormone-releasing hormone analogues.

Topics: Antineoplastic Agents, Hormonal; Granuloma; Humans; Injections; Leuprolide; Male; Prostatic Neoplasms; Skin Diseases

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.. 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.. 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.. 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.

Topics: Aged; Aged, 80 and over; Antigens, CD; Antigens, Differentiation, Myelomonocytic; Antineoplastic Agents, Hormonal; CD3 Complex; Gonadotropin-Releasing Hormone; Goserelin; Granuloma; Humans; Injections, Subcutaneous; Leuprolide; Male; Prostatic Neoplasms

Luteinizing hormone-releasing hormone (LH-RH) analogues have become the main focus of androgen deprivation therapy for prostatic cancer. The occurrence of injection-site granulomas due to the administration of LH-RH analogues has been thought to be a rare reaction. We herein report a rare case presenting injection-site granuloma due to the administration of leuprorelin acetate, mimicking metastatic nodule. A 90-year-old man presented with subcutaneous nodules at the injection-site of leuprorelin acetate 11.25 mg (for 3-month use). Ultrasound examination and computed tomography (CT) revealed two nodules in the bilateral abdominal walls mimicking metastatic nodule. Although he was surgically treated because of the possibility of malignancy, in the end, no evidence of malignancy was found. We should keep in mind that LH-RH analogues may cause injection-site granulomas mimicking metastatic nodule, and therefore we must inform patients undergoing the administration of leuprorelin acetate that it may cause injection-site granuloma and thus when a patient demonstrates a subcutaneous nodule it is essential to confirm whether or not he has received an injection of the LH-RH analogue at the site of nodule.

Topics: Abdominal Wall; Aged, 80 and over; Antineoplastic Agents, Hormonal; Diagnosis, Differential; Granuloma; Humans; Injections; Leuprolide; Male; Prostatic Neoplasms

Although injection-site granulomas caused by leuprorelin acetate have been reported, there have been no reports of granulomas caused by both leuprorelin acetate and goserelin acetate. An 81-year-old man presented with subcutaneous nodules of the abdominal wall and upper arm, where 11.25 mg of leuprorelin acetate had been injected for the treatment of prostate cancer. Because of these nodules, treatment was changed to goserelin acetate. Nevertheless, he presented with another subcutaneous nodule at the injection site. Histological examination showed that these nodules consisted of numerous giant cells that were CD3-positive T lymphocytes and CD68-positive histiocytes associated with granulomatous changes. The granulomas had likely been caused by delayed-type hypersensitivity to leuprorelin acetate injection. The granuloma that formed after goserelin acetate injection might thus have developed owing to the immunogenicity of the previous leuprorelin acetate injections. The patient underwent surgical castration. The present case suggests that both leuprorelin acetate and goserelin acetate can cause injection-site disorders.

Topics: Aged, 80 and over; Goserelin; Granuloma; Humans; Injections; Leuprolide; Male; Prostatic Neoplasms

Luteinizing hormone-releasing hormone agonist (LH-RH analogue) therapy, is one of the most widely used hormonal therapies. Recently, subcutaneous injection of a new long acting 3-month LHRH analogue depot has been developed. We investigated the adverse events induced by injection of an LH-RH analogue in 82 patients (median age was 75 year old, 59-87) using our questionnaire. Forty-eight and 34 cases had been administered leuprorelin acetate (LSR) and goserelin acetate (ZLA). The presentation rate of skin reaction was 8.8% (3/34) in the ZLA group and 14.6% (7/48) in the LSR group. There was no significant difference in rate of skin reaction between the LSR and ZLA group (p = 0.5113). Eight patients had induration (6 in LSR 2 in ZLA). We also present a case of subcutaneous granuloma formation at the injection site after using the three-month type preparation of leuprorelin acetate. We should be aware of the risk of skin reactions at the injection site and monitor carefully when using an LH-RH analogue.

Topics: Aged; Aged, 80 and over; Antineoplastic Agents, Hormonal; Gonadotropin-Releasing Hormone; Goserelin; Granuloma; Humans; Injections, Subcutaneous; Leuprolide; Male; Middle Aged; Prostatic Neoplasms; Skin

Leuprorelin acetate, a chemotherapeutic agent used to treat prostate cancer, is a synthetic luteinizing hormone-releasing hormone (LHRH) agonist. We report a 75-year-old man who presented with several large subcutaneous nodules at the site of leuprorelin acetate injections for his prostatic cancer. A biopsy of the nodules disclosed epithelioid granulomatous inflammation and resulted in a diagnosis of drug-induced granulomatous reaction to leuprorelin acetate.

Topics: Abdomen; Aged; Antineoplastic Agents, Hormonal; Diagnosis, Differential; Gonadotropin-Releasing Hormone; Granuloma; Humans; Injections, Subcutaneous; Leuprolide; Male; Prostatic Neoplasms; Skin Neoplasms

Topics: Aged; Delayed-Action Preparations; Granuloma; Humans; Injections, Subcutaneous; Lactic Acid; Leuprolide; Male; Polyesters; Polymers; Prostatic Neoplasms; Suppuration

Leuprorelin acetate is a luteinizing hormone-releasing hormone (LH-RH) analog, which is used for chemical castration. Chemical castration treatment has an especially important role for prostate cancer. To ensure ongoing chemical castration, a novel sustained-action injection system using spherical microcapsules has been developed. We report a patient who had granuloma caused by administration of the 11.25 mg leuprorelin acetate product. Histological examination revealed many giant cells with vacuoles. On the basis of reported cases, these vacuoles are characteristic for the granuloma caused by leuprorelin acetate product. The vacuoles in the granuloma are the same size as the microcapsules, and their shape is almost spherical. We assume that the vacuoles in the granuloma are actually the microcapsules. We expect that there will be investigations regarding the procatarctic cause of granuloma formation.

Topics: Aged; Antineoplastic Agents, Hormonal; Granuloma; Humans; Injections, Subcutaneous; Leuprolide; Male; Skin Diseases

A case of granuloma which developed following a subcutaneous injection of leuprorelin acetate is presented. A prominent induration developed at the site of injection with a three-month type preparation, and radical retropubic prostatectomy and simultaneous excision of the granulomas were requested by the patient since they were large, infectious and painful. Our experience may indicate the necessity of conversion from leuprorelin acetate to other drugs (e.g., goserelin acetate, castration) if a local induration, caused by a subcutaneous injection of leuprorelin acetate, has developed to a large granuloma.

Topics: Aged; Aged, 80 and over; Antineoplastic Agents, Hormonal; Granuloma; Humans; Inflammation; Injections, Subcutaneous; Leuprolide; Male; Prostatic Neoplasms

Topics: Antineoplastic Agents, Hormonal; Diagnosis, Differential; Granuloma; Humans; Leuprolide; Neoplasm Recurrence, Local; Skin Neoplasms

Topics: Adenocarcinoma; Aged; Aged, 80 and over; Antineoplastic Agents, Hormonal; Diagnosis, Differential; Granuloma; Humans; Injections; Leuprolide; Male; Neoplasm Recurrence, Local; Prostatic Neoplasms; Skin Diseases; Skin Neoplasms