Exuberant Local Tissue Reaction to Intramuscular Injection of Nandrolone Decanoate (Deca-Durabolin)— a Steroid Compound in a Sesame Seed Oil Base—Mimicking Soft Tissue Malignant Tumors: A Case Report and Review of the Literature

Abstract

We present an unusual pseudotumor that formed in reaction to self-administered intramuscular injections of an anabolic steroid, nandrolone decanoate (Deca-Durabolin) in a young soldier. The histopathologic features which closely mimicked several malignant neoplasms could have led to an incorrect diagnosis of malignancy and unnecessary extensive surgery. To our knowledge, this phenomenon has not been previously reported.

Injection site pseudosarcoma in piriformis syndrome

“…Macrophagic myofasciitis, which may represent an injection site reaction to aluminium‐containing vaccines, is histologically characterized by a dense intramuscular infiltrate of periodic acid–Schiff‐positive macrophages without muscle damage; 14,15 a prominent spindle cell component is not seen. There is a single previous case report of an intramuscular sarcomatous reaction to injection, similar to our cases; in this patient, the injected agent was nandrolone decanoate, an anabolic steroid 16 . Further studies will be required to determine the trigger for the spindle cell proliferation in the small number of affected patients.…”

Factitial soft tissue pseudotumor due to injection of anabolic steroids: a report of 3 cases in 2 patients

“…This clinical presentation may simulate a soft tissue sarcoma and potentially may mimic a neoplasm histologically as well [5]. This reaction is presumably a local phenomenon that may have several explanations.…”

“…Although rare, there have been occasional case reports of large reactive lesions in deep soft tissue due to the injection of anabolic steroids [4,5]. This clinical presentation may simulate a soft tissue sarcoma and potentially may mimic a neoplasm histologically as well [5].…”

Selling androgenic anabolic steroids by the pound: identification and analysis of popular websites on the Internet

“…Finally, in the context of website analysis an additional comment is deserved by the minimum/maximum purchase requirements, since in particular the maximum limits (between US$500 and US$2500) indirectly suggest that the purchase of large amounts of products is a common occurrence. Moreover, the additional specification, contained in two websites, that the minimum purchase requirement doubles in case of delivery addresses with military zip codes [and in particular of the APO/AE type, indicating, according to the Military Postal Service Agency (http://hqdainet.army.mil/mpsa/) the geographic location in Europe, Middle East and Africa] raises the issue of AAS use by soldiers, in particular those on missions in foreign countries and/or in war patrol (Bahrke & O'Connor, 1990; Khankhanian et al, 1992; Johnson & Rose, 2006). Indeed, a recent questionnaire‐based study of British military personnel located at the Contingency Operating Base in Basra (Iraq), reported that 41% admitted a history of dietary supplement use, and in particular that 1.4% admitted current use of AAS (Boos et al, 2010).…”