Granuloma caused by subcutaneous injection of leuprorelin acetate product: Case report and histopathological findings

Abstract

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.

Evidence‐based medicine: comparative analysis of luteinizing hormone‐releasing hormone analogues in combination with external beam radiation and surgery in the treatment of carcinoma of the prostate

“…The differences in the method of leuprorelin acetate injection can influence the frequency of granuloma development [66,[68][69][70]. In any case, examples have been reported of a relationship between inflammatory nodes, granulomas or pseudocysts at the site of administration and the existence of escapes with the use of different analogues and administration routes [43, [68][69][70][71][72][73][74][75][76]. The reaction can be the result of either the analogue itself or the excipient used [69] (Fig.…”

¿Se ha de asumir el efecto de clase farmacológica entre los diferentes análogos de la hormona liberadora de la hormona luteinizante usados en el tratamiento del carcinoma de próstata?

“…Asimismo, la dosis administrada tambié n estaría relacionada con su incidencia 49 . La diferencia en cuanto al mé todo de inyecció n del acetato de leuprorelina puede determinar la frecuencia del desarrollo de los granulomas 49,[51][52][53] . De todas maneras se han referido casos de relació n entre los nó dulos inflamatorios, los granulomas o los seudoquistes en la zona de administració n y la existencia de escapes con el uso de diferentes aná logos y vías de administració n 38,[51][52][53][54][55][56][57][58][59] .…”

Granulomas induced by subcutaneous injection of a luteinizing hormone‐releasing hormone analog: a case report and review of the literature

“…Several cases of leuprorelin acetate‐induced granulomas have been reported 3–9 . We have performed detailed histologic examination of six cases of leuprorelin acetate‐induced granulomas and pointed out that degeneration of fat tissues caused by leuprorelin acetate is one of main factors responsible for granuloma formation 10 .…”