Ultrastructural and Microanalytical Study of a Subcutaneous Granuloma HPV Tetravalent Vaccine Induced: A Case Report and Review of Literature

Manuel Scimeca, Lucia Anemona, Alfredo Colantoni, Elena Bonanno


We report the case of an eighteen years old woman who developed a subcutaneous nodular lesion localized on her right upper arm. Conventional histological examination revealed a lesion characterized by a necrotic center surrounded by palisading epithelioid histiocytes embedded into the fibroadipous and skeletal muscle tissue. Transmission electron microscopy analysis confirmed the histological observations in terms of cellular composition of the granuloma. The ultrastructural microanalysis shed light on the elemental composition of the examined granulomatous formation since it clearly detected metallic deposits with an emission pick at EDX for aluminum within the hystocitess granules. Our results support previous published data on the reactive nature of granulomatous reaction at the site of vaccine. The presence of aluminum inside the cytoplasm of macrophages proved by microanalysis gives strength to the etiopatogenic hypothesis of the granuloma formation.

J Med Cases. 2013;4(7):461-465
doi: https://doi.org/10.4021/jmc1193w


Granuloma; HPV vaccine; Transmission electron microscopy; EDX Microanalysis; Aluminum

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