Subcutaneous inflammation mimicking metastatic malignancy induced by injection of mistletoe extract
BMJ 2006; 333 doi: https://doi.org/10.1136/bmj.39044.460023.BE (Published 21 December 2006) Cite this as: BMJ 2006;333:1293
- A I Finall, specialist registrar, histopathology1,
- S A McIntosh, consultant surgeon2,
- W D Thompson, consultant histopathologist2
- 1Department of Histopathology, University Hospital of Wales, Cardiff and Vale NHS Trust, Cardiff CF14 4XW
- 2Unit of Breast Surgery, Aberdeen Royal Infirmary, Aberdeen AB25 2ZD
- Correspondence to: A Finall Alison.Finall{at}CardiffandVale.wales.nhs.uk
- Accepted 20 November 2006
We describe the histological features of subcutaneous inflammation induced by mistletoe, a popular Christmas decoration, when used as an anticancer complementary therapy. We also outline the use of extract of mistletoe in this context.
Case report
A 61 year old woman attending a follow-up appointment two months after excision of tubular carcinoma of the breast complained of an abdominal wall mass. The lesion was subcutaneous, mildly tender, and had a nodular consistency. The patient was worried that the soft tissue mass might be a recurrence of follicular lymphoma, which had been diagnosed in April 2001, although her disease had been stable after five cycles of chemotherapy. The possibility of metastatic breast carcinoma was low considering the good prognostic features of tubular carcinoma.
The lesion was excised and the 4×2×2 cm mass of subcutaneous tissue seemed to consist solely of fibroadipose tissue. Microscopically, we identified a widespread infiltrate of plasma cells, lymphocytes, and eosinophils within the subcutaneous adipose tissue, in a septal and lobular distribution, indicating inflammation or panniculitis.
A large proportion of the inflammatory cells were eosinophils. The lymphocytes formed follicular aggregates, particularly adjacent to blood vessels (fig 1⇓). The architecture of these aggregates was benign. The lymphocytes were normal and immunohistochemistry confirmed a normal distribution of T cells and B cells. We found no evidence of light chain restriction, and Bcl-2 immunoreactivity was negative within the follicle centres, confirming the morphological impression of a reactive lymphoid infiltrate with no evidence …