A Case of Heavy-metal Tungsten Alloy Granuloma Outside of the Nostril

We report a case of foreign body granuloma caused by heavy-metal tungsten alloy outside of the nostril. A 72-year-old woman seen for subcutaneous nostril swelling had the granuloma completely resected. Histopathologically, the granuloma was caused by heavy-metal tungsten alloy that coagulatively necrosed fibrous skeletal muscular and fibrovascular tissue. The rim of the granuloma consisted of spindle cells and epithelioid cells surrounded by small lymphocytes. No foreign-body reaction was seen. The woman had no memory of when and why the foreign substance was injected or implanted. To date, ten cases of foreign body granuloma involving heavy-metal tungsten alloy, including this case, have been reported in Japan. Clinical manifestations, histopathological findings, and treatment of this lesion are discussed.