Hyaline ring granuloma of the mouth—A foreign‐body reaction that dentists should be aware of

Abstract

Hyaline ring granuloma (HRG) is a rare and atypical foreign‐body granulomatous chronic inflammatory condition. Our aim was to make a critical review of the literature cases and also to illustrate histochemical and immunohistochemical findings of a new case. A modified PICO strategy was used. Inclusion criteria were met by case reports and case series with a histologically confirmed diagnosis of HRG, necessarily in mouth or maxillary bones. Exclusion criteria were no access to the full‐text paper. The search was done up to 2019, totalizing 231 selected cases in 54 papers. The new case was analyzed through PAS, Azan‐Mallory's trichrome, and CD34 and CD68 reactions. HRG is found mainly in the mandible of men, edentulous and prosthesis users, between 51 and 60 years of age, with 0.5–120 months of duration, usually causing edema and pain or discomfort. Endogenous and exogenous theories may be complementary in HRG. Eosinophilic areas could represent particles of vegetal origin, while the hyaline material could be the result of collagen degradation. Considering the material is not always present or even is ring‐shaped, we suggest the change from “hyaline ring granuloma” to “granuloma induced by vegetal inoculation.”

Efficient removal technique of foreign body in the mandible with optimization of 3D simulation

“…On the other hand, Shimamura et al reported that inflammation was present at the sites of foreign bodies 15 . Foreign bodies might occur hyaline ring granuloma, which is a rare and atypical granulomatous chronic inflammatory condition 24 . We should judge the timing of removal comprehensively from the viewpoint of the factors mentioned above.…”

A rare case of bilateral pulse granuloma of maxilla

“…Oral pulse granuloma is a rare entity in which no features considered clinically pathognomic of pulse granuloma and remains largely a microscopic diagnosis. 13 A more widespread knowledge on the unusual sites of occurrence and clinical manifestations may aware the clinicians about the diagnostic hazard of mistaking pulse granulomas for other entities. For clinicians, it is very useful to know hyaline ring granuloma, not only because other diseases (which require different therapeutic approaches) can mimic it, leading to misdiagnosis of relevant impact, but also because some clinical situations increase the risk of its occurrence.…”

Pulse Granuloma–Like Reaction on the Forearm Following an Accidental Wound

“…Most authors consider them to originate from the implantation of vegetable matter. 1,2 They are usually seen in the oral mucosa, but have been described in a range of other locations, such as along the gastrointestinal or respiratory tract, the fallopian tubes, and the gallbladder. Rare cases of perianal and periprostatic pulse granulomas have also been reported.…”

“…Positive reactions to Alcian blue at pH 2.5, indicative of acid groups such as carboxyls in plant cell walls, are also seen. 2,6,[8][9][10] Although pulse granulomas have been attributed to local degenerative changes in blood vessel walls, most authors support the exogenous foreign body theory, largely because the hyaline rings observed resemble the histologic structures of plants. 2,9,11,12 Histologic examination of the stalks of several plants that may have penetrated our patient's arm during the accident with the bale of hay showed similar shapes and staining patterns to those observed in the biopsy specimen, confirming diagnosis and etiology, which were consistent with xylem and phloem (Fig.…”

“…Positive reactions to Alcian blue at pH 2.5, indicative of acid groups such as carboxyls in plant cell walls, are also seen. 2,6,8–10…”