Insights into the Pathogenesis and Clinicopathological Spectrum of Oral Vegetable Granuloma. Case Series with Literature Review

Abstract

Oral vegetable granuloma represents an inflammatory lesion of foreign body origin resulting from the implantation of vegetable matter. Controversy regarding its pathogenesis is reflected by the various terminologies used to describe the lesion. Its diverse clinical presentations are due to variations in the antigenic potential of the vegetable material and the host response. As the diagnosis is solely histopathological, it is critical to differentiate vegetable granuloma from other oral granulomatous lesions like tuberculosis, sarcoidosis and Wegner’s granulomatosis. Here, we report six cases with the varied clinicopathological presentation of hyaline ring granulomas in association with different pathological lesions.

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

“…We have also found it to be positive in our case. Because of it, we agree that these eosinophilic areas, as being rich in cellulose, could actually represent vegetal particles, sustaining an exogenous theory (Acharya et al, 2015; Boffano et al, 2013; Gannepalli et al, 2016; Keskin et al, 2000; Kotrashetti et al, 2011; Lima et al, 2015; Manjunatha et al, 2008; Patil et al, 2017; Sato et al, 2005; Shah, 2017; Simon et al, 1982; Talacko & Radden, 1988a, 1988b).…”

“…All lesions diagnosed as HRG in the literature presented, under their microscopy, a foreign‐body granulomatous reaction (with multinucleated giant cells and macrophages), associated with eosinophilic material (Hase et al, 1976; Ide et al, 1982; Martín‐Hernán et al, 2019; Padmanabhan, Aparna, Karthikeyani, Dinakar, & Manickaraj, 2013; Simon et al, 1982), hyaline material (Almeida et al, 2016; Boffano, Gallesio, Campisi, Roccia, & Berrone, 2013; Chou et al, 1990; Ciola et al, 1983; Desai, 2015; El‐Labban & Kramer, 1981; Harrison & Martin, 1986; Lamear et al, 1994; McMillan et al, 1981; Pola, De La Cruz, Bustillo, Gallas, & Lestón, 2003; Sowmya, Patil, & Rao, 2014; Talacko & Radden, 1988a; Virkkunen et al, 2017), or both (Acharya et al, 2015; Brown & Theaker, 1987; Datar, Patil, Mahajan, & Dahivelkar, 2017; Dunlap & Barker, 1977; Gannepalli et al, 2016; Grover, Koshy, Sharma, & Koshy, 2015; Gueiros et al, 2008; Henriques et al, 2013; Keirby & Soames, 1985; Keskin, Duran, Alkan, & Günhan, 2000; Kotrashetti et al, 2011; Lima et al, 2015; Manjunatha et al, 2008; Neves‐Silva et al, 2017; Patil et al, 2017; Philipsen & Reichart, 2010; Santos et al, 2017; Simon et al, 1982; Williams & Bullock, 2015).…”

“…The hyaline material is not always present in the form of rings (Acharya et al, 2015; Almeida et al, 2016; Boffano et al, 2013; Chen et al, 1981; Chou et al, 1990; Ciola et al, 1983; Datar et al, 2017; Desai, 2015; Dunlap & Barker, 1977; El‐Labban & Kramer, 1981; Gannepalli et al, 2016; Grover et al, 2015; Gueiros et al, 2008; Harrison & Martin, 1986; Keirby & Soames, 1985; Keskin et al, 2000; Lamear et al, 1994; Lima et al, 2015; McMillan et al, 1981; Neves‐Silva et al, 2017; Patil et al, 2017; Philipsen & Reichart, 2010; Pola et al, 2003; Sowmya et al, 2014; Talacko & Radden, 1988a; Virkkunen et al, 2017; Williams & Bullock, 2015). They may also be ovoid, horseshoe, filamentous, or amorphous masses (Boffano et al, 2013; Brown & Theaker, 1987; Chen et al, 1981; Chou et al, 1990; Fernandez‐Flores & Saeb‐Lima, 2014; Keirby & Soames, 1985; Kotrashetti et al, 2011; Manjunatha et al, 2008; Martín‐Hernán et al, 2019; McMillan et al, 1981; Padmanabhan et al, 2013; Ponce, Lima, Rodrigues, Souza, & Lara, 2014; Rannie, 1975; Santos et al, 2017; Sato, Miyate, Fukuta, & Satoh, 2005; Scivetti et al, 2009; Talacko & Radden, 1988a; Virkkunen et al, 2017; Yang & Barnett, 1985).…”

“…For oral pathologists, microscopic differential diagnosis in situations where HRG is a distinct entity is very important and includes hyaline vascular disease of hypertension (Shah, 2017), diabetes (Shah, 2017), amyloidosis (Gueiros et al, 2008; Harrison & Martin, 1986; Manjunatha et al, 2008; Scivetti et al, 2009; Shah, 2017), fungal infection by Torulopsis glabrata (Hase et al, 1976), and Wegener granulomatosis (Manjunatha et al, 2008; Patil et al, 2017). All these diagnostic hypotheses are plausible due to the presence of granulomas, but they can be discarded with further investigations.…”

Foreign Body Granuloma in the Tongue by a Pequi Spine

“…After the foreign body penetrates the tissues, the starch, which constitutes the amorphous material, is rapidly metabolized and eliminated by the human organism, while the hyaline ring, composed of cellulose, remains intact and produces an inflammatory response in the organism [ 12 , 13 ]. It is common that in these cases, the foreign body of plant origin is associated with other diseases, being of fundamental importance to identify the initial cause of the pathological process [ 14 ]. In the present case, as the foreign body granuloma was isolated, that is, being the primary disease, the simple removal of the irritant (pequi spine) was enough for the treatment to be successful.…”