Pulse granuloma presenting as a complex pelvic cyst

Abstract

Pulse granuloma, a benign granulomatous lesion, develops due to foreign body reactions to food particles. This rare entity occurs occasionally in the abdominal cavity. However, it has never been reported as a pelvic mass or a recurrent case. A 37-year-old woman with a medical history of pelvic granulomatous lesions treated in Thailand, was admitted for abdominal pain. Imaging study revealed a pelvic complex cyst and disseminated nodules. Ovarian cancer or tuberculous peritonitis was suspected. The appearance at laparotomy was an inflammatory mass encased in adhesions; therefore, only biopsy was performed. The pathology diagnosis was pulse granuloma. The pathology report from Thailand was obtained only after her discharge, suggesting that the previous granulomatous lesion contained vegetable matter. This report demonstrates that pulse granuloma can present as a pelvic mass and may relapse. For complex cystic lesions with solid components in the pelvis, pulse granuloma should be considered as a differential diagnosis.

Pulse Granuloma After Tunneled Nasolabial Island Flap: An Unusual Cause for a Cutaneous Nodule on the Face

“…PG is a foreign body reaction that results from the implantation of vegetable matter. 1 This lesion is typically observed in the oral cavity, with the mandible and maxilla being the most affected sites. More commonly, it has been reported as a complication of periodontal surgery or is associated with deep periodontal pockets due to compromised periodontal health.…”

“…Very rarely, cases of PG mimicking a primary malignancy in the urothelial tract, 4,5 ovary, 1 gastrointestinal tract, or gallbladder 6–8 or the recurrence of a previously diagnosed neoplasia in the gastrointestinal or urothelial tract 4,7,9 have been reported.…”

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

“…There is frequently a connection to the gastrointestinal lumen involving the translocation of vegetable particles related to the presence of an underlying pathology (eg, oral disease, gastrointestinal fistulae, ulcers), the use of an invasive technique (eg, a dental procedure, transrectal prostate biopsy), or accidental aspiration. [3][4][5][6] Pulse granulomas often have nonspecific clinical presentations such as nodules, papules, or masses that can mimic infectious or granulomatous conditions, or tumors (eg, squamous cell carcinoma or gastrointestinal tumors). 1,3,5,7 Although diagnosis ultimately relies on histopathologic findings, a history involving any cause of misplacement of exogenous vegetable material can provide important clues.…”

“…[3][4][5][6] Pulse granulomas often have nonspecific clinical presentations such as nodules, papules, or masses that can mimic infectious or granulomatous conditions, or tumors (eg, squamous cell carcinoma or gastrointestinal tumors). 1,3,5,7 Although diagnosis ultimately relies on histopathologic findings, a history involving any cause of misplacement of exogenous vegetable material can provide important clues.…”

“…There is frequently a connection to the gastrointestinal lumen involving the translocation of vegetable particles related to the presence of an underlying pathology (eg, oral disease, gastrointestinal fistulae, ulcers), the use of an invasive technique (eg, a dental procedure, transrectal prostate biopsy), or accidental aspiration. 3–6…”