Pulse granuloma, unusual localization: appendix

Şimşek, Gülçin Güler; Buluş, Hakan; Güreşçi, Servet

doi:10.4318/tjg.2012.0362

Cited by 6 publications

(5 citation statements)

References 7 publications

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“…PG can clinically mimic malignancy. Although GIT PG have been reported in predominantly case reports, [11][12][13][14][15][16][17][19][20][21][22][23] we provide the largest series of GIT PG and show they are pseudotumors with similar histology to those described in other sites. B, Grossly, the mass consisted of an ill-defined conglomerate of indurated lesions that involved the sigmoid colon (C), small bowel, uterus (U), ovary, and cervix.…”

Section: Discussionmentioning

confidence: 74%

“…A, A 51-year-old white woman presented with a 100 mm obstructing mass clinically suspected to represent a gastrointestinal or gynecologic tract primary. 4,6,10,[13][14][15][16][17][18][19]21,24,25 Regardless of site, all PG show hyaline ribbons and rings in the background of variable amounts of inflammation, granulation tissue, foreign body giant cells, calcifications, and food (Figs. The indurated lesions were in close approximation to colonic diverticular disease (arc).…”

Section: Discussionmentioning

confidence: 99%

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Gastrointestinal Tract–derived Pulse Granulomata

Nowacki¹,

Arnold

Frankel³

et al. 2015

American Journal of Surgical Pathology

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Pulse granulomata (PG) in the lung and oral pathology literature are presumed due to food (pulse) introduced by mucosal injury. Herein, we report the largest series of PG in the gastrointestinal tract (GIT): 22 resections were prospectively collected from 17 patients (8 men, range=28 to 85 y). All patients had a history of intestinal injury/disease: diverticulitis, fistula, adenocarcinoma, perforation, ulcerative colitis, appendicitis, anastomotic site leak, and/or stent leak. Nine of 22 specimens were designated "masses"; most of these were clinically concerning for neoplasia. Sites of involvement included the small and large intestine, appendix, liver, gallbladder, mesentery, omentum, peritoneum, cervix, ovary, and skin. PG were typically nodular (21/22) and multifocal (15/22); most involved the external surface of the bowel (20/22), and they ranged in size from 1.5 to 100 mm. Histologically, they contained variable amounts of hyaline ribbons and rings, inflammation, foreign body giant cells, calcifications, and food; larger lesions displayed circumferential stellate fibrosis (12/22). We describe 3 morphologic variants: hyaline predominant (mimicking amyloid), cellular predominant (mimicking spindle cell neoplasms), and sclerosing mesenteritis-like. All patients are alive and well at the time of follow-up. Histologically processed legumes showed similar structures as those identified in PG, providing support for an entrapped food origin. In summary, we detail important clinicopathologic clues, describe the PG morphologic spectrum, and demonstrate how to distinguish PG from their mimics. Although PG can present as clinically concerning masses, we conclude that they are pseudotumors arising secondary to entrapped food introduced through mucosal trauma, similar to their lung and oral counterparts.

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Section: Discussionmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Gastrointestinal Tract–derived Pulse Granulomata

Nowacki¹,

Arnold

Frankel³

et al. 2015

American Journal of Surgical Pathology

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“…There were three subsequent cases of colonic pulse granuloma, all found incidentally in resected sigmoid diverticular disease [ 8 , 9 ]. Simsek and colleagues reported a pulse granuloma of the appendiceal serosa in the context of perforated appendicitis [ 10 ]. There have been three reports of gallbladder pulse granulomas, one in association with a cholecystoduodenal fistula related to cholecystitis and cholelithiasis [ 11 ] and one with a cholecystogastric fistula with chronic cholecystitis [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

Pulse Granulomas of the Gastrointestinal Tract and Gallbladder: Report of Five Cases

DeRoche¹,

Gates

Huber

2017

Case Reports in Pathology

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Hyaline rings with admixed multinucleated giant cells characterize pulse granulomas; the term pulse refers to edible seeds of legume vegetables. The etiology has been controversial, with theories including vascular degenerative changes or a reaction to vegetable material; ultrastructural studies and experimentally induced lesions in animals favor the latter. This lesion is typically seen in the oral cavity, with only rare reports in the gastrointestinal tract and gallbladder. We herein describe five cases of pulse granulomas identified in these sites. All cases contained foreign-body giant cells and vegetable debris within or near hyaline rings. Pulse granulomas may form mass lesions but are usually an incidental finding on microscopic examination. In incidentally detected cases, recognition of pulse granulomas can suggest a mural abscess, fistula, or perforation of the gut, findings which may not be grossly apparent. The presence of vegetable material in all five cases further supports an exogenous pathogenesis.

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“…The majority of pulse granulomas occur in the oral cavity mandible. 1,2,4,5 However, they have also been more recently described in nasal cavity, 6 prostate, 7 cervix, 8 fallopian tube and ovary, 9 gallbladder, 9 skin, 9 lymph node, 8 gastrointestinal tract (colorectum, small intestine, appendix, and stomach), 3,10-12 and urinary bladder. 13…”

Section: Discussionmentioning

confidence: 99%

A Peculiar Form of Breast Fat Necrosis Simulating Hyaline Ring Granuloma (So-called Pulse Granuloma): A Rare Complication of Hyperparathyroidism

García-Martos

Panizo-Santos

2017

Int J Surg Pathol

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Pulse granuloma is a rare, foreign body inflammatory reaction that occurs mainly in the oral cavity. It is exceedingly rare elsewhere, with only isolated cases described in the literature. We report the case of a 79-year-old woman with a history of normocalcemic hyperparathyroidism who presented to our hospital with a painful 4-cm lump in the upper quadrants-upper outer quadrant of her left breast. The clinical and radiological (BIRADS-5) findings were indicative of a malignant lesion. However, core needle biopsy revealed features simulating hyaline ring granuloma (pulse granuloma-like). A definitive diagnosis of lipomembranous fat necrosis was made by identifying its characteristic histomorphology. Histopathological study is essential to establish an exact diagnosis since clinical and imaging features may mimic breast carcinoma. To our knowledge, this is the first reported case of a hyaline ring granuloma-like in the breast, which may represent a peculiar form of degenerative change of lipomembranous fat necrosis.

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Pulse granuloma, unusual localization: appendix

Cited by 6 publications

References 7 publications

Gastrointestinal Tract–derived Pulse Granulomata

Gastrointestinal Tract–derived Pulse Granulomata

Pulse Granulomas of the Gastrointestinal Tract and Gallbladder: Report of Five Cases

A Peculiar Form of Breast Fat Necrosis Simulating Hyaline Ring Granuloma (So-called Pulse Granuloma): A Rare Complication of Hyperparathyroidism

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