Pulse granulomas in highly unusual sites

Karamurzin, Yevgeniy; Narula, Sukrit; Khanifar, Elham; Kim, Yong-Son; Wu, Mark L-C

doi:10.1111/j.1365-2559.2008.03208.x

Cited by 16 publications

(17 citation statements)

References 6 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: 73%

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: 73%

Gastrointestinal Tract–derived Pulse Granulomata

Nowacki¹,

Arnold

Frankel³

et al. 2015

American Journal of Surgical Pathology

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“…Various theories had been proposed for the composition and origin of the hyaline rings, including degenerated blood vessels related to vasculitis, hence a previous name, "giant-cell hyaline angiopathy" [6,7]. Most research suggest that pulse granulomas represent unique reactions to vegetable matter, hence the alternate name, "vegetable granuloma," and that the hyaline rings are related to cellulose and collagen [1,2,3,4,5]. …”

Section: Discussionmentioning

confidence: 99%

“…Nambudripad et al [2] recently reported a highly unusual pulse granuloma that occupied periprostatic soft tissue and that was iatrogenically caused by prostatic core biopsies. Lastly, Karamurzin et al [4] reported not only periprostatic pulse granuloma but also mesocolonic lymph node and gastric subserosa. We recently detected a nasal pulse granuloma that occurred at a previously unreported site.…”

Section: Discussionmentioning

confidence: 99%

“…Pulse granuloma is an unusual reaction to vegetable matter that is characterized by aggregates of thin, variably sized hyaline rings [1,2]. They have mainly been reported in association with lung aspirations, the oral cavity with a history of oral procedures and less frequently in intestinal fistulae or stomach ulcers [2,3,4,5]. They are exceedingly rare elsewhere.…”

Section: Introductionmentioning

confidence: 99%

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Vegetable or Pulse Granuloma in the Nasal Cavity

Yeo

Eom

Lim

et al. 2014

Clin Exp Otorhinolaryngol

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Vegetable granuloma or pulse granuloma results from the implantation of food particles of vegetable origin. Pulse granulomas have mainly been reported in association with lung aspirations, the oral cavity with a history of oral procedures and less frequently in gastrointestinal tracks. We report a 31-year-old woman who presented with right nasal obstruction and was found to have a firm mass in the right nasal cavity. Paranasal sinus computerized tomography scans identified a calcified ring lesion in her right nasal cavity. Endoscopic sinus surgery was performed, and pathology examination revealed a lesion consistent with a pulse granuloma that contains starch granules with cellulose envelopes appearing as hyaline rings surrounded by inflammation cells and concentrically arranged delicate connective tissue. Pulse granuloma is a well described entity with distinct histopathology. However, pulse granulomas are rare, and especially extraoral pulse granulomas are extremely rare. We found that pulse granuloma can be occurred in the nasal cavity through regurgitation.

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“…In the lungs, they occur following aspiration of vegetable matter. 1,[4][5][6][7][8][9] The first GIT pulse granuloma, a rectal pulse granuloma, was reported in 2001 by Pereira et al 7 Since then only three other cases of peridiverticular colonic pulse granulomata have been reported. 2 Recent reports have documented occurrences in the urinary bladder, lymph node, fallopian tube, gallbladder, skin, liver, ovary and cervix.…”

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confidence: 99%