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Case 459 - Discussion

Uploaded: 2010-11-22, Updated: 2010-11-22


Pulse Granuloma of Rectum

  • Most frequently in the oral cavity, also named oral vegetable granuloma and giant cell hyaline angiopathy

  • Also observed in the skin, lungs, knee, fallopian tube and ovary, and intrahepatic portal vein

  • Mostly representing a foreign body reaction to vegetable particles

  • Histopathology:

    • Nodular lesion in the submucosa and muscularis propria. The center of nodule consists of granulation tissue.

    • Hyalinized rings: on the periphery of the nodule, 200-500 μm, circular and convoluted

    • Calcified basophilic granules: scattered, circular structures, 2–40μm, calcified

    • Scattered foreign body–type giant cells

    • Vegetable matter

  • Special stains for the hyalinized ringlike structures

    • Negative: Congo red, Thioflavin T, CD34, CD31, and factor VIII

    • Variably positive staining for PAS, with and without diastase

    • Trichrome stain, pale blue

    • Von Kossa stain, positive for the calcified fragments within the circular structures

  • Telma C. Pereira, Jeffrey W. Prichard, Mushtaq Khalid, David S. Medich, Jan F. Silverman (2001) Rectal Pulse Granuloma. Archives of Pathology & Laboratory Medicine: June 2001, Vol. 125, No. 6, pp. 822-823