Giant-cell hyalin angiopathy

Pulse or hyaline ring granuloma. Review of the literature on etiopathogenesis of oral and extraoral lesions

“…The findings presented in our review do not lend support to the endogenous theory initially advanced by Dunlap and Barker [2,19]. In the light of the pathogenesis, it is surprising that oral pulse granuloma is not more commonly reported.…”

“…chronic mandibular periostitis [1][2][3], giant-cell hyaline angiopathy [2,16,18], HB and giant cells associated with a radicular cyst [4], periostitis and osteitis associated with HB [5], granulomas in edentulous jaws [6], pulse granuloma [7,10,12,14,15,19,21,22,24,26,28,30], oral vegetable granuloma [17], HR granuloma [13,23,27,29,31], le granulome "alimentaire" des maxillares [25], food-induced granuloma [20]and granuloma tissue with giant cells and hyaline change [12]. The report by Hase et al [9] obviously represents a case of oral infection due to Torulopsis glabrata but superimposed on a case of OPHRG.…”

“…The first is that these structures are derived from a foreign material (exogenous theory), most likely, legumes (pulse) or vegetable material, hence the previous term OPHRG. The second (endogenous) theory proposes that the rings, according to Dunlap and Barker [2], represent a hyaline degenerative change in the walls of blood vessels, leading to the diagnostic term giant-cell hyaline angiopathy.…”

“…This theory was initially introduced by Dunlap and Barker [2] who believed that the characteristic HRs represent a degenerative change in the walls of vessels precipitated by a localized acute vasculitis, hence their suggested term giant-cell hyaline angiopathy. The same authors, 10 years later (Barker and Dunlap [18]), felt-based on more recent literature, and in particular, the detailed report by Harrison and Martin [16]-that the intervening years had not produced convincing evidence to support legumes or other vegetable matter as the sole cause of the HRs.…”

“…The lesion was initially described as "chronic periostitis" characterized by the presence of rings of palely eosinophilic structureless material-so-called hyaline rings (HR)-with numerous multinucleated giant cells around and within the rings and in common with other granulomas showing areas of fibrosis with mature fibroblasts, vacuolated macrophages, plasma cells and lymphocytes. The term "HR" was coined by Dunlap and Barker [2] who were of the opinion that these structures were of endogenous origin (hyaline degenerative changes in the walls of blood vessels). This is in contrast to the view expressed by Lewars [1] and several later authors who considered that minute food particles were impounded on the mucous membrane and driven into the submucous tissue of the periosteum, where they provoke a foreign body reaction.…”