Pulse granuloma of the lip: morphologic clues in its differential diagnosis

Abstract

Pulse granuloma is not a common condition in cutaneous pathology. In diagnosing this condition, it is essential to determine if the foreign fragmented bodies are really vegetable parts. Certain vegetable structures, such as hyaline rings, have been clearly emphasized in the literature. However, other vegetable parts can show certain morphologic similarities with animal structures, especially if observed in a fragmented biopsy, as is the case with the pericarp (which can mimic the cuticle of a maggot) or the endosperm (which can mimic the fat cells of the larva). Herein, we present a case of pulse granuloma involving the lip, an uncommon location for this condition. We also describe the histopathologic appearance of experimentally obtained maggots and pupae, as well as that of several vegetable seeds. We compare some of the vegetable and animal structures and emphasize the differential diagnosis between them.

A 36-Year-Old Man With an Enlarging Nodule on the Buttock

“…10 Harrison and Martin 11 have shown that the pathogenesis is related to the persistent cell wall as an etiologic factor. 32 In our case, there was no systemic or localized reason for the occurrence of the pulse granulomas. No special stain is useful in the diagnosis of pulse granulomas.…”

Disseminated hyaline ring granuloma in the omentum of a dog

“…The analysis under polarised light microscopy is useful in distinguishing plant from animal elements, however some animal structures may show the birefringent properties. On the other hand, the presence of animal structures is mainly related to oral or cutaneous myiasis, but rarely associated with internal infections [18]. Several studies have demonstrated that hyaline rings are residues of plant material and can be of various morphology: roughly ovoid, circular structures; hyaline rod-like shaped structures; hyaline masses lying within the fibrous connective tissue stroma with small calcified basophilic bodies; clearly identifiable plant cells; and metaplastic bone formation [12, 18, 19].…”

“…On the other hand, the presence of animal structures is mainly related to oral or cutaneous myiasis, but rarely associated with internal infections [18]. Several studies have demonstrated that hyaline rings are residues of plant material and can be of various morphology: roughly ovoid, circular structures; hyaline rod-like shaped structures; hyaline masses lying within the fibrous connective tissue stroma with small calcified basophilic bodies; clearly identifiable plant cells; and metaplastic bone formation [12, 18, 19]. Philipsen and Reichart [2] suggested that ring-like structures were formed during degradation of plant material by host phagocytic cells.…”

Morphology of rare exogenous materials in dermatopathology

“…Although pulse granuloma is usually described in the posterior areas of the mandible in relationship to previous periodontal surgery, a dermatopathologist may also find them in perirectal biopsies, as well as in lip biopsies …”

“…If only some parts of the maggots are found in an oral biopsy, there is a chance of misdiagnosis of pulse granuloma . In this respect, we have performed immunohistochemical studies on maggots.…”