Vegetable or Pulse Granuloma in the Nasal Cavity

Abstract

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.

Morphology of rare exogenous materials in dermatopathology

“…These particles often elicit a granulomatous response known as pulse granuloma. Although pulse granuloma is often a common finding in oral and perioral biopsies, 6 it has also been described in several unusual locations, such as the nasal cavity, 7 intestines, 8 urinary bladder, 9 gallbladder, 10 fallopian tubes 10 and skin. 11 Some of these particles show birefringent cellular structures -such as the pericarp -and they are therefore easily identified ( Fig.…”

Pulse granuloma: a rare condition mimicking a gastric tumor

“…Pulse granuloma is a benign lesion ( 1 ) that is extremely rare ( 2 , 3 ) . It was first described in 1969 by Knoblich, who characterized it as lung injury ( 4 ) .…”

“…Pulse granuloma is characterized by a chronic granulomatous reaction to a foreign body of vegetable origin ( 1 ) , typically indigestible cellulose deposited under the mucosa ( 3 ) . Most pulse granuloma patients have a history of bowel disease, including diverticulitis, fistula, perforation, ulcerative colitis, appendicitis, or anastomotic leakage ( 7 ) , allowing the foreign body to reach the deep layers of the intestinal wall.…”

“…Most pulse granuloma patients have a history of bowel disease, including diverticulitis, fistula, perforation, ulcerative colitis, appendicitis, or anastomotic leakage ( 7 ) , allowing the foreign body to reach the deep layers of the intestinal wall. The oral cavity is the site most often affected, the occurrence of pulse granuloma at other sites being extremely rare ( 3 ) . However, there have been reports of pulse granuloma in the stomach, small intestine, colon, peritoneum, mesentery, genitourinary tract, and skin ( 2 , 7 ) .…”

Pulse granuloma of the rectum: an unusual entity

“…These microscopic findings are likely to change over time, as the lesion becomes more chronic. 5 Small or abundant areas of calcification may also be present.…”