Pulse granuloma

Colon nontumor
Nonneoplastic, non-congenital lesions
Pulse granuloma

Topic Completed: 1 May 2016

Revised: 9 January 2019, last major update May 2016

Copyright: (c) 2003-2016, PathologyOutlines.com, Inc.

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Cite this page: Gonzalez R. Pulse granuloma. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/colonpulsegranuloma.html. Accessed December 14th, 2019.

Definition / general

Granulomatous reaction to legume material that breaches the colonic mucosa

Essential features

Reactive process arising from foreign body (food material)
Usually clinically silent and incidental, but may form a mass lesion
Various microscopic appearances, but hyaline rings of pulse material must be present

Terminology

"Pulse" is the seed material of legumes (beans, peas, peanuts, etc.)
It has also been described as "hyaline rings"

Epidemiology

Can be seen in up to 10% of intestine segments that have undergone injury (Am J Surg Pathol 2016;40:137)

Sites

Can occur anywhere in gastrointestinal tract, but may occur most commonly in colon
More commonly recognized in oral cavity, mandible/maxilla and lung
If colon perforates, pulse can access the abdominal cavity and deposit anywhere within (e.g., ovary)

Pathophysiology

Granulomatous reaction to foreign material

Etiology

Most often seen in colon damaged by perforation, diverticulitis, inflammatory bowel disease or malignancy

Clinical features

Generally an incidental finding but can may manifest as a mass lesion clinically
Associated with use of tobacco and NSAIDs (Am J Surg Pathol 2015;39:84)

Case reports

53 year old man with hard, flat rectal lesion (Histopathology 2016;68:938)

Microscopic (histologic) description

Hyaline predominant
- More than half of lesion consists of pink hyaline rings/ribbons; other food present; inflammation and fibrosis minimal
Cellular predominant
- Acute and chronic inflammation and fibrosis
- Relatively less pulse and food material
Sclerosing mesenteritis-like
- Rarest variant
- Arises in mesentery and resembles sclerosing mesenteritis (inflammation, fibrosis), but pulse focally visible
- Average size is 1.0 cm

Microscopic (histologic) images

Images hosted on Pathout server, contributed by Raul S. Gonzalez, M.D.:

Serosal hyaline predominant
pulse granulomas

Pulse material with numerous
foreign body giant cells

Cellular predominant pulse granuloma
with prominent inflammatory reaction

Scant pulse material embedded in colon
wall, alongside other fecal material

Negative stains

Congo red

Differential diagnosis

Amyloidosis: positive with Congo red stain; inflammation generally not present
Sclerosing mesenteritis: for lesions in the mesentery; hyaline rings not present