Table of Contents
Definition / general | Essential features | Terminology | Epidemiology | Sites | Pathophysiology | Etiology | Clinical features | Case reports | Microscopic (histologic) description | Microscopic (histologic) images | Negative stains | Differential diagnosisCite this page: Gonzalez R. Pulse granuloma. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/colonpulsegranuloma.html. Accessed April 19th, 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
Differential diagnosis
- Amyloidosis: positive with Congo red stain; inflammation generally not present
- Sclerosing mesenteritis: for lesions in the mesentery; hyaline rings not present
