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 February 18th, 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.:
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