Mandible / maxilla
Other inflammatory
Hyaline ring-like structures

Author: Annie Morrison, M.D. (see Authors page)
Editor: Kelly R. Magliocca, D.D.S., M.P.H.

Revised: 21 June 2018, last major update June 2014

Copyright: (c) 2004-2018, PathologyOutlines.com, Inc.

PubMed Search: Hyaline ring-like structures

Cite this page: Morrison, A. Other inflammatory: hyaline ring-like structures. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/mandiblemaxillahyalineringlikestructures.html. Accessed September 22nd, 2018.
Definition / general
  • Pulse or hyaline ring granulomas are lesions most likely occurring as a result of implantation of the cellulose moiety of plant foods
Terminology
  • Synonyms: food induced granuloma, giant cell hyalin(e) angiopathy, hyaline rings, oral pulse granuloma, oral vegetable granuloma, pulse granuloma
  • Chronic periostitis: oral pulse granuloma characterized by rings of pale eosinophilic structureless material (so called hyaline rings/HR), with numerous multinucleated giant cells
  • Hyaline bodies/HB: synonymous term for both oral pulse granuloma and Rushton bodies, a completely different histologic finding seen in intraosseous gnathic cysts
  • Rushton bodies: straight or curved eosinophilic structures within the epithelial lining of odontogenic cysts
Sites
  • Mandible > maxilla
  • Less commonly in oral soft tissues and salivary glands
Pathophysiology
  • Most commonly found in mandible, particularly in posterior regions where food stagnation is common
  • Food particles may lodge under an atrophic mucosa overlying the alveolar ridge and be maintained there by the pressure of a denture
  • Minute food particles impounded on mucous membrane can be driven into the submucosa where they provoke a foreign body reaction
  • Other pathways for entry of foreign material into periapical tissue:
    • Gross caries
    • A root canal which is left open to the oral cavity
    • Pericoronitis around mandibular third molar teeth
    • Food particles may be introduced into sockets following dental extraction
  • Once food gains access to these tissues, it is digested and altered by the host responses
  • The cellulose moiety of plant foods is indigestible and persists in the form of hyaline material, inciting a chronic granulomatous response
  • Collagen is probably laid down at the periphery of the cellulose with time, thus explaining the differences between the thick hyaline rings and the thin plant cell walls
  • With time, the implanted food matter may also undergo calcification
Etiology
  • Two theories regarding origin of hyaline rings:
  • Exogenous: foreign material (pulse and legumes) penetrates the oral mucosa, consistent with experimental production of hyaline ring granulomas
  • Endogenous: degenerative changes in walls of blood vessels
Clinical features
  • In jaw and oral cavity, variable presentation, may be associated with:
    • Edentulous portions of alveolar ridge, in sites of prior dental extraction
    • Periapical lesions associated with teeth with a history of endodontic therapy
    • Gnathic intraosseous cysts (dentigerous cyst, residual cyst, nasopalatine cyst, others)
    • Retained tooth roots
    • Impacted third molar teeth with a history of pericoronitis
Case reports
Treatment
  • Depends on site of involvement and co-existing pathologic conditions
Microscopic (histologic) description
  • Small circumscribed pools of eosinophilic material exhibit a corrugated periphery of condensed collagen, often surrounded by lymphocytes and multinucleated giant cells
  • The eosinophilic material may be uniform or contain a variable mixture of lymphocytes, plasma cells, multinucleated giant cells and neutrophils within the center of the hyaline rings or at the periphery
  • Features inconsistently noted are the presence of small, round, calcified basophilic bodies within the amorphous hyaline material, calcification of the entire hyaline structure and clearly identifiable vegetable material
  • All the hyaline material is birefringent, but the pattern is dissimilar to the neighboring collagen; the hyaline is finely granular and microfibrillar as opposed to the wavy collagen
Microscopic (histologic) images

Images hosted on other servers:

Hyalinized rings

Giant cell hyaline angiopathy

Positive stains
Negative stains
Differential diagnosis
  • Amyloid angiopathy with giant cell reaction
  • Foreign material
  • Lipoid proteinosis
  • Myiasis