Mandible & maxilla
Osteomyelitis and inflammatory conditions
Hyaline ring-like structures
Topic Completed: 1 June 2014
Minor changes: 8 July 2020
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PubMed Search: Hyaline ring-like structures
Table of Contents
Definition / general | Terminology | Sites | Pathophysiology | Etiology | Clinical features | Case reports | Treatment | Microscopic (histologic) description | Microscopic (histologic) images | Positive stains | Negative stains | Differential diagnosis | Additional referencesCite this page: Morrison A. Hyaline ring-like structures. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/mandiblemaxillahyalineringlikestructures.html. Accessed January 22nd, 2021.
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
- 35 year old woman with pulse granuloma of urinary bladder associated with interstitial cystitis (Urology 2009;73:209)
- 55 year old man with iatrogenic pulse granuloma detected at prostatectomy (Int J Surg Pathol 2008;16:96)
- 78 year old woman with rectal pulse granuloma (Arch Pathol Lab Med 2001;125:822)
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
- Hyaline material: variable staining with PAS, Alcian blue at pH 2.5
- Calcifications positive by Von Kossa method
Negative stains
- Eosinophilic portions of hyaline rings are negative for Type IV collagen and Congo red
Differential diagnosis
- Amyloid angiopathy with giant cell reaction
- Foreign material
- Lipoid proteinosis
- Myiasis
