Granuloma Presenting Research Articles

Perianal Pulse Granuloma Induced by Plant-Derived Baby Wipes.

Pulse granulomas are unusual foreign body reactions to exogenous plant material, featuring the presence of hyaline ring structures and granulomatous inflammation. Pulse granulomas have been reported to occur in the oral cavity, gastrointestinal tract, and respiratory tract. Cutaneous pulse granulomas are exceedingly rare. All reported cases have been closely associated with underlying pathology such as chronic inflammatory conditions, trauma, or surgical procedures which likely facilitated implantation of exogenous plant material. We report a novel case of a cutaneous pulse granuloma presenting in the perianal region of an otherwise healthy man. The authors propose that the source of the exogenous plant material is plant-derived baby wipes, which the patient had been using daily to the perianal region.

Peri-apical granuloma presenting as a chronic cystic swelling in the hard palate: a case report

Peri-apical granuloma presenting as a chronic cystic swelling in the hard palate: a case report

Atypical gouty tophus masquerading as a foreign body granuloma

Subcutaneous nodular lesions in a patient with significantly elevated inflammatory markers always raise the possibility of infectious diagnoses such as atypical infection, pyogenic abscess, mycobacterial infection, and malignancy. Definitive diagnosis requires tissue biopsy and histopathologic examination. The atypical presentation of a foreign body granuloma with concurrent intraoperative findings supports the diagnosis of gouty arthritis.We report a case of a 67-year-old man who presented with an inflammatory nodular lesion on the left elbow that was initially suspected to have an infectious cause. Histopathologic examination of the nodular tissue later revealed that the patient had a foreign body granuloma due to urate crystal deposition. The atypical appearance of the gouty arthritis, the low serum urate level, the negative crystal identification in the synovial fluid, and the markedly elevated inflammatory markers, which did not respond to the previous antibiotic and steroid therapy, raised the suspicion of atypical infection in this case.

Rare presentation of pyogenic granuloma: a case report

The pyogenic granuloma (PG) Also called lobular capillary hemangioma, is a prevalent tumorlike growth and vascular hyperplasia of the skin and mucous membranes. The condition arises in reaction to a chronic, recurring tissue injury that stimulates an exuberant or excessive tissue repair response. It can manifest at any age. The most common site is gingiva, extra gingival occurrence of PG is rare, although have been reported. Management of PG Depends on the area, size of lesion and patient preferences. However, the conservative surgical excision usually the curative treatment of PG. Alternative treatment modalities that have been employed include laser therapy, corticosteroid injections, cryosurgery, and sclerotherapy. In the case report has described an extra gingival PG which occurred on the lower lip in a 19-year-old female patient. The clinical and histopathological assessments confirmed the diagnosis of PG.

An enigmatic cutaneous presentation of plasma cell granuloma- A rare case report

Plasma cell granuloma is a rare reactive tumour-like proliferations composed mainly of plasma cells, lymphocytes and innate immune cells like macrophages. Cutaneous plasma cell granuloma (CPCG) is extremely rare benign growth. A good immunophenotyping study is required to confirm the diagnosis. Surgical resection is the primary choice of treatment. We report a case of cutaneous plasma cell granuloma in an adult male.

Uncommon Presentation of Pyogenic Granuloma in the Small Intestine: A Rare Case Report

Uncommon Presentation of Pyogenic Granuloma in the Small Intestine: A Rare Case Report

Foreign Body Granuloma Originating From the Lateral Process of Malleus: A Case Series of 19 Children.

A special presentation of foreign body granuloma originating from the lateral process of the malleus (FBGLP) was noted in the absence of a history of foreign body entry into the external auditory canal (EAC). This study reported the clinical features, pathology, and prognosis of patients with FBGLP. Retrospective study. Shandong Provincial ENT Hospital. Nineteen pediatric patients (age, 1-10 yr) with FBGLP. Clinical data were collected from January 2018 to January 2022. Clinicopathologic characteristics of the patients were analyzed. All patients had an acute course, and were within 3 months of ineffective medical treatment. The most common symptoms were suppurative (57.9%) and hemorrhagic (42.1%) otorrhea. FBGLP imaging examinations demonstrated a soft mass blocking the EAC without bone destruction and occasionally concomitant effusion in the middle ear. The most common pathologic findings were foreign body granuloma (94.7%,18/19), granulation tissue (73.7%, 14/19), keratotic precipitate (73.7%, 14/19), calcium deposition (63.2%, 12/19), hair shafts (47.4%, 9/19), cholesterol crystals (5, 26.3%), and hemosiderin (15.8%, 3/19). Foreign body granuloma and granulation tissue showed higher expression levels of CD68 and cleaved caspase-3 than did the normal tympanic mucosa, whereas Ki-67 levels were similarly low in all tissues. The patients were followed up for 3 months to 4 years without recurrence. FBGLP is caused by endogenous foreign particles in the ear. We recommend the trans-external auditory meatus approach for FBGLP surgical excision, as this shows promising outcomes.

An Unusual Presentation of Oral Pyogenic Granuloma on the Tongue

Pyogenic granuloma is a non-neoplastic reactive lesion that commonly occurs in gingiva. It is rarely found in extra gingival sites such as tongue, lip, palate and buccal mucosa. Lesions affecting the tongue are rarer and very few cases are reported. Unusual site of such lesions can be a diagnostic challenge. This case report describes an uncommon location of pyogenic granuloma occurring on the lateral border of tongue in a 60 -year-old male patient.

Atypical Presentation of Traumatic Ulceration Granuloma with Stromal Eosinophilia (TUGSE) of the Tongue: A Case Report

Introduction: This article aims to report a rare case of traumatic ulceration granuloma with stromal eosinophilia (TUGSE) in young children. Contrary to the reported cases in the literature, this article describes an atypical case of TUGSE presented as a solitary tumour on the tongue. Case Report: A 4 years old boy with Down syndrome was referred to the Paediatric Dentistry Department for management of swelling of the tongue, which gradually increased in size. Clinical examination demonstrated a well-defined firm, pedunculated swelling over the left dorsum of the tongue measuring 15 mm x 12 mm. A provisional diagnosis of fibroma was made. Excisional biopsy was performed under general anaesthesia (GA). Recurrence of the lesion was observed and a subsequent surgical excision with the extractions of left primary molars were conducted under GA. The histopathological examination (HPE) reports interpreted the lesion as TUGSE. Conclusion: It is difficult to clinically diagnose TUGSA hence histological findings are paramount to establish the diagnosis. Awareness of TUGSE is crucial to emphasise the correct diagnosis and to deliver appropriate and effective treatment.

Giant foreign body granuloma after endoscopic management of vesicoureteric reflux: a case report

BackgroundDeflux®, a dextranomer/hyaluronic acid copolymer, is extensively used as an endoscopic bulking agent for management of vesicoureteric reflux (VUR). The complications following Deflux® treatment as described in the literature are clinically insignificant transient obstruction and infections of the urinary tract. We report a rare case of a giant Deflux® granuloma presenting as an intraoperative surprise while undergoing open ureteric reimplantation for the failure of prior endoscopic management.Case presentationA 2.5-year-old boy with a primary VUR needed Anderson Hyne’s pyeloplasty of the affected side for concomitant pelviureteric junction obstruction. During removal of the double “J “stent in the postoperative period, subureteric Deflux® was injected, hoping that a more invasive procedure could be avoided. At a later date, as VUR persisted, an open ureteric reimplantation, was performed. Intraoperatively, a large Deflux® granuloma was noted at the site of previously injected site.ConclusionsGiant Deflux® granuloma is a rare complication of this modality of VUR management. A focussed radiological assessment in such pateints during follow-up is required, especially those planned for surgical intervention in the vesicoureteric region later.

Filarial granuloma presenting as a fibroadenoma

Filariasis is an infectious disease endemic in Nepal and the Indian subcontinent. However, filariasis of the breast is not very common. We present a case of a 24-year female with a breast nodule diagnosed with filariasis of the lymph node on the breast on histopathological examination. An infectious pathology should always be borne in mind in the endemic region for the timely management of the patient.

Muscular pseudotumor revealing a mycobacterial granuloma after bacillus Calmette-Guérin therapy

IntroductionThe Bacillus Calmette-Guérin (BCG) is a live attenuated strain of Mycobacterium bovis. Intravesical therapy with BCG has long been proved to be effective in treating early-stage bladder carcinoma. Case reportA 81-year-old male patient with former history of BCG instillations for bladder cancer two years ago was admitted in February 2020 to our department for a pulsatile and painful tumefaction of the right thigh that lasted for 6 months, due to a muscular M. bovis granuloma leading to femoral artery erosion. Emergency vascular surgery associated with prolonged antibiotherapy provided full recovery. DiscussionLate infectious complications of intravesical BCG instillations are classical but rare. Isolated muscular involvement is exceptional. ConclusionMycobacterial infection should be carefully screened face to a granuloma presenting as muscular pseudotumor. A history of BCG therapy, even decades earlier, enhances this hypothesis and should lead to enforce microbiological testing, especially molecular test.

Sarcoidal Granuloma in Cervical Lymph Node: Case Report

Sarcoidosis is a multi‐system granulomatous disease of unknown etiology. The presentation of sarcoidal granuloma in neck nodes without typical manifestations of sarcoidosis is difficult to diagnose. We describe the case of a 60-year-old woman with a left latero cervical lymphadenopathy, the excisional biopsy from the neck mass showed noncaseating epithelioid cell granuloma and th immunohistochemistry confirmed the diagnosis of gonglion sarcoidosis.

Pyogenic Granuloma of Lower Lip: An Unusual Presentation

Pyogenic granuloma is a benign inflammatory hyperplasia of connective tissue. It depicts an overzealous tissue response to a known stimulus or injury and is commonly found in the gingiva, especially in the anterior maxilla, and rarely on lips, oral mucosa, and tongue. It is commonly seen during the second, third, and fourth decade in females, with predilection in the third decade. This case report depicts the unusual presentation of pyogenic granuloma of the lower lip in an 11-year-old male child following a positive history of trauma and lip biting, which was successfully managed by excision under local anesthesia.

Cholesterol granuloma of the maxillary sinus: a forgotten entity

Aim of the study: Cholesterol granuloma is a histological entity which consists of granulation tissue in which a large quantity of cholesterol crystals provoke foreign body giant cell formation. Cholesterol granulomas are often found in the middle ear with rare presentation in the paranasal sinus. We would like to highlight the diagnostic challenges and the management of maxillary sinus cholesterol granuloma in a young woman presenting as a unilateral nasal mass. Case study: We report a young woman with cholesterol granuloma of maxillary sinus who initially presented with unilateral nasal obstruction. Rigid nasoendoscopy and imaging were suggestive of an antrochoanal polyp. Ipsilateral functional endoscopic sinus surgery was done successfully. Conclusion: Albeit rare, cholesterol granuloma ought to be considered a differential diagnosis in a sinonasal tumour. This case report highlights the rare presentation of maxillary sinus cholesterol granuloma which ought to be considered a differential diagnosis of a unilateral nasal mass.

Bone Marrow Granuloma with Miliary Mottling presenting as Pancytopenia- A rare finding in Tuberculosis - A Case report

Bone marrow granuloma and miliary mottling presenting as pancytopenia together is a rare finding in disseminated form of tuberculosis. Here we report a case of a 52-year, old male patient presented with generalized weakness, loss of appetite, decreased physical activity for one month. Initial lab hematological investigations revealed pancytopenia and high Erythrocyte sedimentation rate. Bone marrow biopsy was performed to determine the cause of pancytopenia which showed caseating granulomas with positive acid fast bacilli on Ziehl-Neelsen staining (Z-N). In chest X-ray miliary mottling and bone marrow biopsy findings together confirmed the case of disseminated tuberculosis. This unusual presentation highlights the considerable diagnostic challenge and importance of bone marrow biopsy for early diagnosis and initiation of treatment.
 Mediscope Vol. 8, No. 1: January 2021, Page 63-66

Fascia Lata Donor Site Foreign Body Granuloma: An Unusual Presentation of a Rare Mimic of Soft Tissue Sarcoma

Background: Foreign body granuloma is a rare late complication of fascia lata graft donor site with few reported cases in the literature. It can mimic soft tissue sarcoma. Clinical and radiological findings may not be enough to solve the puzzle and histology remains the mainstay of diagnosis. Aim: Our aim is to highlight the unusual long interval between initial surgery and presentation of foreign body granuloma. Case Presentation: A 65-year-old man who presented 48 years after initial surgery with progressive painless fascia lata donor site soft tissue swelling. The management and histology findings were highlighted. Conclusion: The occurrence of foreign body granuloma remains an important differential following a history of past surgical procedure regardless of the time interval between the surgical procedure and the clinical presentation.

A Case of a Nonpetrous Cholesterol Granuloma Presenting as a Temporal Mass

Objective A case of a skull base cholesterol granuloma (CG) of the squamosal temporal bone. This is the first ever reported case of CG in a well-pneumatized squamous temporal bone. Design Case report and review of the literature. Discussion. CG is a cystic mass typically found in the petrous apex and occasionally in the paranasal sinuses and orbit. Experience with the treatment of these expansile and inflammatory processes has largely been garnered from those occurring in the petrous apex, where they are surgically drained, via a transtympanic, transmastoid, or middle fossa approach. We report a case of cholesterol granuloma situated in the temporal fossa presenting as a temporal mass. The accessible location of this particular lesion made it amenable to total excision, avoiding the need for surgical drainage and possibility for recurrence. Conclusion This case supports the theory of pathogenesis of such lesions typically occurring where pneumatized air spaces interface with bone marrow, in this case, where the reaches of pneumatized cells in the squamous portion of the temporal bone meet diploic bone.

Granuloma piogénico tras blanqueamiento ocular cosmético

Clinical caseA 46-year-old caucasian male with a history of chronic conjunctival hyperemia, presented at our clinic 5 years after he underwent the surgical procedure of cosmetic eye whitening. On examination we observed pyogenic granuloma in the right eye; besides acute nongranulomatous anterior uveitis and necrotizing scleritis in both eyes. ResultComplete clinical evaluation and full work-up exclusion of systemic diseases was done. The pyogenic granuloma was treated with surgical resection, as well as anterior uveitis and necrotizing scleritis were successfully treated with systemic corticoesteroids and methotrexate. ConclusionThe surgical cosmetic eye whitening could have as complication the pyogenic granuloma in addition to necrotizing scleritis and nongranulomatous anterior uveitis; and be present 5 years after the procedure. The surgical resection is a successful treatment for this presentation of pyogenic granuloma.

Pyogenic granuloma after cosmetic eye whitening

A 46-year-old Caucasian male with a history of chronic conjunctival hyperemia, presented at our clinic 5 years after he underwent the surgical procedure of cosmetic eye whitening. On examination we observed pyogenic granuloma in the right eye; besides acute nongranulomatous anterior uveitis and necrotizing scleritis in both eyes. Complete clinical evaluation and full work-up exclusion of systemic diseases was done. The pyogenic granuloma was treated with surgical resection, as well as anterior uveitis and necrotizing scleritis were successfully treated with systemic corticoesteroids and methotrexate. The surgical cosmetic eye whitening could have as complication the pyogenic granuloma in addition to necrotizing scleritis and nongranulomatous anterior uveitis; and be present 5 years after the procedure. The surgical resection is a successful treatment for this presentation of pyogenic granuloma. Hombre caucásico de 46 años con antecedente de hiperemia conjuntival crónica acude a nuestra clínica 5 años después de realizar el procedimiento quirúrgico de blanqueamiento ocular cosmético. En la exploración observamos granuloma piógeno en el ojo derecho además de uveítis anterior no granulomatosa aguda y escleritis necrosante en ambos ojos. Se realizó una evaluación clínica con exclusión de enfermedades sistémicas completas. El granuloma piógeno se trató con resección quirúrgica y la uveítis anterior y escleritis necrotizante se trataron con éxito con corticoesteroides sistémicos y metotrexato. El blanqueamiento ocular cosmético quirúrgico podría tener como complicación el granuloma piógeno además de la escleritis necrosante y la uveítis anterior no granulomatosa y presentarse 5 años después del procedimiento. La resección quirúrgica es un tratamiento exitoso para esta presentación de granuloma piógeno.