Pulse Vegetable Granuloma

This unusual and uncommon chronic inflammatory lesion of oral tissues has been described under a variety of terms including chronic periostitis, giant-cell hyalin angiopathy, oral vegetable granuloma and hyaline ring

Fig. 3.19. Pulse granuloma showing chronic inflammation and eosinophilic, hyaline rings together with multinucleated foreign-body-type giant cells

Fig. 3.20. Giant cell fibroma showing stellate and angular fibroblasts in collagenous matrix granuloma [171]. Most cases are seen in the premolar/ molar region of the edentulous mandible and the most common complaints are recurrent swelling and tenderness. Fifty-three percent of cases are extraosseous (peripheral) and radiographs often show a poorly defined erosion of the underlying alveolar bone. Intraosseous or central lesions (42%) show an irregular radiolucent area that is non-diagnostic. Occasionally, the lesion is found within the fibrous wall of an odontogenic or nasopalatine duct cyst [140].

Microscopy shows chronic inflammation and eo-sinophilic, hyaline rings together with multinucleat-ed foreign-body-type giant cells (Fig. 3.19). The rings may be complete or horse-shoe shaped and may enclose giant cells, connective tissue and blood vessels. Haemosiderin within the centre of the rings is a frequent finding. The suggestion that the histological appearances are due to thickening and hyalinisation of the walls of blood vessels is not supported by most observers. Light and electron microscopical findings suggest that the rings are the cell walls of vegetable remains, often with collagen attached to their surface [71]. There does not appear to be any evidence that these appearances are exclusively due to pulses. Complete excision is curative.

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