foreign body granuloma is a reaction to exogenous (foreign) or
endogenous materials that are too large to be ingested by macrophages.
These localized lesions may occur at any age and clinically present as
papules, plaques or nodules.
granulomas due to exogenous material:
Starch- (Maltese cross birefringence
in polarized light).
Talc - Birefringent
material - (nylon, silk,
dacron)- birefringent refractile multicoloured.
splinter or bone fragment-
Special stains for microorganisms should be performed to rule out
infection due to contamination.
material can be identified
by PAS stain.
bite can cause granulomatous
(glass or sand ), zirconium & beryllium
elicit sarcoidal granulomatous reaction.
pigment is identified and may induce local sarcoidal granulomas.
toxoid (aluminium-adsorbed vaccines)
may induce foreign body reaction.
Granular debris at the centre
surrounded by histiocytes and lymphoid infiltrate with follicle &
eosinophils at the periphery. May resemble
A silicone granuloma is a tissue
reaction elicited by silicone. Silicone granuloma in the breast arises
from leakage of prosthesis. Foreign body giant cells are present near
lacunar spaces filled with amorphous refractile material. Path
granulomas due to endogenous material:
Calcium deposits: Urates-
Gouty Tophus -
Path Quiz Case 57
hair : Granulomatous
inflammation is present adjacent to ruptured
epidermal and pilar cyst,
pilomatrixomas and dermoid cyst.
Damaged hair follicle can elicit granulomatous reaction.
keratin may be identified in the dermis.
Hair shafts are round or oval shaped on section, birefringent and Ziehl-
Neelson stain positive.
Foreign body reaction to keratin is an indication for a careful search
for residual squamous cell carcinoma or recurrent tumour in a patient
with history of carcinoma.
Initially there is suppuration around the foreign material.
which may be tuberculoid,
sarcoidal, suppurative or necrobiotic type.
In the later stage there is
Around the foreign material there are histiocytes, some of these have
differentiated into large cells with indistinct cell boundaries called epithelioid cells.
There are multinucleated giant cell of foreign
body-type often containing ingested foreign material.
In foreign body
giant cells the nuclei are scattered irregularly throughout the
A few Langhans type of giant cells may be present, in which
the nuclei are distributed along the periphery in a semicircle.
In most cases foreign
material can be recognized in
eosin stain sections.
In difficult cases (granulomatous inflammation of skin or panniculitis in which the nature
cannot be diagnosed) polarized light should be used to identify birefringent foreign material.
in deep fungal infection,
atypical mycobacteria or
may simulate features of foreign body reaction.
Special stains for
microorganisms are useful in establishing the diagnosis.