Custom Search


Foreign Body Granuloma

of the Skin

Dr Sampurna Roy MD

 November 2015


Dr Sampurna Roy  MD

Consultant  Histopathologist (Kolkata - India)


submit to reddit


Normal Histology of Skin


Gross examination of the skin specimen

Reporting of biopsies taken for Inflammatory Skin Diseases

Lichenoid (Interface)Tissue Reaction Pattern

Psoriasiform Reaction Pattern

Granulomatous Reaction Pattern

Vesiculobullous Reaction Pattern

Spongiform Reaction Pattern

Vascular Diseases: Various forms of Vasculitis

Lichen planus-like lesions

Lichen Nitidus

Bullous Pemphigoid

Hailey-Hailey Disease 

Cutaneous Deposits

Calcinosis Cutis


Silicone granulomas

Granulomatous Reaction Pattern of the Skin

Granuloma Annulare

Necrobiosis Lipoidica

Necrobiotic Xanthogranuloma   

Rheumatoid Nodule

Lupus Vulgaris

Cutaneous Sarcoidosis

Melkersson Rosenthal Syndrome

Annular Elastolytic Giant Cell Granuloma

Skin lesion in Crohn's Disease

Blastomycosis-like pyoderma


Interstitial Granulomatous Dermatitis

Interstitial Granulomatous Drug Reaction

Granulomatous T-cell lymphoma

Erythema Nodosum





Toxic Shock Syndrome

Drug related cutaneous lesions

Cutaneous lesion in graft-
versus host disease

Cutaneous lesions after exposure to Radiation

Role of immunohistochemistry in Dermatopathology 

Cutaneous Pseudolymphoma

Cutaneous infection and infestations

1: Bacterial, Rickettsial and Chlamydial infection

2: Spirochetal Infection

3 : Mycoses and algal infections

4 : Protozoal Infections

5 : Helminth Infections

6: Viral Infections

Cutaneous lesion associated with AIDS

Skin Tumours

Skin Adnexal (Appendage) Tumours

Benign Sweat Gland Tumours

Nipple Adenoma

Papillary Eccrine Adenoma

Apocrine Adenoma


Classification of Malignant Sweat Gland Tumours 

Tumours of the Hair Follicle




Cutaneous lymphadenoma


Pilar Sheath Acanthoma

Tumour of the Follicular Infundibulum


A 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.

Examples of granulomas due to exogenous material:

Starch- (Maltese cross birefringence in polarized light).

Talc - Birefringent

Suture material - (nylon, silk, dacron)- birefringent refractile multicoloured.

Wood splinter or bone fragment- Special stains for microorganisms should  be performed to rule out infection due to contamination.

Plant material can be identified by PAS stain.

Arthropod bite can cause granulomatous reaction.

Silica (glass or sand ), zirconium & beryllium elicit sarcoidal granulomatous reaction.

Tattoo material- Extracellular pigment is identified and may induce local sarcoidal granulomas.

Tetanus 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 Kimura's disease.

Silicone granulomas: 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 Quiz Case 56.


Examples of granulomas due to endogenous material:

Calcium deposits: Urates- Gouty Tophus - Path Quiz Case 57  Oxalate. :


Keratin & hair : Granulomatous inflammation is present adjacent to ruptured epidermal and pilar cyst, pilomatrixomas and dermoid cyst.


Damaged hair follicle can elicit granulomatous reaction.

Fragments of keratin may be identified in the dermis.

Hair shafts are round or oval shaped on section, birefringent and Ziehl- Neelson stain positive.

Note: 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.

Histological feature:

Initially there is suppuration around the foreign material.

This is followed by granulomatous inflammation  which may be tuberculoid, sarcoidal, suppurative or necrobiotic type.

In the later stage there is fibrosis.

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 cytoplasm.

A few Langhans type of giant  cells may be present, in which the nuclei are distributed along the periphery in a semicircle.

Diagnostic clue:

In most cases foreign material can be recognized in Hematoxylin and 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.

Differential diagnosis:  

Granulomatous inflammation in deep fungal infection, atypical mycobacteria or leishmaniasis may simulate features of foreign body reaction.

Special stains for microorganisms are useful in establishing the diagnosis.


Further reading

A foreign body aspiration in a preschool child mimicking a multitrigger wheezing: a case report and review of the literature.

Foreign body granuloma caused by hyaluronic acid/dextranomer microsphere filler injection.

A foreign body aspiration in a preschool child mimicking a multitrigger wheezing: a case report and review of the literature.

Histopathologic patterns associated with external agents.

Mycobacterium fortuitum cutaneous infection from amateur tattoo.

Pigmented epidermal cyst with dense collection of melanin: A rare entity - Report of a case with review of the literature.

Penile paraffinoma after subcutaneous injection of paraffin. Treatment with a two step cutaneous plasty of the penile shaft with scrotal skin.

Cutaneous mercury granuloma: a case report.

Early granulomatous foreign body reactions to a novel alginate dermal filler: the system's failure?

Granulomatous response due to anabolic steroid injections.

Facial self-induced paraffinoma in an elderly woman.

Cutaneous silica granuloma with generalized involvement of lymph nodes.

Facial granulomas secondary to injection of semi-permanent cosmetic dermal filler containing acrylic hydrogel particles.

Granulomatous rosacea: unusual presentation as solitary plaque.

[Tattoos: natural history and histopathology of cutaneous reactions].

[Granulomas induced by injections of leuprorelin acetate (Enantone®)].

Role for trauma in inducing pencil "lead" granuloma in the skin.

Unusual palisading and necrotizing granulomas associated with a lubricating agent used in lipoplasty.


Foreign body reaction to hyaluronic acid filler injection: in search of an etiology.

Granulomatous foreign body reaction to hyaluronic acid: report of a case after melolabial fold augmentation and review of management.

Dermatitis artefacta: keloids and foreign body granuloma due to overvalued ideation of acupuncture.

Birefringent particles in granulomatous dermatitis, sarcoidal-type, as well as in other non-granulomatous skin disorders in patients without sarcoidosis.

Intrapulmonary and cutaneous siliconomas after silent silicone breast implant failure.

Foreign body granulomas after all injectable dermal fillers: part 2. Treatment options.

Foreign body granulomas after all injectable dermal fillers: part 1. Possible causes.

Foreign body granuloma due to Matridex injection for cosmetic purposes.

Cutaneous pulse granulomas.

Dermatopathology for the surgical pathologist: a pattern-based approach to the diagnosis of inflammatory skin disorders (part II).

Image Links

Foreign body reaction to hair shaft

Foreign body reaction to ruptured epidermal cyst

Foreign body reaction to suture material


Dermato pathology Cases

Pancreatic Pathology Online

Gallbladder Pathology Online

Paediatric Pathology Online


Endocrine Pathology Online

Eye Pathology Online

Ear Pathology Online

Cardiac Path Online

Lung Tumour-Online


Pulmonary Pathology Online

Nutritional Pathology Online

Environmental Pathology Online

Pathology Quiz Online

GI Path Online

Soft Tissue Pathology

Case Index

Infectious  Disease Online

E-book - History of  Medicine with special reference to India

Microscope – Seeing the Unseen


Trichilemmal Carcinoma 

Proliferating Trichilemmal Tumour


Pathology of the Eyelid

Inflammatory diseases of the Eyelid

Verruciform Xanthoma


Pathology of the Eyelid

Inflammatory diseases of the Eyelid

Tumour and tumour-like lesions of the Eyelid

Adnexal Tumours of the eyelid

Epidermal tumours of the Eyelid

Mesenchymal Tumours of the Eyelid

Melanocytic tumours of the Eyelid

Nevus Sebaceous

Folliculosebaceous Cystic Hamartoma

Sebaceous Hyperplasia


Sebaceous Adenoma

Sebaceous Carcinoma

Primary Cutaneous Lymphoma

Lymphomatoid papulosis

Role of immuno histochemistry in Dermatopathology 

Cutaneous Pseudolymphoma

Melanocytic tumours

Acquired Melanocytic Naevus

Ancient Naevus

Halo naevus

Balloon cell naevus

Mongolian Spots /Ota's naevus /Ito's naevus

Blue naevus-variants

Deep penetrating naevus  

Combined Naevus

Recurrent naevus

Spitz naevus

Desmoplastic Spitz Naevus

Dysplastic naevus

Congenital naevus

Spindle cell naevus

Pigmented melanocytic lesions causing diagnostic problems

Prognostic parameters of melanoma

Lentigo maligna melanoma

   Disclaimer  ;  Privacy Policy  ; Advertising Policy  ;  E-mail 

           Copyright © 2016
           All rights reserved