Answer: All of the above

Histology: These images show an unusual giant-cell granulomatous reaction characterized by the presence of so-called “hyaline rings”. The glassy pink ring-like structures are surrounded by multinucleated giant cells. Spherical calcifications are present within some of the rings. Rings may also contain mononuclear cells, giving the impression of an endothelial lining. Degenerating vegetable material is deposited in the surrounding tissue.

Discussion: Giant cell hyaline angiopathy, pulse granuloma, hyaline ring granuloma and oral vegetable granuloma are all terms applied to an unusual giant-cell granulomatous inflammatory lesion. There is lack of agreement surrounding its pathogenesis. One theory favors an intrinsic origin. Within this theory, the hyaline rings has been attributed to altered collagen, the deposition of immunoglobulin light chains, and the degenerated walls of blood vessels. Another theory favors extrinsic origin. According to this theory, the hyaline material represents implanted vegetable particles, in particular, those of pulses/legumes. Hyaline ring granulomas are usually reported in the oral cavity. The case shown here is interesting in that occurs in the abdominal wall in association with a bowel perforation, and the granulomatous reaction clearly appears to be elicited by the implantation of vegetable material.