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 Table of Contents  
LETTER TO EDITOR
Year : 2022  |  Volume : 17  |  Issue : 3  |  Page : 800-801

Foreign-body type of giant cell reaction in a case of spinal epidural abscess


1 Department of Pathology, Narayana Medical College Hospital, Nellore, Andhra Pradesh, India
2 Department of Medicine, Narayana Medical College Hospital, Nellore, Andhra Pradesh, India
3 Department of Neurosurgery, Narayana Medical College Hospital, Nellore, Andhra Pradesh, India
4 Department of Radiology, Narayana Medical College Hospital, Nellore, Andhra Pradesh, India

Date of Submission06-Oct-2016
Date of Decision09-Dec-2016
Date of Acceptance18-Apr-2020
Date of Web Publication2-Nov-2022

Correspondence Address:
Dr. Amit Agrawal
Department of Neurosurgery, Narayana Medical College Hospital, Chinthareddypalem, Nellore - 524 003, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdmimsu.jdmimsu_7_16

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How to cite this article:
Santhi V, Soren B, Agrawal A, Reddy V U, Sandeep Y. Foreign-body type of giant cell reaction in a case of spinal epidural abscess. J Datta Meghe Inst Med Sci Univ 2022;17:800-1

How to cite this URL:
Santhi V, Soren B, Agrawal A, Reddy V U, Sandeep Y. Foreign-body type of giant cell reaction in a case of spinal epidural abscess. J Datta Meghe Inst Med Sci Univ [serial online] 2022 [cited 2023 Feb 8];17:800-1. Available from: http://www.journaldmims.com/text.asp?2022/17/3/800/360232



Dear Sir,

Presence of foreign body stimulates the formation of foreign-body granulomas,[1] which is initiated by the presence of the foreign body and characterized by accumulation of modified macrophages.[2] A 65-year-old male patient presented with a history of fever of 10 days' duration, neck pain of 10 days' duration, and weakness of the right side of the body of 10 days' duration. On the 2nd day, he started developing weakness of all the four limbs with pain and paresthesias below the nipple with tingling and numbness. He had complete bowel and bladder involvement. He was catheterized for urinary retention. There was no history of diabetes, hypertension, or tuberculosis in the past. On examination, the patient was conscious and dull but oriented to time, place, and person. The cranial nerves were normal. Motor examination revealed hypotonia of all the four limbs, and power was Grade 0/5 in all the four limbs. The planters were not elicitable bilaterally, and abdominal reflex was absent. All the deep tendon reflexes in the upper as well as in the lower limbs were absent. Computed tomography scan of the brain plain and contrast was apparently normal. Magnetic resonance imaging cervical spine – sagittal T2-weighted image of the cervical spine – showed reduced disc height of C4–C5 with associated hyperintense anterior epidural collection, which is indenting on the cord after causing complete obliteration of the anterior subarachnoid space [Figure 1]. The patient underwent right anterior cervical approach, C4–5 discectomy, and evacuation of the thick pus. The part of the capsule was sent for biopsy. The pus was thick, yellowish, and nonfoul smelling. Pus culture was sterile. Histopathology examination showed a necrotic material admixed with neutrophils and karyorrhectic debris, and a bony spicule surrounded by osteoclastic giant cells with adjacent foci showed multinucleated foreign body giant cells and fibroblasts [Figure 2]a and [Figure 2]b. The patient had difficulty in extubation and was kept on elective ventilation. The patient received broad-spectrum antibiotics. On day 3 after surgery, elective tracheostomy was performed and gradually the patient could be weaned off from the ventilator.
Figure 1: Sagittal T2-weighted image of the cervical spine showing reduced disc height of C4–C5 with associated hyperintense anterior epidural collection, which is indenting on the cord after causing severe effacement of the anterior subarachnoid space

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Figure 2: (a) Necrotic material admixed with neutrophils and karyorrhectic debris (H and E, ×400) (b) Bony spicule surrounded by osteoclastic giant cells. Adjacent foci showing multinucleated foreign-body giant cells and fibroblasts (H and E, ×400)

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Presence of foreign bodies (e.g., suture material, surgical sponge, gauze pieces, lint pieces, glove powder, hemostatic material, and surgical clips) in the body may elicit an inflammatory response and can result in foreign-body type of giant cell reactions, which includes the presence of multinucleated giant cells.[3],[4],[5] Presence of a foreign body stimulates an acute inflammatory response usually which tries to remove the foreign substance.[6],[7] In this process, macrophages adhere, resulting in foreign-body reaction and if the size of the foreign material is large than to accommodate the foreign body (frustrated phagocytosis),[8] there is formation of giant cells.[6],[7],[9],[10],[11] Depending on the arrangement of the nuclei in the cytoplasm, one can make a histopathological diagnosis of the underlying disease process.[1] However, multinucleated giant cells can also be seen in other granulomatous reactions, which can be due to tuberculosis or fungal infection. Presence of numerous eosinophils along with granulomas containing epithelioid cells, neutrophilic collection, and giant cells characterizes the fungal infection. In the tuberculous lesion, granulomas contain epithelioid cells and Langhans type of giant cells, which differ from foreign-body giant cells in the pattern of arrangement of nuclei. In the present case, probably, the presence of the dead bone spicule would have provoked the foreign-body giant cell reaction. Adjacent proliferating fibroblasts can be misinterpreted as epithelioid cells due to the presence of oval, elongated nuclei. Epithelioid cells can be differentiated from fibroblasts by pale, ovoid nuclei with blunted ends, pale eosinophilic granular cytoplasm, and inconspicuous cell borders. Epithelioid cells are associated with intense immunological activity and they are of mononuclear phagocyte system.[12] It is important to know that the granuloma formation may not result in removal of the foreign body,[13] instead there shall be a need to resolve the underlying cause for the granuloma formation.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Rai H. Foreign body giant cell granuloma of the mandible subsequent to endodontic surgery. J Contemp Dent 2015;5:178-80.  Back to cited text no. 1
    
2.
Yallamraju S, Gunupati S. An unusual foreign body in upper lip. Internet J Dent Sci 2012;10:1-5.  Back to cited text no. 2
    
3.
Davison NL, ten Harkel B, Schoenmaker T, Luo X, Yuan H, Everts V, et al. Osteoclast resorption of beta-tricalcium phosphate controlled by surface architecture. Biomaterials 2014;35:7441-51.  Back to cited text no. 3
    
4.
Fink J, Fuhrmann R, Scharnweber T, Franke RP. Stimulation of monocytes and macrophages: Possible influence of surface roughness. Clin Hemorheol Microcirc 2008;39:205-12.  Back to cited text no. 4
    
5.
McNally AK, Anderson JM. Phenotypic expression in human monocyte-derived interleukin-4-induced foreign body giant cells and macrophages in vitro: Dependence on material surface properties. J Biomed Mater Res Part A 2015;103:1380-90.  Back to cited text no. 5
    
6.
Anderson JM. Biological responses to materials. Annu Rev Mater Res 2001;31:81-110.  Back to cited text no. 6
    
7.
Anderson JM, Rodriguez A, Chang DT. Foreign body reaction to biomaterials. Semin Immunol 2008;20:86-100.  Back to cited text no. 7
    
8.
ten Harkel B, Schoenmaker T, Picavet DI, Davison NL, de Vries TJ, Everts V. The foreign body giant cell cannot resorb bone, but dissolves hydroxyapatite like osteoclasts. PLoS One 2015;10:e0139564.  Back to cited text no. 8
    
9.
Brodbeck WG, Anderson JM. Giant cell formation and function. Curr Opin Hematol 2009;16:53-7.  Back to cited text no. 9
    
10.
Wooley PH, Hallab NJ. Wound Healing, Chronic Inflammation, and Immune Responses. Metal-on-Metal Bearings. New York, NY, USA: Springer; 2014. p. 109-33.  Back to cited text no. 10
    
11.
Shrestha A. Giant cells and giant cell lesions of oral cavity – A review. Cumhuriyet Dent J 2014;17:192-204.  Back to cited text no. 11
    
12.
Turk JL, Narayanan RB. The origin, morphology, and function of epithelioid cells. Immunobiology 1982;161:274-82.  Back to cited text no. 12
    
13.
Kumar V, Abbas AK, Aster JC. Robbins basic pathology: Elsevier Health Sciences; 2012.  Back to cited text no. 13
    


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