Sevelamer is a resin that acts as a phosphate binder. It is used to treat chronic renal failure. Sevelamer helps prevent hypocalcemia caused by elevated phosphorus. It typically has a yellow-orange color and parallel reddish lines that are often referred to as “fish scales”. Mucosal injury may occur in some patients.

In this case the Sevelamer was found in the lumen in of the appendix together with other foreign bodies that are unidentified.

Plant resins may exhibit a very similar appearance to Sevelamer. Therefore, it is important to try to obtain a history of Sevelamer therapy to support the diagnosis.

Image contributed by Dr. Pooja Navale - @navale_pooja

An appendix that was removed because of appendicitis. A length of chain was found inside it, presumably swallowed by the young patient.

The foreign body could be seen on the radiograph (not shown)

Image contributed by Dr. Leon Metlay - @leon_metlay

(Given to him by a resident)

Aspirated seed-derived storage cell exhibiting advanced degenerative changes related to digestion and/or inflammation,

The terminology that has been used for this structure is confusing. Although terms such as legume, lentil, pulse and starch granule have been used, this is actually a large, seed-derived storage cell. The human diet contains seeds such as lentils, peas, beans, corn kernels and many others. Mature seeds contain an embryo and storage cells; endosperm and/or cotyledon cells. The storage cells provide nutrition to the embryo; they contain starch, protein, and lipid granules in varying amounts. Plants that produce seeds with 1 cotyledon are monocots; those with 2 cotyledons are dicots. The main source of nutrition for the embryo in monocots (corn, coconut, grains, etc) is generally from endosperm cells, and from cotyledon cells (peas, beans, legumes, etc.) in dicots. These 2 cell types are usually difficult to distinguish based on their H&E morphology unless the seed of origin is known. However, distinguishing between them is of no practical significance for pathologists.

According to the Food & Agricultural Organization of the UN ,the term "pulses" is limited to leguminous plants harvested solely for dry grain, thereby excluding crops harvested green for food (green peas, green beans, etc.) which are classified as vegetable crops. Also excluded are those crops used mainly for oil extraction (e.g. soy beans and ground nuts) and leguminous crops (e.g. seeds of clover and alfalfa) that are used exclusively for sowing purposes.

Seed derived storage cells may incite the formation of granulomas that are frequently referred to as "pulse granulomas" and "hyaline ring granulomas"; both are misnomers.

Reference: htpps://rdcu.be/cz4ZC.

Image contributed by Dr. Yale Rosen - @yro854

Human scabies is an intensely pruritic skin infestation caused by the host-specific mite Sarcoptes scabiei hominis. The mites reproduce on the skin surface and then burrow into the skin and lay eggs. This causes a pruritic, red skin rash. Scabies occurs worldwide and affects people of all races and social classes. Scabies is contagious; the mite is usually spread by direct, close, prolonged skin-to-skin contact with a person who has scabies. It can spread rapidly under crowded conditions where close body contact is frequent. This image shows the mite on the skin surface. The arrow points to a dorsal spine which is a typical feature of Sarcoptes scabei. . There are typically many, but only 1 is seen in this plane of section.

Images contributed by Dr. Sindy Tu - @Sindytu

The patient had been ingesting iron pills but there was no known history of aspiration. This is not unusual. The diagnosis of aspiration is often initially made by microscopic examination of lung tissue by pathologists. Aspiration often goes unrecognized by both clinicians and pathologists. In a review of 59 surgical lung specimens exhibiting aspiration pneumonia, aspiration was suspected clinically in only 4/45 (9%) of cases in which a clinical impression or differential diagnosis was provided (PMID 17460460). In a report of one hundred consecutive granulomas in a pulmonary pathology consultation practice, it was determined that aspiration pneumonia was the condition most commonly unrecognized by the referring pathologist (PMID 20871220).

Images contributed by Dr. Phillipe Joubert - @PjoubertPatho

Onyx® is a non-adhesive liquid intravascular embolic agent comprised of EVOH (ethylene vinyl alcohol) copolymer dissolved in DMSO (dimethyl sulfoxide), and suspended micronized tantalum powder to provide contrast for visualization under fluoroscopy. It is usually used for treatment of arteriovenous malformations. The DMSO solvent dissipates into the blood, causing the EVOH copolymer and suspended tantalum to precipitate in situ into a spongy, coherent embolus. This material may produce vascular and perivascular inflammation, angionecrosis and a foreign body giant cell reaction. Recanalization occurs in a very small percentage of cases.

These images show a necrotic eschar on the scalp of a man who underwent a brain tumor resection. Some vessels are filled with Onyx® which appears as a black, granular material.

Reference - www.ncbi.nlm.nih.gov/pubmed/19326974

Images and reference contributed by Dr. Irene Carretero – @IreneCarretero

The recent rise in sovereign debt vulnerabilities in many developing countries merits attention, especially in the context of a new creditor landscape and rising shares of domestic, non-concessional and collateralized debts. Key policy questions include: How can sovereigns increase their resilience to exogenous shocks? Can state-contingent debt help? What role can official and private creditors play in preventing and resolving unsustainable debt situations?

This is a most unusual case of foreign body granulomas in a mesenteric lymph node of a patient with Crohn’s disease. A fistulous tract connecting the intestine to the lymph node was responsible for intestinal contents entering the lymph node.

Middle image: Suppurative granuloma containing several plant cells.

Right image: Several granulomas; two containing undetermined foreign bodies; possibly skeletal muscle.

Images contributed by Dr. Mark Ong - @DrMarkOng

Tungiasis is a cutaneous parasitosis that is found in most tropical and sub-tropical climates and is caused by infection with the female sand flea Tunga penetrans (and T. trimamillatain some areas). It is also commonly known as pulga de areia, niguá, pique, bicho do pé, bichodo porco or jatecuba, and, in English-speaking countries, as jigger, sand flea or chigoe. Tungiasis is a zoonosis that affects humans and animals alike. Several mammalian species can act as reservoirs for human infection. In rural areas, these are predominantly pigs and bovines; in resource-poor urban communities, dogs, cats and rats. The lifecycle of the flea occurs in sandy environments. Although males and females feed on blood of warm-blooded animals, only the females burrow into the skin which causes symptoms of itching and pain which may be severe. Skin lesions, which may be numerous, almost always occurs on the feet. Considerable itching and pain occur as the female fleas develop fully and increase their body volume by a factor of 2000 within one week. Bacterial infections of the lesions can cause abscesses, suppuration, or lymphangitis.

Other images of tungiasis in this collection can be viewed by using the SEARCH function.

Image created with Pathpresenter and contributed by Dr. Geronimo Jr. Lapac @GeronimoJrLapac

Images from: Mehta RI et al. Modern Pathology (2010) 23, 921–930 (tinyurl.com/rkjztaj)

Hydrophilic polymers are widely used as surface coatings on vascular medical devices including guidewires, introducer and delivery sheaths, implantable stents and coils as well as cardiac, central and peripheral catheters. These polymers can fragment and embolize to various organs, most commonly the lungs. If they originate from the left side of the heart, embolization throughout the systemic circulation may occur. Their microscopic appearance is that of intravascular, coiled, worm-like structures. They can produce ischemic changes and infarction.

Minocycline is a tetracycline derivative antibiotic commonly prescribed for acne, rosacea, and other inflammatory skin disorders. Minocycline turns black when oxidized, leading to discoloration of the skin and nails. Pigmentation may also involve the bulbar conjunctiva, oral mucosa, teeth, bones, and thyroid gland. Pigmentation has been reported after long-term minocycline therapy with at least 100 mg/day.

Cutaneous minocycline hyperpigmentation is divided into 3 types; see last image. Type I is thought to be related to an iron chelate of minocycline Type II is probably secondary to a drug metabolite protein complex chelated with iron and calcium In Type III pigmentation is probably related to a photo drug induced dermatitis and melanin drop down from the basal layer

Images and text for 2nd paragraph contributed by Dr. Silvija Gottesman - @SGottesmanMD

Crushed barium sulphate crystals within an aphthous ulcer. Birefringence with polarization is seen in the right image.

Barium sulphate is widely used for radiographic diagnosis of lesions in the GI tract. Small and, generally, non-birefringent crystals with smooth edges that are produced by a precipitation technique, are mainly used for studies of the colon, but not in this case. Crushing the naturally occurring compound produces large, birefringent, rhomboidal crystals which have rough edges. Crushed BaSO4 is used primarily for studies of the esophagus and stomach because the rough edges of the particles facilitate mucosal adherence. Small quantities of birefringent, crushed barium sulphate are sometimes added to precipitated commercial suspensions to enhance radiological contrast. This would explain why, in the experience of some, precipitated BaSO4 that is mostly used for barium enemas exhibits birefringence while, in the experience of most, it does not.

Images contributed by Dr. Celina Stayerman - @ariella8

This is a common artifact seen in transbronchial lung biopsies. Compression of lung tissue by the biopsy forceps produces atelectasis and air bubbles of varying size that can be confused with lipid aspiration. While the size and shape of many of these air bubbles resembles lipid many do not have the appearance of lipid.. If there are many macrophages in the lung tissue they may be found at the periphery of the air bubbles and give that false impression that they are reacting to the aspiration of lipid. Biopsy specimens with this appearance have been misdiagnosed as exogenous lipid pneumonia.

Gelfoam® in a papillary renal cell carcinoma (partial nephrectomy). This hemostatic agent was injected by a radiologist to control bleeding associated with a prior needle biopsy of this lesion.

Gelfoam® is a sterile sponge-like material prepared from purified porcine skin, Gelatin USP Granules and Water for Injection, USP. It is intended for application to bleeding surfaces for hemostasis during surgery or for use as a temporary intravascular embolic material. Gelfoam® is usually absorbed completely (depending on the amount used, degree of saturation with blood, and site at which it is used), with little tissue reaction. When used as an embolic material, the vessel recanalizes within a few weeks.

Other examples of Gelfoam® in this collection may be viewed by using the SEARCH function.

Images contributed by Dr. Laurence Galea- @DrLaurenceGalea

Black tattoo pigment in a lymph node. Pigment origin probably skin. Pigment transported to lymph node via lymphatic vessels.

Images contributed by Dr. T. Umashankar - @tumashankar

Although most skin splinters consist of wood, their appearances are variable.

Images contributed by Dr. Jeffrey Cloutier - @JCloutierMD

Gelfoam is a sterile sponge-like material prepared from purified porcine skin, Gelatin USP Granules and Water for Injection, USP. It is intended for application to bleeding surfaces for hemostasis during surgery or for use as a temporary intravascular embolic material. Gelfoam is usually absorbed completely (depending on the amount used, degree of saturation with blood, and site at which it is used), with little tissue reaction. When used as an embolic material, the vessel recanalizes within a few weeks.

Image contributed by Dr. Yale Rosen - @yro854

This lesion was discovered seven years following resection of a meningioma, when the patient was hospitalized complaining of headache, diffuse weakness, and neck pain. Following excision it was found to be a cyst with cheesy, green/yellow and necrotic appearing contents. Microscopically the cyst wall consisted of an outermost rim of brain tissue, a thick layer of fibrotic tissue which merges with numerous macrophages, some hemosiderin-laden, and foreign-body giant cells containing refractile material which is emphasized by polarized light. The appearance of the foreign material is typical of cotton fibers. These fibers undoubtedly originated from a cotton gauze sponge used during surgery.

"Gossypiboma, textiloma or more broadly Retained Foreign Object (RFO) is the technical term for surgical complications resulting from foreign materials, such as a surgical sponge, accidentally left inside a patient's body. The term "gossypiboma" is derived from the Latin (cotton wool, cotton) and the suffix -oma, meaning a tumor or growth, and describes a mass comprising a cotton matrix surrounded by a foreign body granulomatous reaction. Cotton plants belong the genus Gossypium. "Textiloma" is derived from textile (surgical sponges have historically been made of cloth), and is used in place of gossypiboma due to the increasing use of synthetic materials in place of cotton."**

** 2nd paragraph mostly from Wikipedia.

Images contributed by Dr. Ada Baisre - @BrainSlicer

Photomicrographs of feline hair. Characteristic features are the "ladder-like" appearance of the medullla and the crenated or spinous appearance of the cuticle. In the lower right image the arrows point to overlapping scales visible on the surface of the cuticle.

The medullary index (diameter of the medulla relative to the diameter of the hair shaft) is generally greater than 1/3 in animals and less than 1/3 in humans. Spinous type cuticle scales are not found in humans. In the lower right image the arrows point to overlapping scales on the surface of the cuticle, another characteristic feature.

Animal hairs may contaminate open or ulcerated skin lesions in humans. Thus, it is important to be familiar with their appearance.

Images contributed by Taryn Donovan, DVM, DACVP- Animal Medical Center-New York,NY

45-year-old woman with a history of tubal ectopic pregnancy. Giant cell foreign body reaction and xantogranulomatous reaction to suture material. This is a suture of vegetable origin, composed of cotton fibers (95% cellulose), non-absorbable. It is a multifilament suture thread with a white color code, currently little used.

Images contributed by Dr. Varun Kumar Singh - @varunksingh

Chickpea appearance after cooking and freezing falafel. As you can see, after this processing, the storage cells are deteriorated, broken and shrunk, and this is the way we sometimes see them when these food foreign bodies are aspirated through the airways.

Images contributed by Dr. Nicole D. Riddle - @NRiddleMD

Radiesse® is a subdermal implant material composed of synthetic calcium hydroxylapatite microspheres suspended in a water-based gel carrier. It is used for correction of moderate to severe facial wrinkles and folds (nasolabial folds) and for restoration and/or correction of the signs of facial fat loss (lipoatrophy) in patients with HIV.

Images contributed by Dr. Aziz Banasser - @AzizMBan

Bio-Oss® is a natural bone substitute material obtained from the mineral portion of bovine bone. It is used as a bone graft material in dentistry.

From the Academy of Oral and Maxillofacial Pathology

aaomp.org/atlas/graft-materials/hydroxyapatite/

Images courtesy of the Long Island Jewish Medical Center

On the left, Transarterial Chemoembolization (TACE): infusion of chemotherapy-loaded drug-eluting microspheres into the hepatic artery to treat hepatic carcinoma.

On the right: Some microspheres can pass through the hepatic filter and end up in the lung. Here we see it inside a subpleural vessel. The microsphere appears to be engulfed by a giant multinucleated cell.

The appearance of these microspheres, having some resemblance to thyroid colloid, is consistent with trisacryl gel.

You can search for other cases of microspheres in this Atlas by using the SEARCH function..

Images contributed by Dr. Esther Youd - @estheryoud

Intravascular cholesterol and cotton fiber emboli were identified in a heel ulcer. This patient likely had a diagnostic or therapeutic intravascular procedure which dislodged cholesterol from atheromatous lesions in the artery. Microscopic remnants of cotton, which are remnants of antiseptic-soaked cotton used to sterilize the tips of catheters or wires, may embolize as well. The cotton fibers are mostly seen in cross section and typically resemble donuts. They exhibit birefringence with polarization as seen in the last image The cholesterol crystals are large, have a characteristic needle shape, and do not exhibit birefringence.

Images contributed by @Mawgdn

Parotid mass FNA. Granulomatous inflammation due to injection of filler material (microspheres). She had injectable facial dermal filler as a plastic cosmetic procedure, which rarely can cause local reaction & EXTREMELY RARELY, IF EVER involve the parotid gland.

The dermal injections were performed more than a year ago, and the type of filler used has not been identified.

You can search for other cases of microspheres in this Atlas.

Image contributed by Dr. Syed Z. Ali - @sza_jhcyto

Surgicel® (oxidized regenerated cellulose) is a hemostatic agent used in surgical procedures. Other generic names for the same material are Surgicel Powder Absorbable Hemostat®, Spofax®, Stop Bleed® & others. It is derived from plant material that undergoes oxidization. It is available in a variety of forms, including mesh, gauze, powder fibrillar tufts, and sponges; all are absorbable. Foreign body reactions can occur if significant amounts are left in the wound.

Images contributed by Dr. Diego Morales - @DiegoMoralesN

This feline hair was seen on a GMS-stained slide. Compare with chart showing the appearances of the hair shaft medulla in various species.. There must have been a cat nearby.

Animal hairs sometimes contaminate human lesions that are ulcerated and/or draining. and may be seen in biopsy specimens of these lesions.

Photomicrographs contributed by Dr. Amy H. Deeken - @AmyHDeekenMD

Chart by Dr. Kaleem Khan - tinyurl.com/s3sdum2

This is a seed found in the lumen of a cecal appendix removed for acute appendicitis. It can be identified primarily by its size and shape and then by the structure of the coat, which is characterized by an eosinophilic, compact inner layer, and a frayed outer layer with a peripheral hairy or pellucid zone. The storage and embryo cells are quite similar to those of other seeds.

Images contributed by Dr. Rakesh Gupta - @NewjobiRakesh

Crospovidone has a coral-like appearance with a basophilic outer coat and a pink inner layer. It is an insoluble polymer of N-vinyl-2-pyrrolidone that is used as a disintegrant in pharmaceutical tablets. It embolizes to the lungs when aqueous suspensions of pulverized tablets are injected intravenously in drug abusers (IVDA) It is also found in the gastrointestinal tract following ingestion of various types of tablets. The precise architecture of histologically processed crospovidone can vary by medication. This and other features of crospovidone are very well discussed and illustrated in tinyurl.com/yajl3oru.

The very unusual feature of this case is that particles of crospovidone were also observed in the kidneys and brain indicating passage through the pulmonary capillaries. The size of the particle in one of the images of kidney is much larger than the diameter of the pulmonary capillaries thus raising the question of a possible pulmonary arteriovenous shunt.

Images contributed by Dr. Richard Jones - @forensicmed

My ketones seem to be in a pretty good spot whether exogenous or liver produced. My running has improved (faster pace, no recovery, daily running).

I struggle with making dinner my final food for the day. Each day that gets a bit easier, but 8pm-10pm the snacks call to me. Particularly peanuts and chocolate chips!

Here are my numbers (26 days on keto)

Weight: Down 5.2 lbs : current weight: 128.6 lbs

BodyFat: Down 2.7% : current body fat: 9.6%

Blood Sugar: 88

Ketones: 1.0 mmol/L

Now I suspect my blood sugar is lower, but in order to avoid getting light headed during exercise I will often need a small amount of carbs (7g) is usually plenty for a 1-2 hour workout. #ketogenic #ketosis #keto #ketone #blood #ultrarunning #diet #biohacking #hflc #endurance #paleo #quantifiedself #burnfat

31 Likes on Instagram

4 Comments on Instagram:

5footking: Ummm wow! That's outstanding 👍👊👏!!

millennial_keto: 👍

fermentedfoodguy: I am definitely not going into acidosis only ketosis. I am doing it for the mental clarity, avoiding bonking in races and sustained energy. It works great when I stay on the diet.

The patient had been ingesting iron pills but there was no known history of aspiration. This is not unusual. The diagnosis of aspiration is often initially made by microscopic examination of lung tissue by pathologists. Aspiration often goes unrecognized by both clinicians and pathologists. In a review of 59 surgical lung specimens exhibiting aspiration pneumonia, aspiration was suspected clinically in only 4/45 (9%) of cases in which a clinical impression or differential diagnosis was provided (PMID 17460460). In a report of one hundred consecutive granulomas in a pulmonary pathology consultation practice, it was determined that aspiration pneumonia was the condition most commonly unrecognized by the referring pathologist (PMID 20871220).

Images contributed by Dr. Phillipe Joubert - @PjoubertPatho

Canine hair: The ladder like appearance of the medulla is absent or less prominent and the medulla comprises a smaller diameter of the hair shaft when compared with feline hair. The outer surface of the cuticle appears smooth but subtle serrations can sometimes be observed (arrows-upper left image). These serrations are not as prominent as the crenated, spinous appearance of the cuticle in the feline hair.

Animal hairs may contaminate open or ulcerated skin lesions in humans. Thus it is important to be familiar with their appearance.

Images contributed by Taryn Donovan, DVM, DACVP- Animal Medical Center-New York,NY

Polarization demonstrates birefringence of aspirated, crushed barium sulphate crystals.

Barium sulphate is widely used for radiographic diagnosis of lesions in the GI tract. Small and, generally, non-birefringent crystals with smooth edges that are produced by a precipitation technique, are mainly used for studies of the colon. Crushing the naturally occurring compound produces large, birefringent, rhomboidal crystals which have rough edges. Crushed BaSO4 is used primarily for studies of the esophagus and stomach because the rough edges of the particles facilitate mucosal adherence. Small quantities of birefringent, crushed barium sulphate are sometimes added to precipitated commercial suspensions to enhance radiological contrast. This would explain why, in the experience of some, precipitated BaSO4 used for barium enemas exhibits birefringence while, in the experience of most, it does not.

Image contributed by Dr. Yale Rosen - @yro854

Endogenous lipid pneumonia/obstructive pneumonia is characterized by the filling of air spaces with foamy, lipid-laden macrophages. The usual cause is airway obstruction; hence the term obstructive pneumonia. Because lipid imparts a yellowish color when seen grossly it has also been called 'golden pneumonia". The gross photograph and X-ray show endogenous lipid/obstructive pneumonia distal to a large squamous carcinoma which is obstructing a major bronchus. The lipid is phospholipid, derived from breakdown of cells and surfactant distal to airway obstruction. The appearance of the foamy, granular macrophages differs markedly from aspirated lipid which appears as extracellular and intracellular vacuoles of varying size in exogenous lipid pneumonia.

Image contributed by Dr. Yale Rosen - @yro854

Lipid aspiration is characterized by fat globules of varying size; some quite large. Aspirated fat usually incites a severe inflammatory reaction. Collagenous fibrosis is often present in older lesions.

Image contributed by Dr. Yale Rosen - @yro854

Intravascular embolized microcrystalline cellulose with a foreign body giant cell reaction. Microcrystalline cellulose is used as a filler in pharmaceutical tablets. It embolizes to the lungs when aqueous suspensions of pulverized tablets are injected intravenously.

Image contributed by Dr. Yale Rosen - @yro854

Det M.Secq.

Arthrolips fasciata found on a dead Pinus trunk.

1.3 mm Tasmanian beetle, first time captured in France in 1996.

This retained surgical cotton gauze sponge isurrounded by a thick fibrous capsule. was found by ultrasonography ,attached to an ovary, 1 year after the patient had undergone abdominal surgery. The preoperative diagnosis was ovarian tumor

"Gossypiboma, textiloma or more broadly Retained Foreign Object (RFO) is the technical term for surgical complications resulting from foreign materials, such as a surgical sponge, accidentally left inside a patient's body. The term "gossypiboma" is derived from the Latin (cotton wool, cotton) and the suffix -oma, meaning a tumor or growth, and describes a mass comprising a cotton matrix surrounded by a foreign body granulomatous reaction. Cotton plants belong the genus Gossypium. "Textiloma" is derived from textile (surgical sponges have historically been made of cloth), and is used in place of gossypiboma due to the increasing use of synthetic materials in place of cotton."**

*** Text mostly from Wikipedia.

Images contributed by Dr. Maribel Donastorg - @maldovi

Silicone breast implant with fibrous capsule to the left.

Image contributed by Dr. Yale Rosen - @yro854

Aspirated gastric contents are lodged in the the right main stem bronchus.

Image contributed by Dr. Yale Rosen - @yro854

Cellulitis is a diffuse infection of connective tissue with severe inflammation of dermal and subcutaneous layers of the skin. Cellulitis can be caused by normal skin flora or by exogenous bacteria, and often occurs where the skin has previously been broken: cracks in the skin, cuts, blisters, burns, insect bites, surgical wounds, or sites of intravenous catheter insertion. Skin on the face or lower legs is most commonly affected by this infection, though cellulitis can occur on any part of the body. The mainstay of therapy remains treatment with appropriate antibiotics.

This fragment of a barbule of a bird feather, with evenly spaced hooklets along its length, was observed in a bronchoalveolar lavage specimen that was obtained from a young man who lives in the countryside and raises birds, geese, and ducks mainly. He also has pillows that contain bird feathers. He was said to have a typical presentation of hypersensitivity pneumonitis. With all of his exposure to birds and feathers he appears to have inhaled a fragment of a feather barbule. Some anatomical features of bird feathers are seen in the accompanying illustrations.

Photomicrograph contributed by Dr. Emilian Olteanu - @EmiliamPath

Illustration of feather barbule with hooklets from DOI:10.1164/26660644=05602001.

Illustration of feather anatomy from tinyurl.com/26he54rl.

Foreign body giant cell reaction to pigmented plant/vegetable fragment found in sigmoid colon.

Image contributed by Dr. Padma Priya J - @padmapathology

The absence of an inflammatory reaction indicates that the lipid has been aspirated very recently.

Ferruginous bodies in BAL (Bronchoalveolar Lavage).

Dumbbell-shaped, golden yellow to black with Pap stain (bottom left), blue with Perls stain (bottom right) and golden yellow with H&E (top).

Ferruginous bodies usually form around asbestos fibers but a variety of other fibers may incite the formation of similar structures. Ferruginous bodies, when seen in the lungs, are almost always indicative of asbestos exposure.

Asbestos fibers that reach the air spaces of the lungs become coated with iron, usually in a beaded fashion, forming typical ferruginous bodies that stain blue with Perls stain.

You can find more images of ferruginous bodies in this Atlas by using the SEARCH function

Images contributed by Dr. Tamara Zudaire - @LangerPath

ORISE Gel® (Boston Scientific) is one of many types of materials designed to be used for submucosal lift of polyps, adenomas, early-stage cancers or other gastrointestinal mucosal lesions prior to excision with a snare or other endoscopic device. It is composed of water, sodium chloride, poloxamer 188 (bulking and structural agent), polyoxyl-15-hydroxystearate (emulsifier), medium-chain-triglycerides (oil component). This solution includes methylene blue to improve visibility of the lesion and submucosal surface. By providing an immediate and long-lasting cushion beneath the polyp and improving the visibility of the lesion, it may help achieve a complete and safe removal of the lesion. Eleview® (Olympus), a similar solution, shows comparable results. If the material remains in the submucosa, after a period of approximately 2 months, a reaction with giant cells is produced, called "Lifting Agent Granuloma"

Images contributed by Dr. Roger M. Feakins - @RogerFeakins

Braided suture material usually is manufactured from Vicryl (polyglactin 910), an absorbable, synthetic material, or from silk which is non-absorbable. I believe that this material is likely Vicryl.

Upper 2 panels - H&E

Lower 2 panels - polarized

Images contributed by Dr. Jerad M Gardner - @JMGardnerMD

The contact of silicone with human tissues, when the breast prosthesis ruptures, has caused a giant cell reaction to a foreign body. In the photos we see the transparent bubbles of silicone, which are being ingested by the giant cells and the formation of asteroid bodies as a result of the processing of this foreign material.

Asteroid bodies are not specific to any disease, they can form inside giant cells in infectious diseases, diseases of unknown etiology, such as sarcoidosis and as a reaction to foreign materials, such as silicone, being in this condition, probably, one of the which form many asteroid bodies.

Images contributed by Dr. Jasmine Vickery - @VickeryJasmine

Colestipol was found in a pancreatic biopsy that was obtained endoscopically via the stomach. It originated from the stomach and contaminated the pancreatic biopsy specimen. Colestipol is the generic form of Colestid® and others; a micronized form of bile acid sequestrant, which is used to treat elevated cholesterol. It is also sometimes given to treat chronic diarrhea after certain intestinal surgeries, and to relieve itching associated with liver disease. This patient was taking the medication for treatment of hyperlipidemia.

Images contributed by Dr. Michael Feely - @MFeelyDO