PMC5122819_01
Preoperative imaging showed a metal-dense, wedge-shaped foreign body in the range of frontal sinus on the left side, braking through the frontal sinus and creating a connection to the frontal cerebral lobe
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F1
In addition, the left frontal lobe showed a hypodense area [Figure 1].
Intraoperative view: The left side of the frontal sinus is shown (yellow arrow). Cerebral granuloma in situ can also be seen (*). On the right side, frontal lobe can be seen (green arrow)
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F2
After retracting the left frontal lobe, a frontobasal lesion (1 x 1 cm) with cerebral infiltration appeared [Figure 2].
(a, b) After resection of granuloma, a metal-dense, wedge-shaped foreign body in the range of the frontal sinus on the left side can be seen, breaking through the frontal sinus and creating a connection to the frontal cerebral lobe, can be seen. After resection of the foreign body, direct view to the frontal sinus with a chronic inflammatory reaction is seen (c)
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F3
Resection followed [Figure 3].
Resected granuloma (a) and foreign body (b)
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F4
Figure 4a,b], the chronic inflammatory suspected material in the frontal sinusal area was resected and sent for further histopathological examinations. Frontobasal covering by a frontal stemmed galea periost was performed.
Histopathological findings showing hematoxylin and eosin (H and E) staining of representative areas of the dura specimens loose (a, arrow) and proliferating connecting tissue (a-c; arrow head), with only very few fragments of the alleged foreign particle (b, c; asterisk) surrounded by connecting tissue proliferations with higher vascularization (b, c; arrow head) and focal mineralization (a). (d-f) H and E staining of the representative areas of the foreign body granuloma with giant cells (arrows) surrounding fragments of the foreign body (asterisk). (g-j) Immunohistochemical staining against CD68 showing positivity of the giant cells (g-j; arrows) and surrounding macrophages (arrow heads). Similar immunohistochemistry protocols for different antibodies have been previously published. Foreign body fragments are indicated by asterisks
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F5
The material resected from the left frontal sinus showed connective tissue and a necrotic cell detritus with a lymphatic, plasma cellular, and monozytic infiltration [Figure 5a-j].