case_images: PMC5122819_01
case_images: 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
case_images: SNI-7-775-g001.jpg
case_images: PMC5122819_01_SNI-7-775-g001.jpg
case_images: F1
case_images: In addition, the left frontal lobe showed a hypodense area [Figure 1].
case_images: 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)
case_images: SNI-7-775-g002.jpg
case_images: PMC5122819_01_SNI-7-775-g002.jpg
case_images: F2
case_images: After retracting the left frontal lobe, a frontobasal lesion (1 x 1 cm) with cerebral infiltration appeared [Figure 2].
case_images: (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)
case_images: SNI-7-775-g003.jpg
case_images: PMC5122819_01_SNI-7-775-g003.jpg
case_images: F3
case_images: Resection followed [Figure 3].
case_images: Resected granuloma (a) and foreign body (b)
case_images: SNI-7-775-g004.jpg
case_images: PMC5122819_01_SNI-7-775-g004.jpg
case_images: F4
case_images: 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.
case_images: 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
case_images: SNI-7-775-g005.jpg
case_images: PMC5122819_01_SNI-7-775-g005.jpg
case_images: F5
case_images: 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].