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Year : 2018  |  Volume : 7  |  Issue : 1  |  Page : 12-13

Heterotopic cartilage in endocervical polyp: A rare occurrence

Department of Pathology, ESI Hospital Rohini, Delhi, India

Date of Submission05-Jun-2017
Date of Acceptance12-Aug-2017
Date of Web Publication11-Mar-2022

Correspondence Address:
Divya Sethi
C-5/20, Sector-11, Rohini, New Delhi - 110 085.
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijhi.ijhi_6_17

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Cartilaginous metaplasia in uterine cavity is a known entity, but such a presence is extremely rare in the endocervical polyps. The importance lies in differentiating it from mixed mesodermal tumour and retained foetal parts by taking a detailed history and thorough histopathological examination. We hereby present a case of a 31-year-old female presenting with bleeding per vaginum for 1 year who was then operated for polypectomy and on histopathological examination revealed areas of cartilaginous differentiation. Only two cases of such type have been reported in the literature to the best of our knowledge.

Keywords: Cartilaginous metaplasia, endocervical polyp, heterotopic cartilage

How to cite this article:
Sethi D, Lamba S, Nanda A, More S. Heterotopic cartilage in endocervical polyp: A rare occurrence. Int J Histopathol Interpret 2018;7:12-3

How to cite this URL:
Sethi D, Lamba S, Nanda A, More S. Heterotopic cartilage in endocervical polyp: A rare occurrence. Int J Histopathol Interpret [serial online] 2018 [cited 2023 Dec 7];7:12-3. Available from: https://www.ijhi.org/text.asp?2018/7/1/12/339328

  Introduction Top

An endocervical polyp is one of the common benign lesions of the cervix consisting of cervical tissue with occasional squamous metaplasia, microglandular hyperplasia and dilated cervical glands.[1] Cartilaginous metaplasia in an endocervical polyp is a very rare entity. The presence of heterotopic cartilage needs to be differentiated from mixed mesodermal tumour or retained foetal parts. A handful of cases have been reported as heterotopic cartilage in the uterus but to the best of our knowledge, only two cases of heterotopic cartilage have been reported within the endocervical polyp.[2],[3]

  Case Report Top

A 37-year-old female patient presented to the outpatients department of obstetrics and gynaecology with complaints of bleeding per vaginum off and on for 1 year. On perspeculum examination, a polyp was present at the external os. Polypectomy was done and sent for histopathological examination. A polyp with attached stalk was received in pathology department which on gross examination was firm in consistency and measured 2.5 cm × 2 cm × 0.5 cm, and the stalk measured 3.5 cm × 1.5 cm whole of the specimen was sectioned serially and processed. Microsections examined revealed an endocervical polyp with numerous glands bearing columnar lining. Focal areas of cartilaginous differentiation were observed beneath the surface epithelial lining within the cervical stroma [Figure 1] and [Figure 2]. There was no associated surrounding inflammatory infiltrate or any areas of foetal tissues or emotional nests were found. There was no evidence of mixed mesodermal tumour in any other sections.
Figure 1: Polyp with endovervical glands covered by stratified squamous lining, foci of cartilaginous differentiation underneath within the stroma (×40, H and E)

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Figure 2: High power view of cartilaginous differentiation (×100, H and E)

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At other places transition from stroma to cartilage formation was observed. Alcian blue staining was performed which stains the acid mucopolysaccharides in the cartilage, and it came out strongly positive. Surrounding stroma was also weakly positive for the same supporting the hypothesis that accumulation of acid mucopolysaccharides precedes the formation of cartilage.

A detailed history of the patient was obtained retrospectively. Her obstetric status was gravida 2 para 2 with two live issues, her last child birth was 7 years before the time of clinical presentation. There were no medical or surgical abortions and was ligated. Her urine pregnancy test was negative ruling out to some extent the suspicion of retained pedolith or foetal parts. It was finally reported as an endocervical polyp with cartilaginous metaplasia.

  Discussion Top

There are two explanations for the presence of non-foetal non-neoplastic cartilage in the uterus namely heteroplasia and metaplasia. Heteroplasia is the development of embryonally displaced mesodermal cell rests already predestined to form cartilage. Metaplasia is the transformation of mature stromal cells into mesenchymal cells of a different type.[4] In the present case, it is the heterotopic presence of cartilage due to stromal metaplasia into mature cartilage.

Review of the literature shows that cartilage and bone formation, in particular, cartilage formation, in the cervical lesions have rarely been reported. Before this report, only two cases of heterotopic cartilage have been reported in the literature to the best of our knowledge. One case was reported it as hamartomatous endocervical polyp which constituted endocervical polyp with heterologous cartilage and adipose tissue. Other one was a case of heterotopic cartilage in the endocervical polyp amongst others cases with foci of cartilage elsewhere in the uterus.[1],[2]

The presence of cartilage in the uterus raises a suspicion of retained foetal parts or mixed mesodermal tumour. These possibilities should be ruled out before making a diagnosis of heterotopic cartilage.

Endocervical polyp is usually accompanied by chronic inflammation, and its aetiology is thought to be an inflammatory process. Marked inflammation might suggest retention of foetal parts but in this case some points which favour heterotopic cartilage formation over foetal retention are first, no other foetal parts were identified and the cartilaginous elements were present with surrounding transition zone of developing cartilage suggesting stromal metaplasia, second, there was no history of patient being pregnant or aborted for the last 7 years and third, there is very thin chance of cartilage being persisting in the endocervical polyp rather than in the uterus and finally, pedoliths might not show presence of cartilage.

Other differential diagnosis is mixed mesodermal tumour and in the index case presence of no other elements apart from cartilage helped differentiating from mixed mesodermal tumour.

Cartilage and bone formations in the female genital organs are recognised in carcinosarcoma (malignant Müllerian mixed tumour), adenosarcoma, embryonal rhabdomyosarcoma (sarcoma botyroides) and immature teratoma as well which can be easily differentiated on histopathological examination.[5]

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Conflicts of interest

There are no conflicts of interest.

  References Top

Rosai J. Endocervical polyp. In: Rosai and Ackerman’s Surgical Pathology. 9th ed. Edinburgh, London, New York, Philadelphia, St. Louis, Sydney, Toronto: Mosby; 2004. p. 1527.  Back to cited text no. 1
Roth E, Taylor HB. Heterotopic cartilage in the uterus. Obstet Gynecol 1966;27:838-44.  Back to cited text no. 2
Ilhan R, Yavuz E, Iplikçi A, Tuzlali S. Hamartomatous endocervical polyp with heterologous mesenchymal tissue. Pathol Int 2001;51:305-7.  Back to cited text no. 3
Tavassoli FA, Devilee P, editors. WHO Classification of tumours. In: Pathology and Genetics: Tumours of the Breast and Female Genital Organs. Lyon: IARC Press; 2003.  Back to cited text no. 4
Willis RA. The Borderland of Embryology and Pathology. London: Butterworth; 1962.  Back to cited text no. 5


  [Figure 1], [Figure 2]


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