|Year : 2018 | Volume
| Issue : 1 | Page : 8-11
Subcutaneous cartilaginous choristoma of neck: A rare entity
Sonu Kalyan1, Nitesh Kumari2
1 Department of Pathology, Kalpana Chawla Government Medical College (KCGMC), Karnal, Haryana, India
2 Tapadia Diagnostic Centre, Hyderabad, Telangana, India
|Date of Submission||23-Apr-2020|
|Date of Acceptance||11-Oct-2021|
|Date of Web Publication||11-Mar-2022|
Department of Pathology, Kalpana Chawla Government Medical College (KCGMC), Karnal 132001, Haryana.
Source of Support: None, Conflict of Interest: None
The term “choristoma” refers to a hamartomatous tumor-like lesion that is composed of normal tissue in an abnormal location Most of the cartilaginous choristomas involve the tongue. These lesions are very rarely seen in the neck. We present a case report of an 8-year-old child presenting with a swelling on the left lower third of the neck anterior and lateral to the left sternocleidomastoid muscle in the subcutaneous plane. Swelling was present as childhood and progressively increased in size. Surgical excision was done and the specimen was sent for histopathological evaluation. Histopathological examination showed a circumscribed nodule of hyaline cartilage separated from the adjacent subcutaneous tissue and overlying skin by a thin fibrous connective tissue. Excision of the lesion including perichondrium and surrounding soft tissue is considered as curative. Removal of the perichondrium is very essential for avoiding recurrences, because perichondrium may have the capacity to develop a new cartilage.
Keywords: Cartilage, choristoma, neck
|How to cite this article:|
Kalyan S, Kumari N. Subcutaneous cartilaginous choristoma of neck: A rare entity. Int J Histopathol Interpret 2018;7:8-11
|How to cite this URL:|
Kalyan S, Kumari N. Subcutaneous cartilaginous choristoma of neck: A rare entity. Int J Histopathol Interpret [serial online] 2018 [cited 2022 Nov 26];7:8-11. Available from: https://www.ijhi.org/text.asp?2018/7/1/8/339326
| Background|| |
Choristomas are benign tissue islands of essentially normal tissue occurring in an abnormal location. They have been reported in the various parts of the head and neck region including oropharynx, hypopharynx, oral cavity, and middle ear., The complex embryology of the head and neck region renders it prone to developmental malformations. These lesions may be composed of different types of tissues whose only similarity is their close association in fetal development and are designated according to the tissues from which they derive (e.g., salivary gland, cartilage, bone, lingual thyroid, glia, gastric mucosa). There is some debate concerning whether choristomas are developmental, neoplastic, or reparative in nature. Most of the cartilaginous choristomas involve the tongue. They were also found in the buccal mucosa and soft palate, but are rarely seen in the neck.,,
We present a case report of cartilaginous choristoma in the neck region of an 8-year-old child.
| Case Report|| |
An 8-year-old girl presented in the department of surgery with a peculiar projection on left lower third of the neck in the subcutaneous plane. The swelling was present anterior and lateral to the left sternocleidomastoid muscle, felt hard in consistency, and measured 2 cm × 1 cm. The overlying skin appeared normal. The swelling was painless, slightly mobile, and did not move on deglutition. There was a history of presence of swelling since early childhood but it progressively increased in size over the period of time. There was no history of inflammation or discharge and other associated anomalies in the head and neck region [Figure 1] and [Figure 2].
|Figure 1: Photomicrograph at 40× showing skin covered soft tissue with underlying deep subcutaneous tissue that shows a well-circumscribed nodule of cartilaginous tissue|
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|Figure 2: Photomicrograph at 100× showing a well-defined nodule of cartilage with unremarkable surrounding subcutaneous soft tissue. There is no surrounding inflammatory reaction in the sections examined|
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A provisional clinical diagnosis of foreign body granuloma was considered and surgical excision was planned. During surgical exploration, a well-circumscribed round to oval-shaped firm to hard tissue mass was found in the subcutaneous plane on the left lower one-third of neck. It has no connection with the deeper tissue. There was no muscle involvement. The lesion was excised and sent for histopathological examination.
Grossly, we received a partly skin-covered round to oval-shaped grey white firm tissue piece measuring 1.5 cm × 1cm. Cut surface was firm, glistening, and grey-white. Microscopic examination showed a circumscribed nodule of mature hyaline cartilage with areas of dense acellular matrix separated from the adjacent subcutaneous tissue and overlying skin by a thin fibrous connective tissue capsule [Figure 1] and [Figure 2]. Neither nuclear atypia nor mitoses were evident. The diagnosis made was cartilaginous choristoma [Figure 2] and [Figure 3].
|Figure 3: Photomicrograph at 400× showing mature cartilaginous tissue with no evidence of mitotic activity and cellular atypia|
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| Discussion|| |
Childhood tumors and tumor-like lesions of the neck are rare and tend to be benign.
They have been reported in the various parts of the head and neck region including oropharynx, hypopharynx, oral cavity, and middle ear., Cartilage, salivary gland, bone, thyroid, brain tissue, and gastric mucosa are identified as the sources of intraoral choristoma. Most of the cartilaginous choristomas involve the tongue. Cartilaginous choristoma was first described by Berry. Cartilaginous choristomas are found in the buccal mucosa and soft palate, but are rarely seen in the neck.,
In the present case, cartilaginous choristoma was present on the left lower third of the neck anterior and lateral to the left sternocleidomastoid muscle in the subcutaneous plane. Cartilaginous choristomas have been reported in a 1-day-old infant to 90-year old age group, with the mean age being 47 years.,
We found one report similar to our case in the literature. Karamanet al. reported Cervical Subcutaneous Cartilaginous Choristoma in an Infant with no associated congenital anomaly. There were many cases that are associated with other congenital anomalies in the literature. There are a lot of cases associated with cervical cartilage choristoma and branchial remnants.,
Kao et al. reported a second case of cartilaginous choristoma of the neck that coexists with a branchial cleft cyst. In another study, two cases of elastic cartilage choristoma in the skin and subcutaneous tissues of the lower midline of the neck were reported by Rachman and Heffernan.
There is some debate concerning whether choristomas are developmental, neoplastic, or reparative in nature.
These lesions may derive from inflammatory stimuli leading to metaplastic osseous or chondroid formation, stimulation of cartilaginous embryonic rests, stimulation of pluripotent cells, development of a mixed tumor with predominance of osseous tissue or cartilage, other neoplasms, and teratomas with preponderance of bone and cartilage.,,
Congenital choristoma should be carefully distinguished from cartilaginous metaplasia, which is characterized by scattered cartilaginous cells of different stage of maturation and diffuse deposits of calcium. Excision of the lesion including perichondrium and surrounding soft tissue is considered curative. Removal of the perichondrium is essential in order to avoid recurrences, because the perichondrium may have the potential to develop new cartilage.
| Conclusion|| |
Although choristoma is a benign lesion, it must be differentiated from true neoplasms and cartilaginous metaplasia. A pathologist must keep in mind such type of lesion because of its rarity in neck. Surgeons should be aware of associated anomalies and there should be complete excision including the perichondrium and surrounding fibrocollagenous tissue to avoid the risk of recurrence.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Chou LS, Hansen LS, Daniels TE. Choristomas of the oral cavity: A review. Oral Surg Oral Med Oral Pathol 1991;72:584-93.
Lee FP. Cartilaginous choristoma of the bony external auditory canal: A study of 36 cases. Otolaryngol Head Neck Surg 2005;133:786-90.
Toida M, Sugiyama T, Kato Y. Cartilaginous choristoma of the tongue. J Oral Maxillofac Surg 2003;61:393-6.
Rachman R, Heffernan AH. Elastic cartilage choristoma of the neck. Plast Reconstr Surg 1979;63:424-5.
Berry J. Fibro-chondroma of tongue. Trans Pathol Soc Lond 1890;41:81-2.
Karaman A, Ceran C, Uğuralp P, Gürses İ, Demircan M. Cervical subcutaneous cartilaginous choristoma in an infant. Ann Med Res 2021;14:33-5.
Braun H, Hofmann T, Wolfgruber H, Anderhuber W, Beham A, Stammberger H. Case report of bilateral cervical chondrocutaneous branchial remnants. Int J Pediatr Otorhinolaryngol 2003;67:89-92.
Atlan G, Egerszegi EP, Brochu P, Caouette-Laberge L, Bortoluzzi P. Cervical chrondrocutaneous branchial remnants. Plast Reconstr Surg 1997;100:32-9.
Kao CH, Wang HW, Yu CP. Cartilaginous choristoma of the neck associated with a branchial cleft cyst. Otolaryngol Head Neck Surg 2001;124:705-6.
Psimopoulou M, Antoniades K. Submental osseous choristoma: A case report. J Oral Maxillofac Surg 1998;56:666-7.
Mosqueda-Taylor A, González-Guevara M, de la Piedra-Garza JM, Díaz-Franco MA, Toscano-García I, Cruz-León A. Cartilaginous choristomas of the tongue: Review of the literature and report of three cases. J Oral Pathol Med 1998;27:283-6.
Weitzner S, Stimson PG, McClendon JL. Cartilaginous choristoma of the tongue. J Oral Maxillofac Surg 1987;45:185-7.
Ozgursoy SK, Umudum H, Beriat GK, Kaya S. A rare case: Cartilaginous choristoma of the soft palate. Indian J Otolaryngol Head Neck Surg 2015;67:444-6.
[Figure 1], [Figure 2], [Figure 3]