• Users Online: 148
  • Home
  • Print this page
  • Email this page
Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contacts Login 


 
 Table of Contents  
CASE REPORT
Year : 2018  |  Volume : 7  |  Issue : 1  |  Page : 8-11

Subcutaneous cartilaginous choristoma of neck: A rare entity


1 Department of Pathology, Kalpana Chawla Government Medical College (KCGMC), Karnal, Haryana, India
2 Tapadia Diagnostic Centre, Hyderabad, Telangana, India

Date of Submission23-Apr-2020
Date of Acceptance11-Oct-2021
Date of Web Publication11-Mar-2022

Correspondence Address:
Sonu Kalyan
Department of Pathology, Kalpana Chawla Government Medical College (KCGMC), Karnal 132001, Haryana.
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijhi.ijhi_1_20

Rights and Permissions
  Abstract 

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 Aug 20];7:8-11. Available from: https://www.ijhi.org/text.asp?2018/7/1/8/339326




  Background Top


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.[1],[2] 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.[1],[3],[4]

We present a case report of cartilaginous choristoma in the neck region of an 8-year-old child.


  Case Report Top


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

Click here to view
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

Click here to view


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

Click here to view



  Discussion Top


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.[1],[2] 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.[4] Cartilaginous choristoma was first described by Berry.[5] Cartilaginous choristomas are found in the buccal mucosa and soft palate, but are rarely seen in the neck.[1],[4]

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.[1],[5]

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.[6] 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.[7],[8]

Kao et al.[9] 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.[4]

There is some debate concerning whether choristomas are developmental, neoplastic, or reparative in nature.[9]

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.[10],[11],[12]

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.[13]


  Conclusion Top


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.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Chou LS, Hansen LS, Daniels TE. Choristomas of the oral cavity: A review. Oral Surg Oral Med Oral Pathol 1991;72:584-93.  Back to cited text no. 1
    
2.
Lee FP. Cartilaginous choristoma of the bony external auditory canal: A study of 36 cases. Otolaryngol Head Neck Surg 2005;133:786-90.  Back to cited text no. 2
    
3.
Toida M, Sugiyama T, Kato Y. Cartilaginous choristoma of the tongue. J Oral Maxillofac Surg 2003;61:393-6.  Back to cited text no. 3
    
4.
Rachman R, Heffernan AH. Elastic cartilage choristoma of the neck. Plast Reconstr Surg 1979;63:424-5.  Back to cited text no. 4
    
5.
Berry J. Fibro-chondroma of tongue. Trans Pathol Soc Lond 1890;41:81-2.  Back to cited text no. 5
    
6.
Karaman A, Ceran C, Uğuralp P, Gürses İ, Demircan M. Cervical subcutaneous cartilaginous choristoma in an infant. Ann Med Res 2021;14:33-5.  Back to cited text no. 6
    
7.
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.  Back to cited text no. 7
    
8.
Atlan G, Egerszegi EP, Brochu P, Caouette-Laberge L, Bortoluzzi P. Cervical chrondrocutaneous branchial remnants. Plast Reconstr Surg 1997;100:32-9.  Back to cited text no. 8
    
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.  Back to cited text no. 9
    
10.
Psimopoulou M, Antoniades K. Submental osseous choristoma: A case report. J Oral Maxillofac Surg 1998;56:666-7.  Back to cited text no. 10
    
11.
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.  Back to cited text no. 11
    
12.
Weitzner S, Stimson PG, McClendon JL. Cartilaginous choristoma of the tongue. J Oral Maxillofac Surg 1987;45:185-7.  Back to cited text no. 12
    
13.
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.  Back to cited text no. 13
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Background
Case Report
Discussion
Conclusion
References
Article Figures

 Article Access Statistics
    Viewed421    
    Printed14    
    Emailed0    
    PDF Downloaded46    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]