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 Table of Contents  
CASE REPORT
Year : 2019  |  Volume : 7  |  Issue : 1  |  Page : 78-80

Osteocartilaginous choristoma of tonsil: A report of two cases


Department of Pathology, Kempegowda Institute of Medical Sciences, Bengaluru, Karnataka, India

Date of Web Publication12-Jun-2019

Correspondence Address:
Dr. Savithri Ravindra
Department of Pathology, Kempegowda Institute of Medical Sciences, Bengaluru, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/amhs.amhs_33_19

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  Abstract 


Osteocartilaginous choristoma of the tonsil is a rare entity with very few cases reported in the literature. We report two cases presenting with tonsillar enlargement. Histopathological examination revealed the presence of mature cartilage and bone within the tonsillar tissue.

Keywords: Cartilaginous choristoma, osteocartilaginous choristoma, tonsil


How to cite this article:
Ravindra S, Mannem C, Rangaswamy R, Agrawal A. Osteocartilaginous choristoma of tonsil: A report of two cases. Arch Med Health Sci 2019;7:78-80

How to cite this URL:
Ravindra S, Mannem C, Rangaswamy R, Agrawal A. Osteocartilaginous choristoma of tonsil: A report of two cases. Arch Med Health Sci [serial online] 2019 [cited 2019 Oct 15];7:78-80. Available from: http://www.amhsjournal.org/text.asp?2019/7/1/78/260010




  Introduction Top


Choristoma is a microscopic aggregate of normal cell or tissues occurring at an abnormal location.[1] Cartilaginous choristoma – the presence of mature cartilage in the tonsil – is a rare entity, whereas the presence of cartilage and bone is still rarer with very few reported cases. We report two cases of osteocartilaginous choristoma of both the tonsils.


  Case Reports Top


Case 1

A 20-year-old female patient presented to the ENT outpatient department with difficulty in swallowing and throat pain for 1 month. There was no associated history of fever. There was a bilateral Grade1 tonsillar enlargement with keratotic folliculitis. However, no congestion was seen. All the other laboratory investigations were within the normal limits.

Case 2

A 23-year-old male patient presented with throat pain of 20-day duration. There was a bilateral Grade1 tonsillar enlargement with keratotic folliculitis. Routine investigations were within the normal limits.

Clinical diagnosis of keratotic folliculitis was made in both the cases. Both the patients underwent bilateral tonsillectomy, and the specimens were sent for histopathological examination.

In both the cases, tonsillectomy specimens were measured about 2.5 cm × 1.5 cm–2 cm × 1 cm. Cut sections showed focal gray-white/glistening areas [Figure 1], which were gritty to cut.
Figure 1: Cut section of tonsils showing gray-white/glistening areas

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Microscopy showed structure of the tonsil lined by stratified squamous epithelium invaginating at places to form crypts filled with keratin plugs. There was hyperplasia of lymphoid follicles. Furthermore, large islands of mature hyaline cartilage and focal osseous metaplasia were seen [Figure 2] and [Figure 3]. Periphery showed collections of minor salivary glands and skeletal muscle bundles.
Figure 2: Microscopy showing a structure of tonsil with islands of cartilage (H and E, ×100)

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Figure 3: Microscopy showing bone and cartilage in tonsil (H and E, ×400)

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A final diagnosis of osteocartilaginous choristoma of the tonsil was made in both the cases.


  Discussion Top


Choristoma is a microscopic aggregate of normal cell or tissues occurring at abnormal location. Choristoma of the head and neck is rare and reported in the pharynx, hypopharynx, oral cavity, and middle ear.[1] Oral cavity is the site of predilection with maximum cases reported in the tongue.[2] Cartilaginous choristoma was first described by Berry in 1890.[3] A study by Bhargava et al.[4] of cartilaginous choristoma showed 7 cases of 20 involving the tongue, followed by buccal mucosa and soft palate.

Bone, glial tissue, neural tissue, salivary gland, respiratory tissue, sebaceous gland, thyroid, fat cells, and gastric mucosa are other tissues occurring in the oral cavity as choristoma.[1],[4],[5],[6] In the oral cavity, most commonly osseous and cartilaginous choristoma is seen involving the tongue.

Majeed and Farah found that the dorsal aspect of the tongue was more commonly associated with cartilaginous choristoma. However, cartilaginous choristoma seen in the tonsil is a rare entity.[5]

Choristoma word is used for tumor-like mass, whereas heterotopia implies displaced tissue without necessarily being swelling or neoplasm.[1],[4] Mature cartilage is not a normal constituent of nasopharyngeal epithelium which we found in this case along with tonsillar hypertrophy; hence, by definition, our case becomes a choristoma.

The incidence of cartilaginous choristoma is about 3% in tonsillitis specimens.[5]

Presenting age of patients ranges from 10 to 80 years with a mean age of 47 years.[1] It is seen as a painless, firm nodule in young adults, most commonly females, and presents as a recurrent tonsillitis with tonsillar enlargement.[2]

Various theories are given for the origin of cartilaginous choristoma which can be neoplastic, developmental, or reparative in nature. It can be a developmental anomaly of the second pharyngeal pouch. The pharyngeal arches have a core of the mesoderm and are covered by the outer ectoderm and inner endoderm of the developing foregut. Endoderm lines the pharyngeal pouches, and palatine tonsil develops laterally in relation to the second pharyngeal pouch, so any anomaly can cause the formation of abnormal mesenchymal tissue in the tonsil.[5]

Other theory tells that extraskeletal cartilage proliferation is due to the pluripotency of primitive mesenchymal cells. This osteogenic stimulation can occur by trauma, irritation, and physical or chemical changes by chronic inflammation.[7]

Simple surgical excision is indicated as these patients may not respond to medical management as observed by Shoba et al. with their patient.[8]


  Conclusion Top


Osteocartilaginous choristoma is a rare entity and follows a benign course but requires surgical excision. Routine histopathological examination helps to detect these cases.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Dhakal R, Makaju R. Cartilaginous choristoma of tonsil. J Clin Exp Pathol 2015;5:245.  Back to cited text no. 1
    
2.
Bedir R, Erdivanli ÖC, Erdivanli B, Sehitoglu İ, Dursun E. Cartilaginous choristoma of the tonsil: Three case reports. Iran J Otorhinolaryngol 2015;27:325-8.  Back to cited text no. 2
    
3.
Berry J. Fibro-chondroma of tongue. Trans Pathol Soc London 1890;41:81-2.  Back to cited text no. 3
    
4.
Bhargava D, Raman R, Khalfan Al Abri R, Bushnurmath B. Heterotopia of the tonsil. J Laryngol Otol 1996;110:611-2.  Back to cited text no. 4
    
5.
Majeed AA, Farah CS. Mixed choriostoma on the anterior dorsal tongue: A new case and review of literature. Oral Surg 2011;4:26-9.  Back to cited text no. 5
    
6.
Kannar V, Prabhakar K, Shalini S. Cartilaginous choristoma of tonsil: A hidden clinical entity. J Oral Maxillofac Pathol 2013;17:292-3.  Back to cited text no. 6
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7.
Lindholm TS, Hackman R, Lindholm RV. Histodynamics of experimental heterotopic osteogenesis by transitional epithelium. Acta Chir Scand 1973;139:617-23.  Back to cited text no. 7
    
8.
Shoba K, Harikumar, Srinivasan K, Deepak Raj K. Osteo-cartilagenous choristoma of tonsil. J Evol Med Dent Sci 2014;3:8916-7.  Back to cited text no. 8
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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