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An Official Publication of the Indian Association of Oral and Maxillofacial Pathologists


 
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Year : 2014  |  Volume : 18  |  Issue : 3  |  Page : 478-480
 

Osteocartilaginous choristoma of buccal mucosa: A rare entity


Department of Oral and Maxillofacial Pathology, Krishnadevaraya College of Dental Sciences and Hospital, Bangalore, Karnataka, India

Date of Submission18-Dec-2014
Date of Acceptance23-Jan-2015
Date of Web Publication13-Feb-2015

Correspondence Address:
Reshma Venugopal
Department of Oral and Maxillofacial Pathology, Krishnadevaraya College of Dental Sciences and Hospital, Bangalore, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-029X.151362

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How to cite this article:
Venugopal R, Bavle RM, Mallar KB, Rakesh. Osteocartilaginous choristoma of buccal mucosa: A rare entity. J Oral Maxillofac Pathol 2014;18:478-80

How to cite this URL:
Venugopal R, Bavle RM, Mallar KB, Rakesh. Osteocartilaginous choristoma of buccal mucosa: A rare entity. J Oral Maxillofac Pathol [serial online] 2014 [cited 2020 Jul 10];18:478-80. Available from: http://www.jomfp.in/text.asp?2014/18/3/478/151362



   Introduction Top


Choristomas or heterotopias are characterized by presence of tumor-like growth of histologically normal appearing mature tissues in an abnormal anatomical location. [1],[2],[3] Commonly observed choristomas of oral cavity are those of bone, cartilage or both and are called as soft tissue osteomas or soft tissue chondromas. [3] In the oral cavity they are commonly seen on posterior tongue (85%) near foramen cecum and about 70% of them have been reported in women. [3] The osseous choristoma of buccal mucosa is most frequently seen in the 5 th decade with an age range of 5-75 years. [4] The histological variants include lipocartilagenous or osteocartilagenous choristoma. [5] This article reports an osteocartilagenous soft tissue choristoma in the buccal mucosa that presented as a swelling in a 48-year-old female patient.


   Case report Top


A 48-year-old female patient reported to the Dental OPD College with a chief complaint of swelling on the left buccal mucosa, which was more evident since past 4 months. Intraoral examination revealed a sessile oval-shaped swelling with well-defined margins, measuring 1.5 × 1 cm on the left buccal mucosa along the line of occlusion in relation to left mandibular second molar. The lesion was provisionally diagnosed as irritational fibroma, excised under local anesthesia and sent for histopathological examination.

The gross specimen received was oval shaped, well-circumscribed, creamish white in color measuring 0.7 × 1 cm in diameter. A radiograph taken of the cut surface of the specimen revealed a well circumscribed lesion with central radiopacity, representing a calcified area in the center.

Microscopic examination of the hematoxylin and eosin stained section showed predominantly parakeratotic stratified squamous surface epithelium. The lesional area was separated from the overlying epithelium by fibrocollagenous zone [Figure 1]. The lesion was well-circumscribed compressing the surrounding fibrocollageous connective tissue creating a pseudocapsule. The central core of the lesion showed woven bone with interconnecting bony trabeculae lined by active osteoblasts and enclosing plump osteocytes. Marrow tissue consisting of blood vessels and connective tissue fibers was found between the trabeculae of bone [Figure 2] and [Figure 3]. The area of the bony trabeculae close to the epithelium showed a lining of osteoclasts encased in Howship's lacunae [Figure 4] and [Figure 5]. It can be suggested that bone formed was under the process of remodeling as there were areas of both bone formation and resorption. The area surrounding the core of woven bone consisted of plump fibroblasts, fibrocytes and loosely arranged collagen fibers resembling immature connective tissue [Figure 6]. Myxoid areas and endothelial lined blood capillaries were also seen. Serial sections of the tissue showed circumscribed chondroid areas enclosing chondocytes separated by fibrous stroma [Figure 7]. With these features a final diagnosis of soft tissue osteocartilagenous or chondrosseous choristoma was given.


   Discussion Top


Chou et al., recognized the following categories of oral choristomas: [6]

  • Salivary gland choristoma
  • Central
  • Gingival
  • Cartilaginous choristoma
  • Lingual thyroid choristoma
  • Glial choristoma
  • Gastric mucosal choristoma.
The other choristomas that occur in oral cavity include tumor-like masses of sebaceous glands (Fordyce spots), [3] hairy polyp that arises from remnants of ectodermal and mesodermal germ layers in the palatine tonsil and nasopharynx consisting of fibrovascular core, skin appendages with hair, adipose tissue and muscle tissue. [2] Lymph node may contain salivary gland, thyroid follicles, squamous or Mullerian epithelium and nevus cell rests. [7]

According to Chen et al., about 13 cases of buccal osseous choristoma have been reported. [4] Chou et al., have reported 20 cases of cartilaginous choristoma of which two occurred in buccal mucosa. [6]


   Differential diagnoses Top


  • Peripheral ossifying fibroma (POF): Histologically, POF is a reactive lesion and presents with inflammatory cells, which was not seen in our case. POF does not present with marrow tissue enclosed within the trabeculae of bone. These features were observed in our case pointing more towards a choristoma [8]
  • Heterotropic ossification/Myositis ossificans: Heterotopic ossification is a reactive bone-producing soft-tissue proliferation of muscle or other connective tissues associated with trauma. Ossification occurring in subcutaneous or submucosal fat is called as panniculitis ossificans or fasciitis ossificans. The lesion shows poorly organized fibroblastic proliferation with considerable mitotic activity, but cytologic atypia is not seen. The fibroblasts also form fascicles towards the periphery with an admixture of osteoblasts and reactive bone formation. Myositis ossificans is typically associated with muscle bundles. Alternating areas of calcification and muscle tissue is seen histologically. These features could not be appreciated even though the lesion was close to buccinator muscle [8]
  • Dystrophic calcification found in old thrombi or hematoma or keratin-filled soft tissue cysts: Dystrophic calcifications are not organized and present as irregular calcifications. The present case showed well-organized trabeculae of woven bone and hence could be easily excluded [8]
  • Extraskeletal osteochondroma: These show a characteristic pattern of arrangement. They present with peripheral capsule surrounding lobules of mature cartilage which show central areas of mature ossification. The pattern of arrangement of cartilage and bone were not in favor of a diagnosis of extraskeletal osteocondroma in the present case [9]
  • Cutright tumor: Presence of discrete cartilaginous islands within the soft tissue of flabby anterior maxillary ridge is known as Cutright tumor. This represents hyperplasia of existing embryonic cartilaginous rests due to inflammatory factors induced by ill-fitting dentures. They differ from soft tissue choristomas in that they arise directly from the bone beneath the lightly bound mandibular alveolar ridge. [10]

   Conclusion Top


Extraskeletal proliferation of bone and cartilage in oral and maxillofacial soft tissues probably reflects the multipotential nature of primitive mesenchymal cells throughout the region. Osseous and chondroid choristomas are commonly found in the tongue. Here we present a rare case of chondrosseous choristoma in the buccal mucosa.

 
   References Top

1.
Barnes L. Surgical Pathology of Head and Neck. 3 rd ed. Vol. 1. New York: Informa Health; 2009.  Back to cited text no. 1
    
2.
Cardesa A, Slootweg PJ. Pathology of Head and Neck. 1 st ed. Berlin: Heidelberg Springer; 2006.  Back to cited text no. 2
    
3.
Neville BW, Damm DD, Allen CM, Bouquot JE. Oral and Maxillofacial Pathology. 3 rd ed. Philadelphia: W.B. Saunders Company; 2009.  Back to cited text no. 3
    
4.
Chen YK, Shen YH, Lin YJ, Li YT, Tsai KB, Lin LM. Buccal osseous choristoma in a 5-year-old boy. Oral Oncol 2005;41:198-201.  Back to cited text no. 4
    
5.
Perrotti V, Fioroni M, Rubini C, Piattelli A. Cartilaginous choristoma of the gingiva. Oral Oncol 2005;41:216-8.  Back to cited text no. 5
    
6.
Cawson RA, Binnie WH, Speight P, Barrett AW, Wright JM, Thorogood P. Lucas's Pathology of Tumors of the Oral Tissues. 5 th ed. London: Churchill Livingstone; 1998.  Back to cited text no. 6
    
7.
Bansal R. Choristomas of the oral cavity. Indian J Pathol Microbiol 2010;53:373.  Back to cited text no. 7
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8.
Gnepp DR. Diagnostic Surgical Pathology of the Head and Neck. 2 nd ed. Philadelphia: Saunders Elsevier; 2009.  Back to cited text no. 8
    
9.
Singh R, Sharma AK, Magu NK, Kaur KP, Sen R, Magu S. Extraskeletal osteochondroma in the nape of the neck: A case report. J Orthop Surg 2006;14:192-5.  Back to cited text no. 9
    
10.
Daley TD, Damm DD, Wysocki GP, Weir JC. Atypical cartilage in reactive osteocartilagenous metaplasia of the traumatized edentulous mandibular ridge. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1997;83:26-9.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]



 

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   Introduction
   Case report
   Discussion
    Differential dia...
   Conclusion
    References
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