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Osseous metaplasia in an ulcerating tubular adenoma of the colon: a case report
Victoria White, Aidan G Shaw, Gillian M Tierney, Jonathan N Lund, David Semeraro
Journal of Medical Case Reports , 2008, DOI: 10.1186/1752-1947-2-130
Abstract: A 63-year-old woman, who presented with a history of melaena, was found at colonoscopy to have a pedunculated ulcerating polyp. Histological examination demonstrated multiple areas of osseous metaplasia within the polyp stroma.Heterotopic ossification in colonic adenomas is a particularly rare phenomenon, with the majority of cases occurring within malignant lesions. The suggested mechanisms for its aetiology still remain unclear.Heterotopic bone is rarely found in the gastrointestinal tract. The majority of reported cases are associated with malignant lesions [1-6]. There are few reports of osseous metaplasia in benign colonic polyps [7-12]. Various mechanisms have been proposed on the aetiology yet it still remains poorly understood. Here we report a case of osseous metaplasia in a benign ulcerating adenoma and a review of the literature on suggested mechanisms for its aetiology.A 63-year-old woman presented to her general practitioner with a history of intermittent melaena. She was drinking two to three litres of gin per week and was taking ibuprofen for cervical spondylosis. She had a past medical history of alcoholic liver disease and, 6 years previously, a gastroscopy had revealed oesphagitis and duodenitis.A repeat gastroscopy revealed no abnormality. A colonoscopy was performed which revealed a pedunculated polyp in the proximal transverse colon which was subsequently excised, retrieved and sent for histological examination. The patient has subsequently had no further admissions to hospital or episodes of melaena.All sections of the specimen demonstrated an adenomatous polyp with a mostly tubular growth pattern and moderate epithelial dysplasia. Areas of surface ulceration with granulation tissue and slough were also noted (Figure 1). The polyp stroma contained multiple areas of osseous metaplasia; the polyp base demonstrated normal mucosa with complete excision margins (Figure 2).Osseous metaplasia occurs outside the skeletal system in fibrodysplasia ossifi
Traditional serrated adenoma of the sigmoid colon with osseous metaplasia: a case report
Nelson Montalvo, José Beltrán, Ligia Redrobán
Journal of Medical Case Reports , 2012, DOI: 10.1186/1752-1947-6-133
Abstract: We present the case of a 62-year-old Hispanic man with two colonic polypoid lesions, one of which, upon resection and histopathological examination, was found to be a traditional serrated adenoma with a focus of stromal osseous metaplasia.Our patient’s case is the third report of stromal osseous metaplasia in a traditional serrated adenoma of the sigmoid colon.
Osseous metaplasia in renal cell carcinoma: Report of a rare case  [cached]
Murugan Paari,Basu Debdatta,Manikandan R,Dorairajan L
Indian Journal of Pathology and Microbiology , 2008,
Abstract: Focal calcifications are frequently seen in renal masses including renal cell carcinoma (RCC). Osseous metaplasia, on the other hand, is a rare finding in RCC. We report a case of RCC with radiological evidence of speckled calcification that showed osseous metaplasia on histopathological examination. The clinical and pathologic differential diagnosis for this tumor is discussed along with a review of the literature on this unusual phenomenon.
Breast Cancer with Cartilaginous and/or Osseous Metaplasia Diagnosed by Lymph Nodal Metastasis:A Case Report  [PDF]
Tsukuda,Kazunori,Tsuji,Hisashi,Kunitomo,Tadayoshi,Aokage,Keiju
Acta Medica Okayama , 2009,
Abstract: Breast cancer with cartilaginous and/or osseous metaplasia is a type of metaplastic carcinomas and is a rare disease. We report the case of a 49 year-old female who underwent right mastectomy for a large breast tumor. Histological examinations revealed a mixed tumor with both stromal and epithelial elements;the stroma showed poor differentiated spindle-shape and multiform cells with a massive osseous matrix, and atypical epithelial cells, which mainly existed on the surface of the cysts, showed nucleic atypia. The tumor was diagnosed as a malignant phyllodes tumor with osteosarcomatous differentiation;it was not identified as a metaplastic carcinoma because of the lack of proof of a cancerous component. Two years after a mastectomy, swelling of the axillary lymph nodes was found and a biopsy was performed. Histological findings for the lymph node indicated a metastasis of the invasive ductal carcinoma. The primary tumor was re-examined and was considered to be the origin of the lymph nodal metastasis. Lymph nodal metastasis of cancer proved that the primary tumor had cancerous potential, and the pathological diagnosis was altered to a breast cancer with cartilaginous and/or osseous metaplasia.
Osseous metaplasia of the endometrium associated with infertility: a case report and review of the literature
Julio César Rosa-e-Silva, Ionara Diniz Barcelos, Paula Andrea Navarro, Ana Carolina Japur de Sá Rosa-e-Silva, Antonio Alberto Nogueira, Rui Alberto Ferriani
Journal of Medical Case Reports , 2009, DOI: 10.4076/1752-1947-3-7427
Abstract: A 33-year-old Caucasian woman was admitted with a history of secondary infertility and with a regular menstrual cycle. She reported a miscarriage at 12 weeks of gestation 7 years previously and subsequent dilatation and curettage in another medical facility. Vaginal ultrasound was performed and showed an intrauterine structure described as a hyperechogenic image suggesting calcification related to chronic endometritis. Office hysteroscopy revealed a wide endometrial cavity and proliferative endometrium, with a coral-like white plaque 1.5 cm in length on the right horn and posterior wall of the uterus. The lesion was treated by hysteroscopy without complications. Microscopic examination showed endometrial tissue with osseous metaplasia in the stroma. Nine months after the procedure, the patient became pregnant spontaneously.In our patient, hysteroscopy was effective in the diagnosis and treatment of osseous metaplasia of the endometrium associated with infertility.Endometrial ossification is an uncommon disease related to secondary infertility and its etiology and pathogenesis are controversial. More than 80% of reported cases occur after pregnancy [1]. The most widely accepted hypothesis is that ossification represents retained fetal bones following spontaneous, missed, incomplete or therapeutic abortion, suggesting endochondral ossification. It can also be related to transformation of mesenchymal tissue to bone in response to inflammation and the reparative process induced by abortion [2]-[4]. A few cases of endometrial ossification occur after abortion at a very early stage of gestation or without a previous history of pregnancy, suggesting a phenomenon of true heterotopia with metaplasia of mature endometrial stromal cells [5]. Osseous metaplasia is rare and can be misdiagnosed. The gold standard for its diagnosis and treatment is hysteroscopy [6].We present the case of a patient with endometrial ossification associated with secondary infertility after a miscarri
Nasal Polyp With Heterotopic Bone Formation (Osseous Metaplasia): A Case Report
Minoo Shafii,Minoo Saatian,Farid Aliehyai,Ehsan Jangholi
Galen Medical Journal , 2013,
Abstract: Osseous metaplasia is defined by the presence of heterotopic normal bone tissue in a soft tissue. Metaplastic ossification is a rare event in nasal polyps.The authors describe a rare case of bone formation in nasal polyp of a 28-year-old man with chronic right-sided nasal obstruction without history of trauma or allergy symptoms.To our knowledge, this finding has been reported in a few cases in the English medical literature.
Fibrolipoma with Osseous and Cartilaginous Metaplasia of Hoffa’s Fat Pad: A Case Report
Ioannis Gigis,Panagiotis Gigis
Case Reports in Orthopedics , 2012, DOI: 10.1155/2012/547963
Abstract: The most common benign tumors of the mesenchyme are the lipomas. Benign fatty tumors can arise in any location in which fat is present. Fibrolipomas are characterised by fat modules. Most patients affected by such tumors are in the fifth or sixth decade of life. When very close to vital structures such as joints, they may cause functional limitations as well as pain. Osseous and chondroid metaplasia can infrequently manifest after chronic persistence. Given the rarity of this condition, a case of a big fibrolipoma of Hoffa’s fat pad with osseous and cartilaginous metaplasia is reported. A 44-year-old woman presented with an enlarging soft mass on the right knee in the infrapatellar fat pad. After a thorough preoperative clinical and imaging examination, the mass was removed and sent to laboratory where the diagnosis was put. One year after surgery, both local and general condition of the patient were good and no signs of recurrence were found.
Fibrolipoma with Osseous and Cartilaginous Metaplasia of Hoffa’s Fat Pad: A Case Report  [PDF]
Ioannis Gigis,Panagiotis Gigis
Case Reports in Orthopedics , 2012, DOI: 10.1155/2012/547963
Abstract: The most common benign tumors of the mesenchyme are the lipomas. Benign fatty tumors can arise in any location in which fat is present. Fibrolipomas are characterised by fat modules. Most patients affected by such tumors are in the fifth or sixth decade of life. When very close to vital structures such as joints, they may cause functional limitations as well as pain. Osseous and chondroid metaplasia can infrequently manifest after chronic persistence. Given the rarity of this condition, a case of a big fibrolipoma of Hoffa’s fat pad with osseous and cartilaginous metaplasia is reported. A 44-year-old woman presented with an enlarging soft mass on the right knee in the infrapatellar fat pad. After a thorough preoperative clinical and imaging examination, the mass was removed and sent to laboratory where the diagnosis was put. One year after surgery, both local and general condition of the patient were good and no signs of recurrence were found. 1. Introduction The most common [1] benign tumors of the mesenchyme are the lipomas. It is unclear if a soft-tissue lipoma represents a benign neoplasm, a local hyperplasia of fat cells, or a combination of both processes. They may arise in any location in which fat is present, the majority found in the upper half of the body, particularly the trunk and neck, though may also develop in other sites such as the hand [2, 3]. Benign lipomatous tumors have been classified by the World Health Organisation (WHO) in the following categories: classic lipoma, lipoblastoma, lipomatosis, angiolipoma, spindle cell/pleomorphic lipoma, angiomyolipoma, myelolipoma, hibernoma, and atypical lipoma [4]. The infrapatellar Hoffa’s fat pad is an intracapsular extrasynovial structure. The most common tumour or tumour-like abnormalities of the infrapatellar fat pad reported are para-articular chondroma/osteochondroma, focal pigmented villonodular synovitis, synovial lipoma, synovial chondromatosis, synovial haemangioma, ganglia/cysts, and intra-articular malignancy [5]. Some lipomas may exhibit morphological variations. These include fibrolipoma characterized by the presence of prominent bundles of mature fibrous tissue traversing the fatty lobules [6]. It can be noticed that fibrolipomas are extremely rare variants excluded from the above classifications and some times are also called benign mesenchymomas [7]. Most are subcutaneously located [8]. Uncommonly, they can manifest osseous and/or chondroid metaplasia over extended periods of time, causing additional functional problems and pain compression syndromes like the case we present
A spindle cell carcinoma presenting with osseous metaplasia in the gingiva: a case report with immunohistochemical analysis
Naoki Katase, Ryo Tamamura, Mehmet Gunduz, Jun Murakami, Jun-Ichi Asaumi, Goichi Tsukamoto, Akira Sasaki, Hitoshi Nagatsuka
Head & Face Medicine , 2008, DOI: 10.1186/1746-160x-4-28
Abstract: A case of Spindle cell carcinoma with bone-like calcified materials, occurring at the mandibular molar region of 71-years-old Japanese male patient was presented with gross finding, histological findings and MRI image. To identify the characteristics of the bone-like materials, immunohistochemistry were performed.Histologically, the cancer cells were composed of spindle cells and epithelial cells which form nests with prominent keratinization. Histological findings showed typical histology of the SpCC, however, as an uncommon finding, spatters of calcified, bone-like materials were observed in between the cancer cells. Immunohistochemistry revealed that cancer cells were positive for cytokeratins and vimentin to a varying degree and negative for Desmin, S-100, Osteopontin, BMP-2 or BMP-4. These findings implied that the calcified materials were formed by metaplasia of the stromal cells.Bone-like materials formation by osseous and/or cartilaginous metaplasia of the stroma in the carcinoma has been reported. However, the detailed mechanism of these metaplasia and affection on the clinical feature, prognosis and therapies are not well established. In summary, we presented an unique case of SpCC, which has not been described in the literature.Spindle cell carcinoma (SpCC), also known as sarcomatoid carcinoma or pseudosarcoma, of head and neck is a rare neoplasm. SpCC is known as a high malignant variant of squamous cell carcinoma, which is composed of conventional squamous cell carcinoma component, either in-situ and/or invasive and malignant spindle component with sarcomatous appearance. Although it is generally accepted that SpCC is a monoclonal epithelial neoplasm [1-5], and the sarcomatous components are derived from squamous epithelium with divergent mesenchymal differentiation [6], the diagnosis, classification and management of this tumor infrequently may become subject matter deluded of its histological variety in sarcomatous components. These sarcomatous compon
Osseous Metaplasia and Bone Marrow Elements in a Case of Renal Cell Carcinoma  [PDF]
Seyma Ozkanli,Asif Yildirim,Ebru Zemheri,Sarp Korcan Keskin,Erem Kaan Basok
Case Reports in Urology , 2012, DOI: 10.1155/2012/649257
Abstract: Renal cell carcinoma with osseous metaplasia and bone marrow elements is a relatively rare event in these tumors. We discuss pathological differential diagnosis for this tumor with a review of the literature on this unusual case. 1. Introduction Whereas focal calcificationsmay be present in renal cell carcinomas (RCC), metaplastic bone formation is a rare finding in RCC. We report a unique case of a large calcified renal cell carcinoma with massive osseous metaplasia and bone marrow elements. 2. Case Report A 68-year-old man was admitted with left lumbar pain. He was taking medications for coronary artery disease and chronic obstructive pulmonary disease and had no previous surgical procedures. The physical examination did not reveal an abdominal mass. There was no family history of kidney tumors. The complete blood count and differential were normal. The serum creatinine was 0.9?mg/dL (normal: 0.7–1.4?mg/dL) and liver function tests were normal. Abdominal ultrasonograhy and computerized tomography (CT) imaging revealed a round, sharply delineated, and diffusely calcified mass of 90?mm in diameter in the center of the left kidney (Figure 1). A left radical nephrectomy was performed without complications. The postoperative period was uneventful, and the patient was discharged 6 days after operation. Figure 1: (a) Unenhanced CT scan of left kidney, showing areas of calcifications corresponding to metaplastic bone. (b) Coronal imaging of MR reveal a well-defined, solid tumor of left kidney with heterogenous enhancement. Gross examination of the nephrectomy specimen revealed a ?cm renal tumor. It is solitary well-circumscribed mass composed entirely of cysts, separated from adjacent renal parenchyma by a fibrous wall. The cysts containing hemorrhagic fluid are 1-2?cm in size. The cut section showed an extensively ossified mass that contained hemorrhagic, friable tissue with fat (Figure 2(a)). Histopathological examination of the tumor consisted of cysts separated by delicate septa, solid, trabecular sheets, and nesting of polygonal epithelial cells with abundant cytoplasm and prominent cell border. Besides, this tumor contained lamellar bone forming trabeculae intermingled with fat tissue containing myeloid and erythroid cells and varying numbers of foamy histiocytes (Figures 2(b)–2(d)). Thus, this case was reported as renal cell clear cell carcinoma with osseous metaplasia containing bone marrow. Figure 2: (a) Longitudinal section of specimen shows cystic lesions throughout the kidney. (b) Metaplastic bone intermingled with fat tissue containing myeloid
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