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LETTER TO EDITOR Table of Contents   
Year : 2008  |  Volume : 51  |  Issue : 4  |  Page : 568-569
Heterotopic chondroid tissue in the uterus


1 Consultant Pathologist, RML Mehrotra Pathology Pvt. Ltd., Lucknow, India
2 Department of Pediatrics, ELMCH, Lucknow, India
3 GSVM, Kanpur, India

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How to cite this article:
Sethi S, Bhatnagar S, Sethi S. Heterotopic chondroid tissue in the uterus. Indian J Pathol Microbiol 2008;51:568-9

How to cite this URL:
Sethi S, Bhatnagar S, Sethi S. Heterotopic chondroid tissue in the uterus. Indian J Pathol Microbiol [serial online] 2008 [cited 2020 Apr 10];51:568-9. Available from: http://www.ijpmonline.org/text.asp?2008/51/4/568/43768


Sir,

The occurrence of heterotopic cartilage islands in the uterus wall is very rare. [1] We report one such case with a brief review of the literature. Two months before, a 25-year-old female was admitted in severe septicemic shock following the medical termination of pregnancy. An emergency hysterectomy was performed; it revealed an enlarged uterus with hard spicules projecting from the posterior surface of uterus. Similar spicules were also observed on the anterior rectal wall and omentum.

Gross examination revealed an enlarged uterus measuring 9 7 5 cm. The uterine cavity was dilated with a reddish brown friable mass measuring 6 3 3 cm. The posterior uterine wall showed a nodular structure measuring 1 1 cm [Figure 1]. Microscopically, the myometrium was found to be lined by proliferative nonsecretory endometrium with foci of adenomyosis. Histopathological examination of the friable mass showed decidual tissue, blood clots and a number of chorionic villi. The nodular projection on the posterior wall was composed of lobules of hyaline cartilage surrounded by smooth muscle fibers [Figure 2].

Heterotopia is the occurrence of a mature tissue at an abnormal location. [2] Heterotopic uterine cartilage can be of metaplastic origin or it can result from the displacement and retention of fetal tissues in the uterine wall. The multipotent cells present in normal endometrial stroma can show metaplastic transformation into various elements, including the cartilage. [3] Such cartilage metaplasia usually follows trauma secondary to child birth. In fact, Roth and Taylor [4] have described cases of heterotopic uterine cartilage in which they demonstrated the accumulation of acid mucopolysaccharide material similar to cartilaginous matrix in the adjacent endometrial stroma.

Other mechanisms proposed for uterine cartilage formation include hypercalcemia and hyperoestrinism. Dystrophic calcification and cartilage formation may be secondary to chronic inflammation as in pyometra. [5] Another interesting mechanism is iatrogenic implantation of the fetal tissue, including the cartilage, into the uterine wall following dilatation and curettage. [6]

Clinical and histopathological findings in our case reveal that the chondroid tissue in the uterine wall originated from retained fetal tissues which during the course of time migrated into the peritoneal cavity with implants in uterus, rectum and omentum.

Although the entity of heterotopic chondroid tissue is rare, it is a well known feature of uterine neoplasms such as malignant mixed mullerian tumors. Hence, a careful clinical and histopathological examination is required to avoid the misinterpretation of nontumor cartilaginous foci as a component of malignant neoplasm.

 
   References Top

1.Remmele W, Schmidt-Wontroba H, Kaiser E, Piroth H. Heterotopic cartilage tissue in the uterus: Repost of 2 cases. Geburtshilfe Frauenheilkd 1988;48:184-8.  Back to cited text no. 1  [PUBMED]  
2.Madiwale C, Dahanuka S. Hetrotopic uterine cartilage. J Postgrad Med 2001;47:281.  Back to cited text no. 2  [PUBMED]  Medknow Journal
3.Scully RE. Smooth muscle differentiation genital tract disorders. Arch Pathol Lab Med 1981;105:505-7.  Back to cited text no. 3  [PUBMED]  
4.Roth E, Taylor HB. Heterotopic cartilage in the uterus. Obstet Gynecol 1966;27:838-44.  Back to cited text no. 4  [PUBMED]  
5.Ganem KJ, Parsons L, Friedell GH. Endometrial ossification. Am J Obstret Gynecol 1962;83:1592-4.  Back to cited text no. 5    
6.Tyagi SP, Saxena K, Rizvi R, Langley FA. Foetal remnants in the uterus and their relation to other uterine heteropia. Histopathology 1979;3:339-45.  Back to cited text no. 6  [PUBMED]  

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Correspondence Address:
Shipra Sethi
Consultant Pathologist, F-2314, Raja Ji Puram, Lucknow. Uttar Pradesh - 226 017
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.43768

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