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Year : 2011  |  Volume : 54  |  Issue : 1  |  Page : 189-190
Glandular heterotopia on the neck of femur


1 Department of Pathology, Shri Guru Ram Rai Institute of Medical and Health Sciences, Patel Nagar, Dehradun, India
2 Department of Orthopedics, Shri Guru Ram Rai Institute of Medical and Health Sciences, Patel Nagar, Dehradun, India

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Date of Web Publication7-Mar-2011
 

How to cite this article:
Chawla N, Kishore S, Kudesia S, Kalia R B. Glandular heterotopia on the neck of femur. Indian J Pathol Microbiol 2011;54:189-90

How to cite this URL:
Chawla N, Kishore S, Kudesia S, Kalia R B. Glandular heterotopia on the neck of femur. Indian J Pathol Microbiol [serial online] 2011 [cited 2019 Dec 10];54:189-90. Available from: http://www.ijpmonline.org/text.asp?2011/54/1/189/77401


The term heterotopia is derived from the Greek word heteros meaning different and topos meaning localization. Heterotopia refers to an abnormal localization of a well-differentiated tissue. Heterotopia can occur in any part of the body but is most common in the gastrointestinal tract. [1] Most of the heterotopias are explained by embryologic or metaplastic hypothesis. [1],[2] In the present case, we report glandular heterotopia at a site, that is, the neck of femur, which cannot be explained for its origin.

A 70-year-old female presented to the orthopedics department with a nonhealing fracture in the neck of the left femur [Figure 1] following trauma due to fall in the bathroom 4 months earlier. The patient was taken to the operation theatre for curetting edges of the bone. On exposing the femur, there was a small globular soft tissue seen adherent to the lateral surface of femur 2 cm above the fracture site. The tissue was excised along with bony fragments.
Figure 1: X-ray photograph showing a fracture on the neck of left femur (arrow).

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Gross examination of the excised tissue showed gray yellow soft tissue bits measuring 2 × 2 × 1 cm along with bony bits, which were curetted from the edges of the fractured bone. Histologic examination of the tissue showed bone with surrounding fibrocollagenous tissue displaying mucous and serous glandular acini along with large and small ducts lined by pseudostratified columnar epithelium on the inside and myoepithelial cells on the outside [Figure 2] and [Figure 3]. There was no evidence of dysplasia or malignancy in the ducts or the glands. Mucin histochemistry showed positivity with Periodic acid-Schiff (PAS) and Alcian blue [Figure 4]. Mucicarmine stain was found to be negative. A diagnosis of glandular heterotopia was given.
Figure 2: Photomicrograph showing bony spicule with surrounding stroma showing seromucinous glands (arrows) and ducts (arrowheads) (H and E, ×100). The inset shows seromucinous glands (H and E, ×400)

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Figure 3: Photomicrograph showing a large duct lined by pseudostratified columnar epithelium (H and E, ×100) with inset showing myoepithelial cells (arrows) (H and E, ×1000).

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Figure 4: Photomicrograph showing glands positive for PAS (left side) and Alcian blue (right side) (×400)

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Heterotopia is defined as a normal tissue, which is abnormally localized. Most of the heterotopias are of epithelial origin, while some of them arise from the mesenchymal tissue. Most common types of epithelial heterotopia include breast, gastric, pancreatic, salivary, and prostatic tissue in various locations. [3],[4] Most frequently observed mesenchymal heterotopia include bone and cartilaginous heterotopias. [5] A majority of them can be explained either by metaplastic or embryologic hypothesis. The latter is better accepted, which explains that most of the heterotopias arise from totipotent cells present in the line of development of the tissue. This is one of the reasons why heterotopias are seen in young individuals. The others are explained by metaplastic hypothesis in which an epithelium is converted to another type as is seen in endometriosis. [2] Most of the heterotopias remain asymptomatic throughout life and cause significant clinical manifestations only in rare cases. The major clinical implication of heterotopia is due to its potential risk for malignant transformation. [1],[2] In our case, the heterotopia presented in a 70-year-old female patient contrary to common age of occurrence, was located on the lateral surface of the femur adherent to the periosteum and was an incidental finding with no clinical symptoms or malignant transformation noted. Histopathologic examination showed glandular tissue composed of serous and mucinous acini, few small and large ducts were also seen lined by pseudostratified columnar epithelium on the inside and myoepithelial cells on the outside. Mucin histochemistry showed positivity for PAS and Alcian blue, whereas it was negative for mucicarmine. The tissues that have similar histologic features are pancreas, salivary gland, and breast. To the best of our knowledge, no case of an epithelial heterotopia occurring on the neck of the femur has previously been reported in the literature. The occurrence of this heterotopia could not be explained either by embryologic or metaplastic hypothesis.

In pancreatic heterotopia, serous acini and ducts are seen, whereas mucinous glands are absent. Breast heterotopia shows serous acini and ducts, however, the ducts are not lined by pseudostratified columnar epithelium. Immunohistochemistry was not performed due to the inability of these studies in localization of parent tissue in the heterotopia. Since the tissue of origin could not be positively identified in our case, a histopathologic diagnosis of glandular heterotopia most probably arising from the salivary tissue was offered.

 
   References Top

1.Pradines P, Brauner M, Legrand I. Heterotopic gastric mucosa in gall bladder. Am J Radiol 1989;152:432.  Back to cited text no. 1
    
2.Egyedi L. Case of polyps of the gall bladder containing an aberrant gastric mucous membrane. Gyogyaszat 1934;74:596-9.  Back to cited text no. 2
    
3.Lessel AM, Martin DF. Heterotopic gastric mucosa in duodenum. J Clin Pathol 1982;35:591-5.  Back to cited text no. 3
    
4.Castro Barbosa JJ, Dockerty MB, Waugh JM. Pancreatic heterotopias. Surg Gynecol Obstet 1946;82:527-42.  Back to cited text no. 4
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5.Wilson JD, Montague CJ, Salcuni P, Bordi C, Rosai J. Heterotopic mesenteric ossification- a report of 5 cases. Am J Surg Pathol 1999;23:1464-70.  Back to cited text no. 5
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Correspondence Address:
Nitin Chawla
124/7, Rajender Nagar, Street-4, Lane-8, Dehradun, Uttarakhand
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.77401

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  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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