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Year : 2013  |  Volume : 56  |  Issue : 1  |  Page : 62-63
Nasopharyngeal glial heterotopia: A rare cause of airway obstruction in an infant


Department of Pathology, All India Institute of Medical Sciences, New Delhi, India

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Date of Web Publication6-Aug-2013
 

How to cite this article:
Kamath S, Subbarao K C. Nasopharyngeal glial heterotopia: A rare cause of airway obstruction in an infant. Indian J Pathol Microbiol 2013;56:62-3

How to cite this URL:
Kamath S, Subbarao K C. Nasopharyngeal glial heterotopia: A rare cause of airway obstruction in an infant. Indian J Pathol Microbiol [serial online] 2013 [cited 2020 Feb 27];56:62-3. Available from: http://www.ijpmonline.org/text.asp?2013/56/1/62/116155



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An 8-month-old male baby presented with noisy breathing and fever for 2 days. His parents also gave a history of frequent upper respiratory tract infections since birth. On anterior rhinoscopy, a fleshy pedunculated mass was seen arising in the left lateral nasopharynx. Magnetic resonance imaging and computed tomography scans did not reveal any intracranial communication. An elective endoscopic excision of the mass was done.

Gross pathologic examination revealed a single well-circumscribed globular mass measuring 3 × 3 × 2 cm with interspersed myxoid areas. Representative sections taken for histopathologic examination revealed polypoidal tissue fragments lined by non-keratinized stratified squamous epithelium [Figure 1]a. Subepithelium showed fine fibrillary stromal nodules of varying sizes with intervening slightly dense eosinophilic stroma [Figure 1]a and b. On careful search, rudimentary ependymal elements [Figure 1]c were seen. Masson's trichrome (MT) stain performed showed the differential character of the stroma in the subepithelial stromal nodules (stained pink, suggesting glial) and intervening areas (stained blue, suggesting collagenous) [Figure 1]d. Immunostaining with glial fibrillary acidic protein (GFAP) was positive in the areas corresponding to those staining pink in MT [Figure 1]e. Rudimentary ependymal elements on immunohistochemistry (IHC) stained positively [Figure 1]f for epithelial membrane antigen (EMA). A diagnosis of nasopharyngeal glial heterotopia was offered.
Figure 1: Hematoxylin and eosin stained secti ons (×40) Showing stratified squamous epithelial lining (a) beneath which are varying sized fi ne fi brillary nodules. (b) with interspersed stroma. (c) Few rudimentary ependymal canals lying in close proximity with glial islands were seen at places. (d) Masson's trichrome (×200) stain depicti ng the differenti al staining character of the nodules (pink) and stroma (blue). Immunostains for (e)GFAP and (f) EMA displaying posti vity in the fibrillary stroma of nodules and in the cells lining the rudimentary ependymal canals(x200)

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   Discussion Top


Heterotopia is a condition where microscopically normal cells or tissues are identified in abnormal locations. [1] The presentation of nasal heterotopias is mostly in infancy; however, case reports identifying the condition in adults also exist. [2],[3] Heterotopic rests are of little significance, but may proliferate to such an extent to cause mass effects. Cases of neuroglial heterotopia have been described in various sites with nose and nasopharynx being the commonest. [3],[4] Glial tissue in the nose can be extranasal (60%), intranasal (30%), and combined (10%). [5] Histologically they comprise glial elements within interspersed fibrous tissue. The presence of glial tissue can be confirmed by IHC for GFAP and by trichrome stains, as highlighted in our case. Neurons are found in about 10% cases only. [4] The differential diagnosis for glial tissue in the intranasal location has been illustrated in [Table 1]. About 5-41% cases of glial heterotopia are found to be associated with anomalies of the central nervous system and other organ systems. [5]

The definite management of these cases is surgical. An early intervention is necessary to prevent permanent facial deformities.

 
   References Top

1.Chawla N, Kishore S, Kudesia S, Kalia RB. Glandular heterotopia on the neck of femur. Indian J Pathol Microbiol 2011;54:189-90.  Back to cited text no. 1
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2.Altissimi G, Ascani S, Falcetti S, Cazzato C, Bravi I. Central nervous system tissue heterotopia of the nose: Case report and review of the literature. Acta Otorhinolaryngol Ital 2009;29:218-21.  Back to cited text no. 2
    
3.Farneti P, Balbi M, Foschini MP. Neuroglial choristoma of the middle ear. Acta Otorhinolaryngol Ital 2007;27:94-7.  Back to cited text no. 3
    
4.Mohanty S, Das K, Correa MA, D'Cruz AJ. Extranasal glial heterotopia: Case report. Neurol India 2003;51:248-9.  Back to cited text no. 4
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5.Krishna LG, Uppoor R, Rao KN, Harish K. Heterotopic central nervous tissue- Nasal glioma: A case report. Indian J Radiol Imaging 2005;15:511-6.  Back to cited text no. 5
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Correspondence Address:
Shwetha Kamath
1st floor, Teaching Block, Department of Pathology, Ansari Nagar, New Delhi - 110 029
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.116155

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