Indian Journal of Pathology and Microbiology

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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


Shwetha Kamath, KC Subbarao 
 Department of Pathology, All India Institute of Medical Sciences, New Delhi, India

Correspondence Address:
Shwetha Kamath
1st floor, Teaching Block, Department of Pathology, Ansari Nagar, New Delhi - 110 029
India




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;56:62-63


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 Aug 4 ];56:62-63
Available from: http://www.ijpmonline.org/text.asp?2013/56/1/62/116155


Full Text

 Images in Pathology



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}

 Discussion



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

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