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Indian Journal of Pathology and Microbiology
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LETTER TO EDITOR  
Year : 2021  |  Volume : 64  |  Issue : 2  |  Page : 423-424
Histopathological analysis of a rare presentation of glial choristoma of chin


Department of Oral Pathology, Maulana Azad Institute of Dental Sciences, Bahadur Shah Zafar Marg, Delhi, India

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Date of Submission16-Jan-2020
Date of Decision15-Feb-2020
Date of Acceptance14-Aug-2020
Date of Web Publication9-Apr-2021
 

How to cite this article:
Urs AB, Kumar P, Bharti A, Malhotra R. Histopathological analysis of a rare presentation of glial choristoma of chin. Indian J Pathol Microbiol 2021;64:423-4

How to cite this URL:
Urs AB, Kumar P, Bharti A, Malhotra R. Histopathological analysis of a rare presentation of glial choristoma of chin. Indian J Pathol Microbiol [serial online] 2021 [cited 2021 May 16];64:423-4. Available from: https://www.ijpmonline.org/text.asp?2021/64/2/423/313268




Dear Editor,

A 35-year-old female patient presented with the chief complaint of swelling on her chin, since two months. Patient gave history of mild, intermittent pain with no past history of trauma. The swelling was not apparent on inspection. However, on palpation, a firm, mildly tender nodular growth of size approximately 1 × 1 cm was noted. Intraoral findings were not significant. The clinical differential diagnosis included subepidermal cyst, neurofibroma, fibroma, lipoma, or any other benign soft tissue lesion. Fine-needle aspiration cytology suggested a spindle cell lesion, possibly of neurogenic origin.

The excised mass showed varying morphology on Hand E stained tissue microscopically as shown in [Figure 1]. Some areas were hypercellular with numerous spindle-shaped cells having wavy nuclei and ovoid cells having hyperchromatic, vesicular nuclei. Other areas showed moderately collagenous tissue with haphazardly arranged collagen fiber bundles along with homogenization at some places and intervening eosinophilic homogenous material. Diffuse mild lymphocytic infiltration was seen along with abundant adipocytes, skeletal muscle fibers, and neurovascular bundles. Necrosis, mitosis, or cellular atypia were not noted. The routine H and E stained sections of the tissue suggested that the lesion had neural origin which was confirmed by immunohistochemistry. GFAP, NSE, S-100, Vimentin, and Pan-CK markers were applied. GFAP showed strong, diffuse positivity in all the lesional cells confirming that the lesional cells were astrocytes. S-100, NSE, and Pan-CK expression was negative. Vimentin showed only mild focal positivity in the fibrocollagenous tissue. Based on the histomorphological and immunohistochemical findings, a diagnosis of Glial Choristoma was given. Patient is healthy with no recurrence seen after six months follow up.
Figure 1: (a) Hypercellular and hypocellular areas- [H&E × 40] (b) eosinophilic fibrillar background representing fibrillar acidic protein-[H&E ×100] (c) hypercellular areas with round to oval cells exhibiting hyperchromatic nuclei and some cells exhibiting wavy nuclei- [H&E ×100] (d) strong immunoexpression for GFAP- [H&E ×100]

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Glial choristoma (GC) is a rare developmental anomaly usually occurring in the first two years of life. It is composed chiefly of glial cells along with presence or absence of other normal brain tissue elements. GC usually affects midline structures with nasal glioma being the most common. Nearly 30 cases have been reported in the oral region till 2017.[1] Present case is a rare description of GC on the mental region in an adult patient.

GC may result from the sequestration of the encephalocele,[2] neuroglial tissue which protruded from the developing cerebral tissue, and was isolated later because of disturbance in the time of fusion of chondrocranium,[2] or it may be derived from pluripotential cells rests that differentiate into mature glial tissue.[1],[3] Clinically, the lesion may mimic other benign entities like, fibroma, fibromyxoma, neurofibroma, dermoid cyst, teratomas, lymphangiomas, encephaloceles, etc.[2] Literature shows that GC chiefly comprises of mature glial tissue which constitutes astrocytes exhibiting round to oval basophilic nuclei and a background of eosinophilic fibrillar cytoplasm, similar to our case. GC shows strong immunoexpression with GFAP. S- 100, synaptophysin, neurofilament protein and NSE also show positivity, but GFAP is a more specific and reliable marker for mature glial tissue.[4],[5]

Recurrence rate is very low after surgical excision. In conclusion, GC should be considered as a differential diagnosis for facial swelling even in the adult age group.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Corsi A, Veccia N, Riminucci M. Glial choristoma of the tongue. Clinicopathological analysis of a case and pathogenetic insights. Pol J Pathol 2017;68:162-7.  Back to cited text no. 1
    
2.
Mahalik SK, Lyngdoh TS, Menon P, Sodhi KS, Vashishta RK, Kanojia RP, et al. Glial heterotopia of maxilla: A clinical surprise. J Indian Assoc Pediatr Surg 2011;16:58.  Back to cited text no. 2
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3.
Chou L, Hansen LS, Daniels TE. Choristomas of the oral cavity: A review. Oral Surg Oral Med Oral Pathol 1991;72:584-93.  Back to cited text no. 3
    
4.
Sun LS, Sun ZP, Ma XC, Li TJ. Glial choristoma in the oral and maxillofacial region: A clinicopathologic study of 6 cases. Arch Pathol Lab Med 2008;132:984-8.  Back to cited text no. 4
    
5.
Theaker JM, Fletcher CD. Heterotopic glial nodules: A light microscopic and immunohistochemical study. Histopathology 1991;18:255-60.  Back to cited text no. 5
    

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Correspondence Address:
Priya Kumar
Department of Oral Pathology, Maulana Azad Institute of Dental Sciences, Bahadur Shah Zafar Marg, Delhi - 110 002
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJPM.IJPM_13_20

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