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 Table of Contents  
CASE REPORT
Year : 2018  |  Volume : 2  |  Issue : 2  |  Page : 21-22

Tonsillar cartilaginous choristoma: A rare entity


1 Department of Pathology, Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, Karnataka, India
2 Department of Anaesthesia and Critical Care Medicine, Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, Karnataka, India

Date of Web Publication24-Apr-2019

Correspondence Address:
Dr. Jay Prakash
Department of Anaesthesia and Critical Care Medicine, Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aiao.aiao_22_18

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  Abstract 


Choristoma is a tumour like mass which is an island of normal cells or tissues in abnormal locations due to defects during embryological development. Choristoma is most frequently seen in the tongue and presence of choristoma in the tonsil is extremely rare. On histopathological examination, an island of mature cartilage with normal appearing chondrocytes amidst the lymphoid follicles were seen. We present here a case of cartilaginous choristoma with the complaint of chronic tonsillitis.

Keywords: Cartilage, choristoma, tonsil


How to cite this article:
Saran K, Vinayakamurthy S, Vidya K, Prakash J. Tonsillar cartilaginous choristoma: A rare entity. Ann Indian Acad Otorhinolaryngol Head Neck Surg 2018;2:21-2

How to cite this URL:
Saran K, Vinayakamurthy S, Vidya K, Prakash J. Tonsillar cartilaginous choristoma: A rare entity. Ann Indian Acad Otorhinolaryngol Head Neck Surg [serial online] 2018 [cited 2019 May 24];2:21-2. Available from: http://www.aiaohns.in/text.asp?2018/2/2/21/256993




  Introduction Top


Choristoma is a tumor-like mass which is an island of normal cells or tissues in abnormal locations due to defects during embryological development.[1] It is a developmental anomaly of the second pharyngeal arch which follows a benign course and could be the cause of recurrent tonsillitis. Previously, it has been reported in the oral cavity, middle ear, pharynx, and hypopharynx.[1],[2] Choristoma is most frequently seen in the tongue, and the presence of choristoma in the tonsil is extremely rare and few cases have been reported so far.

Here, we present a case of cartilaginous choristoma with a complaint of chronic tonsillitis.


  Case Report Top


A 38-year-old female presented to the otorhinolaryngology outpatient department of our tertiary care institute with a complaint of recurrent episode of sore throat, pain, and fever. On oral examination, bilateral keratosis was present. Clinically, it was diagnosed as chronic tonsillitis. The patient was admitted, and tonsillectomy was performed. The specimen was sent for histopathological examination. On gross examination, two gray–white tissue bits were received. The largest bit measured 2.5 cm × 1.2 cm and the smallest bit measured 1.5 cm in diameter [Figure 1]. The cut sections of both the tissue bits showed gray–white to gray–brown areas with few glistening areas. On microscopy, the section showed lymphoid tissue, focally lined by stratified squamous epithelium. The subepithelium displayed numerous follicles with well-developed germinal centers [Figure 2]. Many lobules of mature cartilage with normal-appearing chondrocytes amidst the lymphoid follicles were seen [Figure 3].
Figure 1: Gross appearance of tonsil showing gray–white to gray–brown areas with few glistening areas

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Figure 2: Histopathological examination showing lymphoid tissue, focally lined by stratified squamous epithelium with well-developed germinal centers

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Figure 3: Histopathology showing mature cartilage with normal-appearing chondrocytes amidst the lymphoid follicles

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  Discussion Top


Berry in 1890 first described the cartilaginous choristoma.[3] It may be diagnosed at any age from birth up until old age. During embryogenesis, this heterotopic congenital lesion results from normal tissue migrating to or remaining in an abnormal location. On the dorsum of the tongue, posterior to the foramen cecum osseous choristoma presents as a pedunculated, painless, hard lump and most often presents as a brown–black-pigmented macule of variable sizes (3–11 mm).[4] In the auditory canal, choristoma presents as a mass causing hearing loss and may predispose to infection. Oral choristoma may also occur on the gingiva or buccal mucosa.[5] Hence, cartilaginous choristoma is frequently seen in the oral cavity, i.e., tongue, buccal mucosa, and soft palate as a painless firm nodule; however, it is rarely seen in the tonsil. Cartilaginous choristoma usually found in the soft tissue beneath the dentures which are ill-fitting should be differentiated from the cartilaginous metaplasia.[6] Cartilaginous choristoma follows a benign course and can occur elsewhere in the body, and simple excision with perichondrium is necessary because of recurrence.[7] In this case, calcification was not seen, and the mature cartilage was present which is not a normal constituent of the tonsil.


  Conclusion Top


Choristoma in tonsil remains a rare entity and comprises a very small minority of all nasopharyngeal lesions. Therefore, to avoid false diagnosis, pathologists should be aware of the properties of such lesions.

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.
Chou LS, 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. 1
    
2.
Lee FP. Cartilaginous choristoma of the bony external auditory canal: A study of 36 cases. Otolaryngol Head Neck Surg 2005;133:786-90.  Back to cited text no. 2
    
3.
Bhargava D, Raman R, Khalfan Al Abri R, Bushnurmath B. Heterotopia of the tonsil. J Laryngol Otol 1996;110:611-2.  Back to cited text no. 3
    
4.
Curto-Barredo L, Vicente A, Rovira C, García-Diez E, Pujol RM, González-Enseñat MA. Epidermal choristoma of the tongue mimicking a congenital melanotic macule. Pediatr Dermatol 2015;32:536-8.  Back to cited text no. 4
    
5.
Batra R. The pathogenesis of oral choristomas. J Oral Maxillofac Surg Med Pathol 2012;24:110-4.  Back to cited text no. 5
    
6.
Cutright DE. Osseous and chondromatous metaplasia caused by dentures. Oral Surg Oral Med Oral Pathol 1972;34:625-33.  Back to cited text no. 6
    
7.
Ashraf MJ, Azarpira N, Gandomi M. Cartilaginous choristoma in palatine tonsil. Iran Red Crescent Med J 2010;12:65-7.  Back to cited text no. 7
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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