A case of osseous metaplasia in a gastric hyperplastic polyp: An unexpected finding in a common polyp

Abstract Introduction/Objective Foveolar hyperplastic polyp is a common gastric polyp characterized by foveolar hyperplasia with erosion, acute and chronic inflammation, granulation tissue formation, and smooth muscle strands extending from the muscularis mucosae. Although foveolar hyperplastic polyps may rarely contain foci of dysplasia or invasive carcinoma, osseous metaplasia/heterotopic bone formation in foveolar hyperplastic polyps of the stomach is extremely rare with a few case reports. Methods/Case Report A 63-year-old female with a history of hypertension, sick sinus syndrome, and Hashimoto’s thyroiditis was referred to our facility for evaluation of a mass in segment eight of the liver. The liver biopsy showed a moderately differentiated adenocarcinoma, most consistent with intrahepatic cholangiocarcinoma. A screening gastrointestinal endoscopy revealed a 7-mm sessile polyp in the antrum. The polyp was removed with a cold snare. No other abnormalities were identified in the stomach. Sections of the polyp showed fragments of antral-type gastric mucosa with foveolar hyperplasia, erosion, acute and chronic inflammation, and focal granulation tissue formation. In addition, multiple foci of woven bone formation without bone marrow surrounding dilated gastric foveolae were identified. No Helicobacter infection, intestinal metaplasia, dysplasia or malignancy was identified histologically. Osseous metaplasia/heterotopic bone formation is a well-known finding reported in various neoplastic and non- neoplastic conditions. However, osseous metaplasia in foveolar hyperplastic polyps of the stomach is extremely rare. There have been only four previous case reports published in English language. Our current case shows clinicopathologic features similar to those of the previous case reports including the findings of small-sized polyp found incidentally in middle-aged patients with no clinical history of hypercalcemia or any other abnormalities causing heterotopic bone formation. Results (if a Case Study enter NA) N/A Conclusion Although the pathogenesis of osseous metaplasia in a gastric hyperplastic polyp remains unknown, the finding of osseous metaplasia in a gastric hyperplastic polyp is very intriguing.

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Nasal Polyp With Heterotopic Bone Formation (Osseous Metaplasia): A Case Report

Galen Medical Journal ◽

10.31661/gmj.v2i2.58 ◽

2013 ◽

Vol 2 (2) ◽

pp. 80-82

Author(s):

Minoo Shafii ◽

Minoo Saatian ◽

Farid Aliehyai ◽

Ehsan Jangholi ◽

Reza Najibpour ◽

...

Keyword(s):

Bone Formation ◽

Nasal Polyp ◽

Rare Event ◽

Osseous Metaplasia ◽

Heterotopic Bone ◽

Heterotopic Bone Formation ◽

English Medical Literature ◽

History Of ◽

Normal Bone Tissue ◽

Metaplastic Ossification

Osseous metaplasia is defined by the presence of heterotopic normal bone tissue in a soft tissue. Metaplastic ossification is a rare event in nasal polyps. The authors describe a rare case of bone formation in nasal polyp of a 28-year-old man with chronic right-sided nasal obstruction without history of trauma or allergy symptoms. To our knowledge, this finding has been reported in a few cases in the English medical literature.

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Bone morphogenetic protein-induced heterotopic bone formation: What have we learned from the history of a half century?

Japanese Dental Science Review ◽

10.1016/j.jdsr.2014.09.004 ◽

2015 ◽

Vol 51 (2) ◽

pp. 42-50 ◽

Cited By ~ 7

Author(s):

Takenobu Katagiri ◽

Kenji Osawa ◽

Sho Tsukamoto ◽

Mai Fujimoto ◽

Arei Miyamoto ◽

...

Keyword(s):

Bone Formation ◽

Bone Morphogenetic Protein ◽

Heterotopic Bone ◽

Heterotopic Bone Formation ◽

Half Century ◽

Morphogenetic Protein ◽

History Of

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Clear cell renal cell carcinoma with heterotopic bone formation: A case report and literature review

Case Reports in Clinical Pathology ◽

10.5430/crcp.v5n2p16 ◽

2019 ◽

Vol 5 (2) ◽

pp. 16

Author(s):

Estelle Oertling ◽

Cacey Peters ◽

Robert Wood ◽

Jonathan Silberstein ◽

Andrew B. Sholl ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Bone Formation ◽

Cell Carcinoma ◽

Renal Cell ◽

Clear Cell ◽

Bone Morphogenetic Protein 2 ◽

Osseous Metaplasia ◽

Heterotopic Bone ◽

Heterotopic Bone Formation ◽

Tissue Ischemia

The phenomenon of heterotopic bone formation (osseous metaplasia) is defined as an abnormal ossification of non-skeletal tissues and does represent a rare occurrence in the renal cell carcinoma setting. We describe a case of a 40-year old man with bilateral renal cell carcinomas of the histological clear cell subtype, with the right-sided renal cell carcinoma demonstrating heterotopic bone formation, as well as the presence of intratumoral adipose tissue. The etiology of bone formation in a renal cell carcinoma is unclear, but possible explanations include a response to tissue ischemia and the expression of Bone Morphogenetic Protein 2. The detection of these rare morphologic variations is of paramount importance, not to be mistaken as sarcomatoid transformation and renal sinus fat invasion, which would advance the pathologic tumor stage and aggressiveness of the disease.

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Osseous Metaplasia in Mucinous Tubular and Spindle Cell Carcinoma of the Kidney: A Case of Massive, Bilateral Tumors

Case Reports in Urology ◽

10.1155/2015/465450 ◽

2015 ◽

Vol 2015 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Aeen M. Asghar ◽

Matthew A. Uhlman ◽

Laila Dahmoush ◽

Sundeep Deorah

Keyword(s):

Bone Formation ◽

Cell Carcinoma ◽

Renal Mass ◽

Spindle Cell ◽

Spindle Cell Carcinoma ◽

Osseous Metaplasia ◽

Heterotopic Bone ◽

Heterotopic Bone Formation ◽

Limited Information ◽

Histologic Subtypes

Renal cell carcinoma (RCC) is the most common kidney malignancy, with many histologic subtypes. One of the rare forms of RCC is mucinous tubular and spindle cell carcinoma (MTSCC), which is newly described with limited information on clinical picture and outcome. Heterotopic bone formation (osseous metaplasia) is a rare finding within any renal mass. Here we report a case of a massive, bilateral MTSCC with histologic findings of heterotopic bone formation, which has not been described before.

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External Beam Radiation Helps Prevent Heterotopic Bone Formation in Patients With a History of Heterotopic Ossification

The Journal of Arthroplasty ◽

10.1016/j.arth.2005.08.014 ◽

2006 ◽

Vol 21 (5) ◽

pp. 731-736 ◽

Cited By ~ 23

Author(s):

Samuel T. Chao ◽

Shih-Yuan Lee ◽

Lester S. Borden ◽

Michael J. Joyce ◽

Viktor E. Krebs ◽

...

Keyword(s):

Bone Formation ◽

Heterotopic Ossification ◽

External Beam Radiation ◽

Heterotopic Bone ◽

External Beam ◽

Heterotopic Bone Formation ◽

Beam Radiation ◽

History Of

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Heterotopic Bone Formation (Osseous Metaplasia) in Nasal Polyps

Journal of Craniofacial Surgery ◽

10.1097/scs.0b013e3182420592 ◽

2012 ◽

Vol 23 (2) ◽

pp. 620 ◽

Cited By ~ 5

Author(s):

Mehmet Yilmaz ◽

Metin Ibrahimov ◽

Erkan Kilic ◽

Ozcan Ozturk

Keyword(s):

Bone Formation ◽

Nasal Polyps ◽

Osseous Metaplasia ◽

Heterotopic Bone ◽

Heterotopic Bone Formation

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Comment to: The utility of ultrasound examination in cubital tunnel syndrome caused by heterotopic ossification

Medical Ultrasonography ◽

10.11152/mu-3458 ◽

2021 ◽

Vol 23 (4) ◽

pp. 496

Author(s):

Yei Heum Park ◽

Daeseok Oh

Keyword(s):

Bone Formation ◽

Ulnar Nerve ◽

Soft Tissues ◽

Plain Radiography ◽

Cubital Tunnel ◽

Heterotopic Bone ◽

Heterotopic Bone Formation ◽

Medial Side ◽

History Of ◽

The Right

Ultrasound (US) could visualize the pathological anatomy of HO and the enlargement site and compression location of the nerve in the cubital tunnel [1]. We read with great interest the article of Jačisko et al[2]. In addition, we report rare US images of HO in direct contact with the swollen ulnar nerve in the cubital tunnel that was not detected by plain radiography. A 60-year-old female presented with a six-month history of elbow pain. Her pain was located at the medial side of the right elbow joint and accompanied by numbness of the fifth finger. She had a history of excessive manual labor due to her occupation as a gardener over the past few decades. The numbness began with the fifth finger initially and gradually extended toward the medial side of the elbow joint. US images showed hyperechoic masses causing acoustic shadowing, in direct contact with the ulnar nerve in the cubital tunnel. The HO seems to be related to compression of the ulnar nerve. The ulnar nerve was swollen (Figure 1-a, b). The maximal cross-sectional-area was 0.10 cm2. Plain elbow radiographs demonstrated osteophyte formation in the coronoid process of the ulna, the coronoid fossa of the humerus, and in the radial head (Figure 1-c). Radiographic imaging showed no heterotopic bone formation in the soft tissues surrounding the medial side of the right elbow. We performed US-guided perineural injection with a mixture of 1 cc of 10 mg triamcinolone and 3 cc of 0.2 % ropivacaine. Her pain and numbness gradually diminished with no adverse effects. Her pain reduced by 70% after two weeks, with pain improvement sustained for 6 months after the injection. Jačisko et al[2]have presented some diagnostic US imaging on neuropathy caused by HO located close to the ulnar nerve in the cubital tunnel. Especially, this case showed definite heterotopic bone formation in the soft tissue surrounding the medial side of the elbow on plain radiography. The classic sonographic patterns of HO were defined by the presence of central hypoechoic area surrounded by foci of calcification [3, 4]. The distortion of normal soft tissue and the formation of hypoechoic areas, with or without foci of calcification can also be shown as early signs[3, 4]. The use of US for HO is highly sensitive and provides an earlier diagnosis compared with other radiologic modalities [3-5]. It can be an effective treatment strategy and may improve the prognosis of neuropathy. We highlight that US evaluation can provide early diagnostic information about ulnar nerve morphology and various HO formations even if plane radiographs did not show heterotopic bone formation in the soft tissues surrounding the medial side of the elbow.

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