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LETTERS TO THE EDITOR
Year : 2023  |  Volume : 28  |  Issue : 3  |  Page : 267-268
 

Osseous metaplasia in a juvenile rectal polyp: A rarely encountered histopathological finding


1 Department of Pathology and Laboratory Medicine, School of Medical Sciences and Research, Sharda University, Noida, Uttar Pradesh, India
2 Department of Pathology and Laboratory Medicine, SGPGI, Lucknow, Uttar Pradesh, India
3 Department of Agad Tantra Evum Vidhi Vaidyak, Uttarakhand Ayurved University, Haridwar, Uttarakhand, India
4 Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
5 Department of Gastroenterology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
6 Department of Pediatric Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India

Date of Submission15-Oct-2022
Date of Decision30-Oct-2022
Date of Acceptance21-Feb-2023
Date of Web Publication02-May-2023

Correspondence Address:
Arvind Kumar
Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaps.jiaps_148_22

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How to cite this article:
Kalonia T, Kumari N, Singh D, Kumar A, Mohan R, Ahmed I. Osseous metaplasia in a juvenile rectal polyp: A rarely encountered histopathological finding. J Indian Assoc Pediatr Surg 2023;28:267-8

How to cite this URL:
Kalonia T, Kumari N, Singh D, Kumar A, Mohan R, Ahmed I. Osseous metaplasia in a juvenile rectal polyp: A rarely encountered histopathological finding. J Indian Assoc Pediatr Surg [serial online] 2023 [cited 2023 Jun 9];28:267-8. Available from: https://www.jiaps.com/text.asp?2023/28/3/267/375520




Sir,

Juvenile polyp is a hamartomata's lesion which most commonly occurs in the rectum.[1] Heterotopic bone formation or osseous metaplasia in the gastrointestinal tract is a rare phenomenon, especially in pediatric population. Osseous metaplasia has been described in the literature, mainly in colonic polyps and mucin-producing adenocarcinomas of the stomach and colon.[1],[2]

An 8-year-old male presented to the pediatric surgery outpatient department with symptoms of per rectal bleeding for the past 20 days. There was no history of any mass coming out anus/painful defecation and no history of bleeding from any other site. On per rectal digital examination, tone was normal. On colonoscopy, mucosa was normal in appearance, with a pedunculated polyp measuring 1.0 cm in the greatest dimension [Figure 1]a. Polypoidal tissue piece measuring 0.9 cm × 0.75 cm × 0.7 cm was sent for histopathological examination. Microscopic examination showed a polypoidal tissue lined by tall columnar epithelium with focal areas of ulceration and granulation tissue on surface. Subepithelium showed many hyperplastic, cystically dilated glands along with moderate inflammatory cell infiltrate with edematous stroma with two foci of osseous metaplasia [Figure 1]b and [Figure 1]c. A diagnosis of Juvenile polyp with osseous metaplasia was given.
Figure 1: (a) Colonoscopic finding reveals a pedunculated polyp with yellowish-brown mucosa. (b and c) Two metaplastic foci of osseous tissue deposition in different submucosal areas along with cystically dilated glands, focal ulceration, and moderate inflammation (H and E, b: ×100 and c: ×200)

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Osseous metaplasia has been described in both benign and malignant conditions of the upper and lower gastrointestinal tract. Barrett's esophagus, carcinoid tumor and adenocarcinoma of the stomach, Peutz–Jeghers syndrome, hyperplastic polyp, tubular adenoma, and adenocarcinoma of the colon and rectum are the usual gastrointestinal pathologies showing osseous metaplasia.[1],[3] However, rectosigmoid polyp presenting with osseous metaplasia is rarely seen. On thorough search of literature, only 17 cases of polyp of rectosigmoid origin have been noted.[4],[5] Epithelial metaplasia might be seen in the upper gastrointestinal tract, but osseous metaplasia is rarely seen. Gruber in 1913 reported the first case of Osseous metaplasia in a gastric adenocarcinoma.[6] Constant inflammation and pluripotent stromal cells in the polyp might be the contributing factors in osseous metaplasia in the polyp. However, the exact mechanism of osseous metaplasia is still a topic of significant debate. Evidence to support these theories is very limited, hence more work needs to be done in this field to elucidate the pathogenesis and prognostic significance of osseous metaplasia.

Due to rare association of osseous metaplasia in rectal polyp, makes this entity worth notifiable at the global platform.

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.
Haque S, Eisen RN, West AB. Heterotopic bone formation in the gastrointestinal tract. Arch Pathol Lab Med 1996;120:666-70.  Back to cited text no. 1
    
2.
Dukes CE. Ossification in rectal cancer: (section of surgery: Sub-section of proctology). Proc R Soc Med 1939;32:1489-94.  Back to cited text no. 2
    
3.
Naimi A, Hosseinpour M. Osseous metaplasia in rectal polyp: A case report with review of probable pathogenesis. Adv Biomed Res 2018;7:78.  Back to cited text no. 3
[PUBMED]  [Full text]  
4.
Sperling MH, Friedman CJ. Osseous metaplasia in a benign colon polyp. Gastrointest Endosc 1981;27:198-9.  Back to cited text no. 4
    
5.
Haynes HR, Wiskin AE, Basude D, Gradhand E. Osseous metaplasia in a juvenile rectal polyp. J Pediatr Gastroenterol Nutr 2018;67:e123.  Back to cited text no. 5
    
6.
Gruber GB. Knochebildung in einem magen karzinom. Z Beitr Path Anat 1913;55:368-70.  Back to cited text no. 6
    


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