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Heterotopic mesenteric ossification: a distinctive pseudosarcoma commonly associated with intestinal obstruction
Rajiv M Patel1, Sharon W Weiss, Andrew L Folpe
1Department of Pathology and Laboratory Medicine, 1364 Clifton Road NE, Emory University, Atlanta, GA 30222, USA.
The American Journal of Surgical Pathology
|December 7, 2005
Summary
Heterotopic mesenteric ossification (HMO) is a rare intraabdominal pseudotumor. This study highlights its distinct features, differentiating it from extraskeletal osteosarcoma (EO) in male patients, often post-surgery or trauma.
Area of Science:
- Pathology
- Surgical Oncology
- Gastroenterology
Background:
- Heterotopic mesenteric ossification (HMO) is an exceedingly rare intraabdominal condition, often misdiagnosed as extraskeletal osteosarcoma (EO) or other sarcomas.
- Fewer than 14 cases of HMO have been previously reported, underscoring its rarity and diagnostic challenges.
- Distinguishing HMO from EO is critical for appropriate patient management and prognosis.
Purpose of the Study:
- To report on six additional cases of intraabdominal heterotopic mesenteric ossification (HMO).
- To emphasize the key clinicopathological features that differentiate HMO from extraskeletal osteosarcoma (EO).
- To enhance the understanding and diagnosis of this rare ossifying pseudotumor.
Main Methods:
- Retrospective review of six intraabdominal lesions diagnosed as HMO, ossifying pseudotumor, or reactive myofibroblastic proliferation with ossification.
- Analysis of clinical data, including patient demographics, medical history (surgery, trauma), presenting symptoms, and follow-up information.
- Detailed histopathological examination to identify characteristic microscopic features.
Main Results:
- All six cases occurred exclusively in males, with a mean age of 49 years.
- Lesions were located in the mesentery or omentum and were often preceded by abdominal surgery or trauma.
- Common presentations included bowel obstruction or abdominal sepsis; microscopically, lesions showed reactive (myo)fibroblastic proliferation with abundant, lace-like osteoid and bland cytology, distinguishing them from EO.
Conclusions:
- Heterotopic mesenteric ossification (HMO) is a distinct intraabdominal ossifying pseudotumor.
- HMO typically affects males, often occurs after abdominal surgery or trauma, and may present with intestinal obstruction.
- Key distinguishing features include clinical history, reactive zones resembling nodular fasciitis, thick osteoid, and absence of significant atypia, aiding differentiation from extraskeletal osteosarcoma (EO).