Choristomas are nodules of normal cells in an abnormal location and very rare lesions especially when they appear in the mouth. It can simulate an oral tumor. The etiology is still unknown. The pathogenetic accepted theories are: ossification of the aberrant rests of a branchial arch, congenital anomaly, abnormal ossification, bone degeneration, post-traumatic tissue mesenchymal metaplasia. The last hypothesis seems more accepted. Recurrence is very rare and it was found only in few cases. Clinically they appear as asymptomatic nodules, covered by integral mucosal and the patients may report various stages of their diseases, like as compression of neural and vascular structures. It can develop at any age. The tissue that forms the choristomas is reported more often to cartilage and bone tissue. We analyze the clinical and microscopic features and specially the etiopathogenetic causes of two cases.

We reported two cases of choristoma, the first in the submental region, with osseous appearance, and the second, with

cartilaginous appearance, on the tongue. Both patients are males: an adult of 45 years old and a children of 11 years.

The patients reported the appearance of a slow and progressive swelling in the affected areas without pain. The medical

history reported traumatic episodes at the site of lesion. The chosen treatment was surgical excision with free margin

tumor.

Seconda Università degli Studi di Napoli FACOLTA’ DI MEDICINA E CHIRURGIA ODONTOIATRIA E PROTESI DENTARIA

ORAL CHORISTOMAS Laino Luigi(1), Di Napoli Antonio(1), Guglielmotti Mario(1), De Rosa Alfredo(1), Menditti Dardo(1)

I N T R O D U T I O N

M AT E R I A L S A N D M E T H O D S

C A S E S R E P O R T

R E S U LT S Post operative follow up, up to four years for the first case and three years for the second one, was negative for recurrence. Microscopic and

immunohistochemical features are observed; they revealed a bone tissue in the first case and cartilage tissue in the second one.

R E F E R E N C E S

The presence of tumor-like masses with abnormal clinical features might suggest diagnosis of choristoma and the lesion must be excised

completely. The diagnosis must be confirmed by histological examination.

Both cases seems to support the traumatic pathogenesis: the etiology of the first case may be a post traumatic osseous metaplasia developed by

a chronic inflammation. In the second case, microtraumas by mastication, which are more frequent on the lateral side of the tongue, might

stimulate embryonic cartilaginous remnants migrated from branchial arches Furthermore, the complete excision, including the surrounding soft

tissue, is recommended as definitive treatment for tumor-like lesions, because the definitive diagnosis is made by pathologists and because the

complete excision is important to avoid recurrences.

An oral 'follicular' choristoma presenting in the anterior floor of the mouth.

Sood V. Guy's, King's and ' Schools of Medicine, Dentistry and Biomedical Sciences, Guy's Hospital, . Dent Update. 2000

Jun;27(5):231-3

Glial choristoma of the tongue: report of a case and review of the literature.

Song-Qing SQ Fan, Yang-Min YM Ou and Qing-Chun QC Liang Pediatr Surg (2008) Int 24(4): 515-9

Neonatal lingual choristoma with respiratory and gastric epithelium.

Mandell DL, Ranganathan S, Bluestone CD. Department of Pediatric Otolaryngology, Children's. Arch Otolaryngol Head Neck

Surg. 2002 Nov;128(11):1321-4

Cartilage choristoma (soft tissue chondroma): a rare presentation in the lower lip.

Kim Y, Moses M, Zegarelli DJ, Yoon AJ, Clin Pediatr Dent. 2009 Spring;33(3):253-4.

C O N C L U S I O N

(1) Seconda Università degli Studi di Napoli, Dipartimento Discipline Odontostomatologiche, Ortodontiche e Chirurgiche,

Cattedra di Chirurgia Speciale Odontostomatologica, Presidente Prof. Gregorio Laino

Clinical aspect (A) and a step of surgical operation (B) of second case (male, 11 years). A focus of the nodule (C) and the histological examination that shows cartilage tissue (D)

Clinical (A) and surgical (B) aspects of first case (male, 45 years), the lesion completely enucleated (C) and the bone tissue marked in the histological examination (D)

Presidente del Corso di Laurea Specialistica in Odontoiatria e Protesi Dentaria

Prof. Gregorio Laino