Case History
71-year-old patient with small bowel obstruction after two surgical procedures: inguinal hernia repair (5 days prior) and prostatectomy (12 days prior). Patient underwent small bowel resection during which a low anterior abdominal adhesion on the pubis was also noted.
What is the diagnosis?
- Fibromatosis with ossification
- Heterotopic mesenteric ossification
- Ossifying fibrosarcoma
- Extraskeletal osteosarcoma
Answer: B - Heterotopic mesenteric ossification
Heterotopic mesenteric ossification is a rare tumor-like condition associated mostly with male patients after surgery or trauma. Histologically, lesional tissue consists of a myofibroblastic proliferation with fat necrosis, hemorrhage, and extensive bone and osteoid deposition. The clinical history or prior surgery or trauma is important in raising this possibility in the differential diagnosis. Although the process is reactive, the extreme morphologic findings require exclusion of neoplastic processes. Some entities in the differential diagnosis include: nodular fasciitis, inflammatory myofibroblastic tumor, gastrointestinal stromal tumor(GIST), solitary fibrous tumor, fibromatosis, fibrosarcoma, extraskeletal osteosarcoma.
Case contributed by: Leona Council, M.D., Assistant Professor, Anatomic Pathology, Chief, Pathology and Laboratory Medicine, Birmingham VAMC