J Pathol Transl Med.  2022 Sep;56(5):294-300. 10.4132/jptm.2022.07.23.

Heterotopic mesenteric ossification: a report of two cases

• Bahmad HF
• Lopez O
• Sutherland T
• Vinas M
• Ben-David K
• Howard L
• Poppiti R
• Alghamdi S

• KMID: 2533706
• DOI: http://doi.org/10.4132/jptm.2022.07.23

Abstract

Heterotopic mesenteric ossification (HMO) is abnormal bone formation in tissues which usually do not undergo ossification. There are approximately 75 cases reported worldwide. We present two cases of HMO. The first case is that of a 39-year-old man who presented with abdominal pain and a computerized tomography scan of the abdomen and pelvis revealed an apple core lesion resulting in small bowel obstruction. The second case is that of a 36-year-old woman who presented 2 months after undergoing robotic gastric sleeve resection complaining of weakness and emesis. An esophagogram revealed kinking at the distal esophagus. Surgical resection was performed in both, yielding the diagnosis of HMO. There are various theories as to the pathophysiology of HMO, but no clearly defined mechanism has been established. Management should be conservative whenever possible to prevent further ossification with subsequent surgical intervention.

Keyword

reports; Heterotopic; Ossification; Mesentery; Stomach; Small bowel

Figure

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  Fig. 1 Computerized tomography scan of the abdomen and pelvis with intravenous contrast. Results showed segmental concentric thickening of the jejunum in the right upper quadrant of the abdomen (with apple core configuration, white arrowhead) resulting in small bowel obstruction and stranding of the surrounding mesentery.

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  Fig. 2 Gross examination of the resected segment of small intestine. (A) An area of luminal constriction is seen. (B) Induration in the surrounding mesenteric fat showing chalky white cut surface.

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  Fig. 3 Microscopic examination showing heterotopic ossification. Histopathologic examination of the resected segment of small intestine demonstrated focal mucosal erosion (A) with acute and chronic inflammation in the surrounding peri-intestinal soft and adipose tissue, granulation tissue, fat necrosis (B), fibrosis, hemosiderin deposition, focal foreign body giant cell reaction (C), and new bone formation (D).

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  Fig. 4 Exploratory laparoscopy showing significant abdominal scar tissue and previous sleeve gastrectomy.

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  Fig. 5 Microscopic examination showing heterotopic ossification. Histopathologic examination of the resected segments of stomach and small intestine demonstrated chronic inflammation, suture granulomas, foreign body giant cell reaction (A), and new bone formation (B).

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  Fig. 6 Schematic diagram illustrating the proposed hypotheses for the formation of heterotopic mesenteric ossification. ECM, extracellular matrix; ALP, alkaline phosphatase; BMP, bone morphogenetic protein; TGF-β, transforming growth factor-β; PTH, parathyroid hormone; IGH-1, insulin-like growth factor 1; FGF, fibroblast growth factor.

Reference

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