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Nasal glial heterotopia.

Nasal glial heterotopia (nasal giloma) is the term used to describe a mass made up of mature brain tissue that is isolated from the cranial cavity or spinal canal. Most of these rare, benign, congenital rumors are found in the nasal region, particularly at the bridge of the nose and in the nasal cavity. Nasal glial beterotopia is frequently diagnosed in newborns; a few cases have been found in adults.

The differentiation of nasal glial heterotopia from encephalocele is based on the presence of a connection between the mass and the intracranial tissue. However, even with high-resolution computed tomography and magnetic resonance imaging, the connection may be very small and unapparent. Occasionally, the distinction can be made by noting the presence of meningitis and/or cerebrospinal fluid rhinorrhea, either before or after surgical manipulation. Because of the difficulty in definitively identifying a connection to the brain, caution must be exercised to decrease complications.

Histologically, nasal glial heterotopia and encephaloceles are characterized by varying proportions of neurons and gila; they may also contain gemistocyfic astrocytes (figure 1). There are varying degrees of fibrosis, frequently associated with inflammation. Masson's strichrome staining or an S-100 protein and glial fibrillary acidic protein (GFAP) are most helpful in accentuating the neural tissue in the background fibrosis (figure 2). It must be noted that there are no significant histologic differences between lesions with and without a demonstrable central nervous system connection. Therefore, the accurate diagnosis of heterotopia as opposed to encephalocele requires knowledge of the patient's radiographic and/or operative findings.


Suggested reading

Mills SE, Gaffey MJ, Frierson HF. Neural, neuroendocrine, and neuroectodermal neoplasia. Tumors of the upper aerodigestive tract and ear. Third series. Washington, D.C.: Armed Forces Institute of Pathology, 1997:119-200.

Penner CR, Thompson LD. Nasal glial heterotopia: A clinicopathologic and immunophenotypic analysis of 10 cases with a review of the literature. Ann Diagn Pathol 2003;7:354-9.

From the Department of Pathology, Woodland Hills Medical Center, Southern California Permanente Medical Group, Woodland Hills, Calif (Dr. Thompson).
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Title Annotation:Pathology Clinic
Author:Thompson, Lester D.R.
Publication:Ear, Nose and Throat Journal
Geographic Code:1USA
Date:Feb 1, 2004
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