Heterotopic Ossification with Classical Hodgkin Lymphoma in a Surgical Incision: A Case Report

Main Article Content

Bárbara Loeser Faro
https://orcid.org/0009-0008-4759-499X
Leonardo Fleury da Silva
https://orcid.org/0000-0001-7348-2109
Nathalia Nakase Mizoguti
Ana Carolina Medeiros
Mariana Marques Wolski
https://orcid.org/0009-0001-0324-660X
Fernando Andrade Vellozo
Adônis Nasr

Abstract

Heterotopic ossification (HO) is the formation of bone tissue in areas where bone does not normally exist. It most commonly affects soft tissues after orthopedic surgeries involving major joints and is a rare complication of abdominal surgeries. When heterotopic ossification is excised, histopathological and immunohistochemical studies are essential to assess and rule out neoplastic tissue. Hodgkin lymphoma (HL) is a lymphoproliferative neoplasm characterized by the proliferation of morphologically and immunophenotypically altered cells, derived from the malignant transformation of germinal center B lymphocytes. Less commonly, patients with classical HL may also present with other very rare manifestations, such as heterotopic ossification. This case report aims to present a heterotopic ossification found in the preperitoneal space of a midline incision during laparotomy for retroperitoneal lymph node biopsy due to suspected lymphoproliferative disease, with a rare immunohistochemical result consistent with classical Hodgkin lymphoma.

Article Details

How to Cite
Faro, B. L., Silva, L. F. da, Mizoguti, N. N., Medeiros, A. C., Wolski, M. M., Vellozo, F. A., & Nasr, A. (2025). Heterotopic Ossification with Classical Hodgkin Lymphoma in a Surgical Incision: A Case Report. Brazilian Journal of Case Reports, 5(1), bjcr99. https://doi.org/10.52600/2763-583X.bjcr.2025.5.1.bjcr99
Section
Clinical Case Reports
Author Biographies

Bárbara Loeser Faro, Department of General and Gastrointestinal Surgery, Clinical Hospital Complex, Federal University of Paraná (UFPR)

Department of General and Gastrointestinal Surgery, Clinical Hospital Complex, Federal University of Paraná (UFPR), Curitiba, Paraná, Brazil.

Leonardo Fleury da Silva, Department of General and Gastrointestinal Surgery, Clinical Hospital Complex, Federal University of Paraná (UFPR), Curtiba, Paraná, Brazil.

Department of General and Gastrointestinal Surgery, Clinical Hospital Complex, Federal University of Paraná (UFPR), Curitiba, Paraná, Brazil.

Nathalia Nakase Mizoguti, Department of General and Gastrointestinal Surgery, Clinical Hospital Complex, Federal University of Paraná (UFPR)

Department of General and Gastrointestinal Surgery, Clinical Hospital Complex, Federal University of Paraná (UFPR), Curitiba, Paraná, Brazil.

Ana Carolina Medeiros, Federal University of Paraná (UFPR)

Federal University of Paraná (UFPR), Curitiba, Paraná, Brazil.

Mariana Marques Wolski, Department of Pathology, Clinical Hospital Complex, Federal University of Paraná (UFPR), Curtiba, Paraná, Brazil.

Department of Pathology, Clinical Hospital Complex, Federal University of Paraná (UFPR), Curitiba, Paraná, Brazil.

Fernando Andrade Vellozo, Department of Pathology, Clinical Hospital Complex, Federal University of Paraná (UFPR)

Department of Pathology, Clinical Hospital Complex, Federal University of Paraná (UFPR), Curitiba, Paraná, Brazil.

Adônis Nasr, Department of General and Gastrointestinal Surgery, Clinical Hospital Complex, Federal University of Paraná (UFPR)

Department of General and Gastrointestinal Surgery, Clinical Hospital Complex, Federal University of Paraná (UFPR), Curitiba, Paraná, Brazil.

References

McCarthy EF, Sundaram M. Heterotopic ossification: a review. Skeletal Radiol. 2005;34(10):609-19. doi:10.1007/s00256-005-0901-5.

Kim J, Kim Y, Jeong WK, Song SY, Cho OK. Heterotopic ossification developing in surgical incisions of the abdomen: analysis of its incidence and possible factors associated with its development. J Comput Assist Tomogr. 2008;32:872-6. doi:10.1097/RCT.0b013e3181715d7e.

Koolen PGL, Schreinemacher MHF, Peppelenbosch AG. Heterotopic ossifications in midline abdominal scars: a critical review of the literature. J Vasc Surg. 2010;52:521. doi:10.1016/j.jvs.2010.02.013.

Ebrahim MK, Kanjoor JR, Bang RL. Heterotopic calcification in burn scars and non-healing ulcers. Burns. 2003;29:378-83. doi:10.1016/S0305-4179(03)00012-4.

Potter BK, Burns TC, Lacap AP, Granville RR, Gajewski DA. Heterotopic ossification after traumatic and combat-related amputations: prevalence, risk factors, and preliminary outcomes of excision. J Bone Joint Surg Am. 2007;89:298-305. doi:10.2106/JBJS.F.00304.

Christofi T, Raptis DA, Kallis A, Ambasakoor F. True trilineage hematopoiesis in heterotopic ossification excised from a laparotomy scar: case report and literature review. Ann R Coll Surg Engl. 2008;90(5):12-4. doi:10.1308/003588408X300213.

Luo X, Tan C, Liu Y, Yin Y. Abdominal wall heterotopic ossification with true trilineage hematopoiesis misdiagnosed as abdominal incisional hernia: a case report and literature review. Asian J Surg. 2023;46(12). doi:10.1016/j.asjsur.2023.01.002.

Jacob MO, Reddipogu J, Jacob J. Abdominal wall heterotopic ossification following damage control laparotomy: an unusual bone to pick. ANZ J Surg. 2021;91(5):902-6. doi:10.1111/ans.16571.

Ma J, Xian M, Liao B, et al. Heterotopic mesenteric ossification and postoperative incision. Chin Med J. 2013;19:3780-9. doi:10.3760/cma.j.issn.0366-6999.2013.19.001.

Lai HJ, Jao SW, Lee TY, Ou JJ, Kang JC. Heterotopic mesenteric ossification after total colectomy for hemorrhagic diverticulosis of the colon: a rare case report. Formosan Assoc Med J. 2007;2:32-6. doi:10.1016/S0929-6646(08)60115-8.

Meyers C, Lisiecki J, Miller S, et al. Heterotopic ossification: a comprehensive review. JBMR Plus. 2019;4. doi:10.1002/jbm4.10117.

Vanden Bossche L, Vanderstraeten G. Heterotopic ossification: a review. Rev Bras Reumatol. 2005;3:129-36. doi:10.1590/S1516-31802005000300005.

Namias N, Sleeman D. Penetrating trauma secondary to heterotopic ossification in a laparotomy scar: case report. Can J Surg. 1996;6:504-6. doi:10.1503/cjs.006096.

Zhang X, Xia PT, Ma YC, Dai Y, Wang YL. Heterotopic ossification below the upper abdominal incision after radical gas-trectomy: two case reports. World J Clin Cases. 2022;17:5805-9. doi:10.12998/wjcc.v10.i17.5805.

Hartmann APBJ, Ximenes ARS, Hartmann LGC, et al. Imaging diagnosis in the assessment of heterotopic ossification. Rev Bras Reumatol. 2004;44:291-3. doi:10.1590/S0482-50042004000600003.

Convente MR, Wang H, Pignolo RJ, Kaplan FS, Shore EM. The immunological contribution to heterotopic ossification di-sorders. Curr Osteoporos Rep. 2015 Apr;13(2):116-24. doi: 10.1007/s11914-015-0258-z. PMID: 25687936; PMCID: PMC4417939.

Most read articles by the same author(s)