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Hair within bony trabeculae in a mature cystic teratoma with mucinous adenocarcinoma of ovary: An undocumented finding

1 Department of Pathology and Lab Medicine, All India institute of Medical Sciences, Bhubaneswar, Odisha, India
2 Department of Surgical Oncology, All India institute of Medical Sciences, Bhubaneswar, Odisha, India

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Date of Submission01-Jun-2021
Date of Acceptance18-Jun-2021
Date of Web Publication27-Apr-2022

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Sharma I, Singh A, Muduly DK, Adhya AK. Hair within bony trabeculae in a mature cystic teratoma with mucinous adenocarcinoma of ovary: An undocumented finding. Indian J Pathol Microbiol [Epub ahead of print] [cited 2023 Jan 29]. Available from:

A 51-year-old female patient presented with abdominal pain for 2 months duration. Her general examination did not show any abnormalities. Per abdominal examination revealed a 8 × 5 cm size lump in the left hypogastrium. A CT scan of the abdomen showed a solid cystic mass in the left adnexa measuring 9.6 × 12.8 × 13 cm size. In addition, moderate ascites and omental thickening were observed. A provisional diagnosis of carcinoma of ovary was made and a total abdominal hysterectomy with bilateral salpino-ophorectomy was done. Gross examination of the left ovarian mass showed a solid cystic tumor. The outer surface was smooth and capsular breach was noted. The tumor was multiloculated. Few of the loculi contained cheesy material with hair and bony hard areas. Rest of the locules showed the presence of thick mucinous material [Figure 1]a. Sections from the cyst showed typical features of a mature cystic teratoma [Figure 1]b with a mucinous cystadenocarcinoma [Figure 1]c arising within the teratoma. There were no immature components. An interesting finding in this case was the presence of numerous hair shafts within bony trabeculae which was noted from the sections taken from the bony hard areas of the mature cystic teratoma [Figure 2]a. These hair shaft did not have any hair follicles [Figure 2]b.
Figure 1: (a) Gross appearance of the tumor cut surface shows a multiloculated tumor. Tufts of hair are seen in a locule at the upper end and rest of the locules are filled with thick mucinous material. (b) A section from the tumor shows the presence of a stratified squamous epithelium along with sebaceous glands, hair follicles, and keratin in the lumen. H & E stain, 100×. (c) Sections from the mucinous areas showed a high-grade mucinous adenocarcinoma arising within the teratoma

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Figure 2: (a) A section from the bony hard areas showed numerous hair shafts within mature bony trabeculae. H & E stain, 200×. (b) Hair shafts are seen within the bony trabeculae, there are no hair follicles, and bone marrow is present in between the trabeculae. H & E stain, 400×

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The finding of hair shaft within bony trabeculae is very unusual and has not been demonstrated previously in the literature, although hairs with follicles present within mature glial tissue of a teratoma have been reported once previously.[1] The exact pathogenesis of this finding is not clear, but it might be explained by the fact that the stem cells residing within the hair follicles have the potential to differentiate into osteoblast and give rise to mature bone, as suggested by a recent publication.[2] Lack of any foreign body giant cell reaction to the hair shafts also suggests that the hair shafts were indigenous to that site not merely loose broken hairs entrapped within the process of ossification. The clinical implications of this finding are unclear.

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There are no conflicts of interest.

   References Top

Pai SA. A hairbrained mature cystic ovarian teratoma: With bone marrow, meninges, and intraglial hair. Int J Surg Pathol 2021;29:404-5.  Back to cited text no. 1
Aran S, Zahri S, Asadi A, Khaksar F, Abdolmaleki A. Hair follicle stem cells differentiation into bone cells on collagen scaffold. Cell Tissue Bank 2020;21:181-8.  Back to cited text no. 2

Correspondence Address:
Amit Kumar Adhya,
Department of Pathology and Lab Medicine, All India institute of Medical Sciences, Bhubaneswar - 751 019, Odisha
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijpm.ijpm_542_21


  [Figure 1], [Figure 2]


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